No one can tell you what your labour will be like, or how long it will last. Every woman's labour is different, but you can prepare yourself by learning about the different stages of labour. There are three distinct phases of labour. The first stage is when your uterus starts to contract and then relax (aka contractions). It will soften, shorten and dilate (open). The second stage is when your cervix is fully dilated. This bit includes the pushing phase, and ends with the birth of your baby. The third stage is the delivery of your placenta.
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Here’s an in-depth look at what you need to know about the stages of labour, from the first hints that things are on the move, to the birth of your baby.
What is childbirth like?
Every woman's labour experience and birth is different. The duration of each stage can also vary from pregnancy to pregnancy.
But there are plenty of things you can do to prepare yourself. Understanding what happens to your body and your baby during labour is a great first step.
What are the stages of labour?
In first-time births, labour moves forward in three clear stages:
- First stage: contractions open up the cervix, which is the neck of your uterus. The first stage consists of early labour, active labour and then the transitional phase.
- Second stage: when you push your baby out into the world.
- Third stage: when you deliver the placenta.
There's also a phase called prelabour, or the latent phase, which is when your body gears up for the first stage of labour. Second births are often a lot faster. The stages of birth are not as obvious.
What happens in prelabour?
During pregnancy, your cervix is closed. It’s plugged with mucus to keep out infection. Your cervix is long and firm, giving you a strong base to your womb. It also points slightly towards your back (posterior position).
Before labour can start properly, your cervix has to go through some changes. It has to move forward (anterior position), soften, and shorten (Simkin and Ancheta 2011). The softening of your cervix is often called ripening.
Prelabour changes may take hours, days, or even weeks (APA 2018, Simkin and Ancheta 2011). You may not notice it. Or, you may be aware of contractions (sometimes called labour pains) that can range in intensity and disturb your sleep, even though labour has yet to really get going (Simkin and Ancheta 2011). You might lose your mucus plug during prelabour. This is a thick gloopy blob, sometimes blood tinged, which has been plugging up your cervix to prevent bacteria getting in.
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What happens in the first stage of labour?
In the first stage of labour, your cervix has to open (dilate), so your baby can be born. The muscles of your uterus tighten with each contraction and then they release, slowly drawing your cervix up into the lower section of your uterus.
In the early phase of first stage labour, it may seem as if no changes are happening at all. Early labour can be slow. Your contractions may not last for long and could have long gaps between them that differ in length. They may even stop for a while, before starting again. Labour pain is likely not to be too intense during this phase.
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As you enter the active phase of the first stage of labour, when your cervix has dilated to about 4cm (1.575 inches) (JOGC 2016), the contractions tend to last longer, and will become more frequent, consistent and strong.
Towards the end of the first stage, your labour may become much more intense. This phase of labour is called transition (Alberta Health Services, 2021). By the end of the first stage, your cervix will be fully dilated (10cm), and you may get the urge to push (Alberta Health Services, 2021).
What happens in the second stage of labour?
This is the stage in which your baby is born. During the second stage of labour, your baby will start to move down the birth canal.
You may not feel the urge to push with your contractions right away. Birth professionals call this the passive second stage. When your baby has descended enough that your midwife or birth partner can see them, and you have the urge to push your baby out, you're in the active second stage (NCCWCH 2014).
During the active second stage, you’ll feel the pressure of your baby's head low down in your pelvis. With each contraction, you may feel strong urges to bear down. Listen to your body, and push in response to the urges (Alberta Health Services, 2021). Take a few breaths between pushes if that's what feels right. With an epidural, you likely won’t feel the urge to push until late into this second stage. Often, your caregiver will just let your body work on its own rather than getting you to actively push until the very end.
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With every push, your baby will move further through your pelvis. But at the end of the contraction, they'll probably slip back a little again. This is normal and gives the muscles of your pelvic floor some time to stretch (Downe and Marshall 2014). As long as your baby keeps moving down, you're doing fine.
Keeping upright can help you and your baby to progress through the active second stage (Gupta et al 2017, NCCWCH 2014).
When your baby's head can be seen at the entrance to your vagin*, and stays there when the contraction has ended, it's called crowning.
Your doctor or midwife will tell you when they can see your baby's head, and may ask you to stop pushing, and to blow or pant out your breaths instead (Alberta Health Services, 2021). This helps you to resist the urge to push for two contractions or three contractions, so that your baby is born gently and slowly.
Taking this approach may help to protect your perineum (the area between your vulva and your anus)(Alberta Health Services, 2021). You'll probably feel a hot, stinging sensation as the opening of your vagin* starts to stretch around your baby's head (Alberta Health Services, 2021). Your birth provider may use warm compresses to support your perineum as it stretches, to help prevent a tear.
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Once you've birthed your baby, the second stage is over (NICE 2014). Your midwife or doctor may wipe your baby with a clean towel and then place them on your tummy or chest for a skin-to-skin (Alberta Health Services, 2021) cuddle.
What happens in the third stage of labour?
The third stage of labour begins once your baby is born, and ends when you deliver the placenta and the empty bag of waters that are attached to it (membranes). These come away as your uterus contracts after the birth.
Your midwife or doctor may offer you an injection for the third stage, to help your uterus to contract and the placenta to come away. This is what’s known as a (managed third stage) (JOGC 2016).
The injection may cause side-effects such as nausea and vomiting, because of the drugs used (NCCWCH 2014). Once the placenta is detached, your doctor or midwife will gently pull it out, along with the membranes from the amniotic sac (NICE 2014).
If all went well in your pregnancy and labour, and there are no concerns for your baby, you can choose to have a natural (physiological) third stage (NICE 2014). This is when you deliver the placenta without an injection.
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With a natural third stage, your contractions will be weaker when they begin again. The placenta will peel away from the wall of your uterus and move down into the birth canal. You may get the urge to push as this happens (Begley 2014). This usually happens within 10–30 minutes after your baby is born (Alberta Health Services, 2021).
Easing yourself into an upright position, cuddling your baby skin-to-skin (Karimi et al 2019), and starting to breastfeed them, may all help to stimulate your body to expel the placenta.
Whether you have a natural or managed third stage, as long as there aren’t any concerns for your baby, your healthcare provider will wait at least a few minutes before clamping the cord. While you're waiting to expel the placenta, the cord will still pulse with nutrient-rich blood. Waiting to clamp the cord gives your baby a helpful boost of this blood (NCCWCH 2014). While all this is going on, you're likely to be cuddling and getting to know your newborn better.
As long as you and your baby are well, you should be left in peace to have some time together. Your doctor or midwife should let you have at least an hour of gazing at, and possibly feeding, your new baby. During this time, the caregiver is still monitoring the vitals of both mom and baby to ensure both are well. After that, your provider will ask to carry out the standard newborn checks. These include weighing your baby, measuring their head size, and taking their temperature (NICE 2014).
