- First stage: Dilation of the cervix (mouth of the uterus)
- Second stage: Delivery of the baby
- Third stage: Afterbirth where you push out the placenta
- Fourth stage: Recovery
Stage 1: Dilation
During the first stage of labor, the cervix begins to thin and dilate (open) due to the hormones that are released during labor. For a vaginal delivery, the cervix must be fully dilated (about 10 centimeters) for the baby to pass through.
The first stage of labor begins from the time the contractions start until the time the cervix is fully dilated. It’s the longest of the 4 stages and divided into 3 phases:
1. Early phase
The early phase is also called the latent phase. It’s the longest and can last up to 20 hours, especially for first-time mothers. A typical early phase of labor starts with contractions coming every 5 to 20 minutes and lasting for 30 to 60 seconds each. Contraction pains are not as severe as the active phase.
- At the beginning of the early phase, the contractions are milder, shorter and irregular.
- As labor progresses, contractions become stronger, regular and more frequent.
- When the contractions come every 5 minutes, it is time to visit the hospital.
During the early phase, the cervix opens to about 3 centimeters (1 inch). As the cervix begins to open, a sticky, jelly-like, pink or slightly bloody discharge called “show” may come out of the vagina. This is the mucus plug that blocks the cervical opening during pregnancy.
The fetal membranes often rupture in the early phase of labor and the amniotic fluid leaks or gushes out. This is called “water breaking” and is painless. If your water breaks or if you experience significant vaginal bleeding, you need to contact your doctor.
2. Active phase
After the cervix dilates to around 3 centimeters (1 inch), the active phase of labor begins.
- Contractions become stronger, more painful, and occur every 2-3 minutes, without much time to relax in between contractions.
- The cervix starts dilating faster and will continue to open till about 8 centimeters (3 inches). The baby’s head will descend farther and farther into the pelvis.
- If it hasn’t already, your water breaks and you may experience pressure in your lower back.
3. Transitional phase
During the transitional phase, the cervix will open to about 8-10 centimeters (3-4 inches), which is the diameter needed for the baby to pass through.
- Contractions become intense, occurring about every 2-3 minutes and lasting for 60 seconds or more.
- At this point, the legs may cramp and you may feel shaky or nauseated. Some women choose to receive pain medication such as tranquilizers and regional blocks like epidurals.
- The baby’s head continues to descend more into the pelvis.
- By the end of the transitional phase, a birth canal will have formed. This is a single passage of the open womb, cervix and vagina for the baby to pass through.
Stage 2: Delivery
The second stage of labor begins when the cervix is fully dilated to 10 centimeters and ends with the delivery of the baby. This stage may last between 20 minutes to 2 hours. It may take longer for first-time mothers and for those who have an epidural.
- Strong and regular contractions come every 1-3 minutes and last for 45-75 seconds. As each contraction increases, you may feel the urge to bear down and push.
- Your doctor may ask you to push to help the baby move through the birth canal. With each contraction and push, the baby moves farther down into the pelvis, through the birth canal.
- At the end of stage 2, the top of the baby’s head emerges at the opening of the vagina. This is called "crowning." The baby’s head will work to stretch out the vagina. An episiotomy may be administered at this stage.
- Your doctor may ask you to stop pushing to prevent or minimize tears in the perineal area and ease out the baby’s head slowly.
- After the baby's head is delivered, the shoulders and the rest of the baby's body will follow. The airway of the baby will be cleared to help the baby take their first breath. The umbilical cord would be clamped and the cord is cut.
Stage 3: Afterbirth
- Contractions begin again, helping the placenta to separate from the wall of the uterus. Your doctor may ask you to push while they pull gently on the umbilical cord and massage the uterus to help the placenta come out.
- The placenta is examined to ensure that it is intact. Fragments, if any, are also removed to prevent bleeding and infection.
- The uterus will continue to contract after the delivery of the placenta to help it return to its normal size.
- Medication may be given before or after the placenta is pushed out to encourage uterine contractions and minimize bleeding.
- If stitches are required because of a tear or an episiotomy, your doctor will perform the suturing under local anesthesia.
Stage 4: Recovery
Recovery begins during the first 2-3 hours after delivery. During this time, the uterus contracts here and there, pushing out what’s left inside and reestablishing muscle tone.
- Tremors and chills
- Discomfort from pain, episiotomy, tears, or hemorrhoids
- Weakness and dizziness, especially while standing up
- Difficulty urinating due to swelling in the genital area
When you can, you may take a warm shower and then rest while recovering from the stress of labor and childbirth. You can also start breastfeeding as needed. Keeping skin-to-skin contact with the baby is the best way to help the baby learn to breastfeed and keep them warm and calm.
Your partner can also use skin-to-skin contact to help keep the baby warm if you don’t feel up to it. Your baby will also be cared for or monitored during this time by a neonatologist.
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Hutchison J, Mahdy H, Hutchison J. Stages of Labor. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK544290/
National Health Service. The Stages of Labour and Birth. https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/the-stages-of-labour-and-birth/
MedicineNet. Medical Definition of Fourth Stage of Labor. https://www.medicinenet.com/fourth_stage_of_labor/definition.htm
Kaiser Permanente. The Four Stages of Labor. https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=/common/healthAndWellness/pregnancy/birth/laborStages.html