The First Stage of Labor

Written by Jacquelyn Cafasso | Published on October 6, 2014
Medically Reviewed by George Krucik, MD, MBA on October 6, 2014

What Is Labor and When Does It Begin?

A pregnancy lasts for about 40 weeks, and then labor begins. Labor is the process that occurs when the fetus and the placenta leave a woman's uterus through her vagina and the baby is born.

Labor occurs in three stages. Its progression and how long it lasts can be very different for every woman.

What Are the Signs of Labor?

As a woman approaches her due date, she may notice signs that labor is about to start. If you notice one or more of the following, you may be in labor or going into labor soon:

  • “Lightening” is when the baby’s head moves down into your pelvis and your belly looks lower than before.
  • Bloody discharge from the vagina.
  • The baby may move less right before labor. However, if you sense a sudden decrease in movement by your baby, call your doctor.
  • The water breaks. Fluid will come out from your vagina when the amniotic sac ruptures and labor is about to start. For some women, this doesn’t happen until labor is already well underway.
  • Diarrhea, which is caused by the baby’s head pressing against your bowels.
  • Contractions that become stronger and more frequent. Contractions are when your uterus tightens and then relaxes. They are sometimes described as a stronger version of period pains.

False Labor

Many women feel what they think are weak contractions before they're truly in labor. These are called Braxton Hicks contractions. It can be hard to tell if you are feeling Braxton Hicks contractions or labor contractions.

In general, real contractions are:

  • regular
  • strong
  • about five minutes apart
  • last about 45-60 seconds
  • wrap around from your back to your belly

Whereas false labor (Braxton Hicks) contractions are typically:

  • irregular
  • sporadic
  • halt if you change positions or lie down
  • felt in just the belly and the groin area

What Are the Stages of Labor?

Labor occurs in three stages. The experience can be very different for every woman. In general, the following stages are true for every woman going through a normal labor.

First Stage

This stage is the longest stage of labor, usually lasting about 12 to 19 hours. This is when the cervix begins to open up (dilate). Many women spend part of this time at home resting. When contractions become more frequent, your doctor will tell you to go to the hospital or birthing center.

At the hospital or birthing center, the doctor monitors the progress of your labor. They will check the cervix and the baby’s position in the birth canal.

Contractions will gradually become longer, more intense, and more frequent. It’s important to use relaxation tips and breathing exercises during this time.

According to the National Institutes of Health, the cervix is fully expanded (dilated) when it reaches 10 centimeters.

Second Stage

The baby travels through the birth canal. You will push hard during contractions and rest in between contractions. It usually takes anywhere from 20 minutes to two hours to deliver the baby. When the top of the baby’s head appears on the outside of your vagina, your doctor will tell you to push hard to finally deliver your baby.

Third Stage

In the last stage of labor the placenta is delivered. According to the Office on Women’s Health, this typically starts five to 30 minutes after birth of the baby. Labor is finished after the delivery of the placenta.

What Is a Cesarean Delivery?

A cesarean delivery, also called a C-section, is when the baby is taken out by surgery through a mother’s abdomen. A C-section is a major surgery and carries some risks. According to the Office on Women’s Health, nearly one in three women have babies by C-section in the United States.

Doctors may recommend a C-section in the following situations:

  • The mother is carrying multiple babies (twins, triplets, etc.).
  • The mother has health problems like HIV, high blood pressure, or heart disease.
  • There are problems with the shape of the pelvis.
  • There are problems with the placenta, or umbilical cord.
  • The baby is turned around feet first (breech).
  • The baby is showing signs of distress.
  • The mother has had a C-section in the past.

Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. Although many women have a safe C-section, there are many risks. These include infection, bleeding, blood transfusions, and blood clots. Additionally, women who have a C-section stay at the hospital for longer than women who deliver their baby vaginally.

What If the Due Date Passes?

This is called a “post-term pregnancy.” When this happens, there are increased risks to both the mother and baby’s health. For example, the placenta may stop working as effectively as it had before, which can affect the oxygen and nutrients that the baby receives from the mother. For this reason, a doctor might decide to induce labor. Induced labor means the doctor uses medications to help bring about labor.

If you do reach 41-42 weeks, stay in close contact with your doctor to assess the situation and decide if inducing labor is the best option for you and your baby. Inducing labor is not always necessary, and most babies born post term are perfectly healthy.

How Is Pain Managed During Labor and Delivery?

Labor and delivery can be very painful for the mother.

Some natural strategies to help minimize the pain or make it more bearable include:

  • dimming the lights
  • keeping your mind occupied
  • listening to music
  • massage
  • cool compresses
  • making noises, like moaning or groaning
  • wearing comfortable clothing
  • focusing on breathing
  • trying different positions, like sitting, standing, squatting, or crouching

Many women choose to use medications to help relieve the pain. Nowadays, women have many options for pain relief.

Opioids

Opioids are given through a tube in your vein or injected into your muscle. They make the pain more bearable, but don’t get rid of all the pain. They are short-acting and can make you feel very drowsy, nauseous, or itchy.

Epidurals

For an epidural, a tube is placed into the spinal canal and small doses of medicine are given through the tube as needed. A woman will feel very little pain during childbirth. However, an epidural can prolong labor and increase the need for a doctor to assist with the delivery.

What Happens to the Baby After Delivery?

Right after birth, many important tests are done on babies to make sure they are healthy. Some of these tests are recommended by hospitals, while others are required by law in the United States.

The very first test that your baby will have is called the Apgar test. The test is done twice — 1 minute and 5 minutes after birth. The test measures five signs:

  • heart rate
  • breathing
  • activity
  • reflexes
  • skin color

The Apgar test is graded on a scale from 1 to 10. A score of seven or higher generally means the baby is very healthy. According to the Office on Women’s Health, more than 98 percent of babies have a score of 7 or higher 5 minutes after birth.

A baby will need monitoring and additional medical care if the score is lower than 7.

Soon after delivery, doctors may also do the following:

  • measure the baby’s weight, height, and the circumference of the baby’s head
  • take the newborn’s temperature
  • give the baby a bath and clean the umbilical cord stump
  • give the baby eye drops to prevent infections
  • give the baby a vitamin K shot to help the blood clot. Newborns usually have low levels of the vitamin in their body (in very rare cases, this can cause serious bleeding problems)
  • administer a hearing test
  • vaccinate the baby against hepatitis B virus
  • take a sample of blood from the baby to screen for phenylketonuria, hypothyroidism, galactosemia, sickle cell disease, and several other diseases, depending on the state you live in

How Can a Mother Recover From Childbirth?

Childbirth is a tiring process. It’s important that a new mother takes care of her body after delivery so she is best able to take care of her new baby. The following is recommended to help a new mother recover and regain energy:

  • Get plenty of rest and try to nap while the baby naps.
  • Don’t be afraid to ask for help with cleaning, laundry, and preparing meals.
  • Avoid alcohol.
  • Keep your feet elevated when possible to reduce swelling.
  • Drink plenty of water and eat fresh fruits and vegetables to alleviate constipation.
  • Follow your doctor’s instructions on how much activity you can do for the next few weeks.
  • When you feel ready, develop a healthy eating plan along with regular physical fitness schedule in order to lose any weight gained during pregnancy.
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