While there are things you can do to prepare yourself for labor and delivery, like taking a childbirth class or creating a birth plan, remember that it’s a famously unpredictable process.

Choosing a vaginal delivery

Every delivery is as unique and individual as each mother and infant. In addition, women may have completely different experiences with each new labor and delivery. Giving birth is a life-changing event that will leave an impression on you for the rest of your life.

Of course, you’ll want this to be a positive experience and to know what to expect. Here’s some information about what may happen as you’re delivering your baby.

Birth plans: Should you have one?

As you approach the latter part of your pregnancy, you may want to write a birth plan. Consider carefully what’s important to you. The overall goal is a healthy mother and baby.

The birth plan outlines your ideal birth and may need to be adjusted as the actual situation unfolds.

Talk with your partner and decide who you want to have attending the birth. Some couples feel that this is a private time and prefer not to have others present.

A birth plan may include other subjects like pain relief during labor, delivery positions, and more.

Early phases of labor

Amniotic sac

The amniotic sac is the fluid-filled membrane surrounding your baby. This sac will almost always rupture before the baby is born, though in some cases it remains intact until delivery. When it ruptures, it’s often described as your “water breaking.”

In most cases, your water will break before you go into labor or at the very beginning of labor. Some women experience their water breaking as a gush of fluid, although it can also be a trickle of fluid. The fluid should be clear and odorless.

When your water breaks, contact your obstetrician gynecologist (ob-gyn) or other obstetric care provider and follow their guidance.


Contractions are the tightening and releasing of your uterus. These motions will eventually help your baby push through the cervix. Contractions can feel like heavy cramping or pressure that begins in your back and moves to the front.

Contractions aren’t a reliable indicator of labor. You might already have felt Braxton-Hicks contractions, which may have started as early as your second trimester.

A general rule is that when you are having contractions that last for a minute, are five minutes apart, and have been so for an hour, you’re in true labor.

Cervix dilation

The cervix is the lowest part of the uterus that opens into the vagina. The cervix is a tubular structure approximately 3 to 4 centimeters in length with a passage that connects the uterine cavity to the vagina.

During labor, the role of the cervix must change from maintaining the pregnancy (by keeping the uterus closed) to facilitating delivery of the baby (by dilating, or opening, enough to allow the baby through).

The fundamental changes that occur near the end of the pregnancy result in a softening of the cervical tissue and thinning of the cervix, both of which help prepare the cervix. True, active labor is considered to be underway when the cervix is dilated 3 centimeters or more.

Labor and delivery

Eventually, the cervical canal must open until the cervical opening itself has reached 10 centimeters in diameter and the baby is able to pass into the birth canal.

As the baby enters the vagina, your skin and muscles stretch. The labia and perineum (the area between the vagina and the rectum) eventually reach a point of maximum stretching. At this point, the skin may feel like it’s burning.

Some childbirth educators call this the ring of fire because of the burning sensation felt as the mother’s tissues stretch around the baby’s head. At this time, your healthcare provider may decide to perform an episiotomy.

You may or may not feel the episiotomy because the skin and muscles can lose sensation due to how tightly they’re stretched.

The birth

As the baby’s head emerges, there is a great relief from the pressure, although you’ll probably still feel some discomfort.

Your nurse or doctor will ask you to stop pushing momentarily while the baby’s mouth and nose are suctioned to clear out amniotic fluid and mucus. It’s important to do this before the baby starts to breathe and cry.

Usually the doctor will rotate the baby’s head a quarter of a turn to be in alignment with the baby’s body, which is still inside you. You’ll then be asked to begin pushing again to deliver the shoulders.

The top shoulder comes first and then the lower shoulder.

Then, with one last push, you deliver your baby!

Delivering the placenta

The placenta and the amniotic sac that supported and protected the baby for nine months are still in the uterus after the delivery. These need to be delivered, and this can happen spontaneously or it may take as long as half an hour. Your midwife or doctor may rub your abdomen below your belly button to help tighten the uterus and loosen the placenta.

Your uterus is now about the size of a large grapefruit. You may need to push to help deliver the placenta. You may feel some pressure as the placenta is expelled but not nearly as much pressure as when the baby was born.

Your healthcare provider will inspect the delivered placenta to make sure it was delivered in full. On rare occasions, some of the placenta doesn’t release and may remain adhered to the wall of the uterus.

If this happens, your provider will reach into your uterus to remove the leftover pieces in order to prevent heavy bleeding that can result from a torn placenta. If you would like to see the placenta, please ask. Usually, they’ll be happy to show you.

Pain and other sensations during delivery

If you opt for a natural childbirth

If you decide to have a “natural” childbirth (delivery without pain medication), you’ll feel all types of sensations. The two sensations you’ll experience the most are pain and pressure. When you begin to push, some of the pressure will be relieved.

As the baby descends into the birth canal, though, you’ll go from experiencing pressure only during the contractions to experiencing constant and increasing pressure. It will feel something like a strong urge to have a bowel movement as the baby presses down on those same nerves.

If you choose to have an epidural

If you have an epidural, what you feel during labor will depend on the effectiveness of the epidural block. If the medication properly deadens the nerves, you may not feel anything. If it’s moderately effective, you may feel some pressure.

If it’s mildly so, you’ll feel pressure that may or may not be uncomfortable to you. It depends on how well you tolerate pressure sensations. You may not feel the stretching of the vagina, and you probably won’t feel an episiotomy.

Possible tearing

Although significant injuries aren’t common, during the dilation process, the cervix may tear and ultimately require repair.

Vaginal tissues are soft and flexible, but if delivery occurs rapidly or with excessive force, those tissues can tear.

In most cases, lacerations are minor and easily repaired. Occasionally, they may be more serious and result in longer-term problems.

Normal labor and delivery often result in injury to the vagina and/or cervix. Up to 70 percent of women having their first baby will have an episiotomy or some sort of vaginal tear requiring repair.

Fortunately, the vagina and cervix have a rich blood supply. That’s why injuries in these areas heal quickly and leave little or no scarring that could result in long-term problems.

The outlook

It’s not impossible to prepare yourself for labor and delivery, but it’s a famously unpredictable process. Understanding the timeline and hearing about other mothers’ experiences can go a long way to making childbirth less mysterious.

Many expectant mothers find it helpful to write out a birth plan with their partner and share it with their medical team. If you do create a plan, be prepared to change your mind if the necessity arises. Remember that your goal is to have a healthy baby and a healthy, positive experience.