The 3 Stages of Labour
Labour is divided into three distinct stages, with each stage lasting a certain time.
This section looks at each stage of labour, what to expect, how long each stage will last, and what is involved in the afterbirth.
Labour for a first-time mother can be daunting, but with the support and courage from our forums of mothers, you’ll be ready for every stage.
The duration of labour
How long labour lasts, and how demanding it can be, varies among different women, and also in an individual woman from birth to birth. The length of labour is dependent on several factors, largely on whether this is your first or subsequent baby. Generally, however, the duration of a first labour is 12-14 hours, with subsequent labours tending to be shorter, at seven hours or so. Some women may be in labour for 24 hours or more, while others can deliver in only a couple of hours; both these situations, however, are unusual.
Labour is divided into three distinct stages, with each stage lasting a certain time. Your midwife will be with you the whole time towards the end of the first stage of labour, and in the final two stages, and will guide you through until your baby is born. If you have your own obstetrician, or one is needed because of problems, he/she will normally visit you during the first stage (especially if there are problems), and then be there for the second stage and the birth.
Your partner can also be a great help throughout your labour by giving you physical and moral support. Not only can he comfort and massage you, help you with your breathing and relaxation exercises during labour and encourage you to push when you need to, but he’ll also be there to interact with hospital staff on your behalf if you’re busy concentrating on your labour.
The first stage of labour
The first stage of labour covers the period of the onset of labour (the presence of regular painful contractions) up until the point when the cervix is fully dilated (stretched or opened to the maximal 10cm diameter). This initial stage normally lasts the longest and can take six to 12 hours or more if this is your first baby, and just a few hours if you’ve already had a baby.
Over the final weeks of your pregnancy, your cervix will start to soften under the influence of pregnancy hormones and increasing painless non-labour contractions, which help to thin out (efface) and dilate your cervix in preparation for delivery (this all happens before the onset of labour).
Your contractions are usually weak and infrequent at the beginning (occurring at intervals of five to 20 minutes and lasting only around 20-30 seconds). They will become stronger (30-60 seconds), more painful and regular (three to seven minutes apart), when actual labour starts, and usually don’t stop until your baby is born.
With each contraction, your cervix will begin to open gradually, from 2cm to around 10cm, until it’s fully dilated and ready for the baby to move down in the birth canal and be born.
First-stage labour can be broken down into two separate phases:
- The latent phase, which is usually the longest, normally about eight hours if this is your first baby. During this period, your contractions will increase in duration and regularity, and your cervix will start to efface and open from 2cm to about 4cm. When your cervix has dilated to at least 3cm, you’re in what is known as established labour. Once in established labour, you may be asked not to eat anything, mainly in case you need an anaesthetic later.
- The active phase, which generally lasts for three to five hours. At this stage, your contractions will become more painful and cause your cervix to efface and dilate even more, to about 8cm. Contractions during this phase typically occur every two to four minutes and last for 60 or so seconds. It’s at this point when you may want some pain relief. Towards the end of the first stage, your contractions may become stronger. If your waters have not already broken, they will probably do so at this point, as the contractions become more intense. This is when you may feel the most pain and discomfort, and may find it difficult to relax. Many women experience shivering, sweat more profusely, feel nauseous or actually vomit and/or lose control of their bladder and bowel movements due to the pressure of the baby’s head. You may also be quite emotional, feeling irritable, anxious or angry. Additionally, you may now have a strong urge to push (known as bearing down) with each contraction as your baby moves down and starts to push on your rectum (back passage), although you’ll be advised to hold on until your cervix is fully dilated at 10cm. It’s during this phase that your relaxation and breathing exercises during labour will help.
The second stage of labour
The second stage of labour begins when your cervix is fully dilated and lasts until the moment that you’ve been waiting for, when your baby is born. It can last from 30 minutes to two hours or more, and as little as 10-20 minutes if you’ve already had a baby. Your breathing and relaxation exercises are again important in this second stage of labour.
Contractions in labour are considerably stronger during this phase and occur every two to four minutes and last 60-90 seconds. As your baby’s head descends towards the pelvic floor muscles and rectum, this causes it to rotate from the side on (known as occipitotransverse) position until the baby’s chin points downwards towards your back passage or rectum. When your baby is pushed further downwards, the rectum and perineum (the area that runs between your vagina and rectum) start to protrude, and eventually the head will appear in the vaginal opening. With your baby’s head pressing on the pelvic floor and rectum, you’ll feel an overwhelming natural (although involuntary) urge to bear down. At this point, you’ll be encouraged to push your baby out smoothly and continuously with each contraction.
While you are pushing, it’s quite normal to urinate or have a bowel movement, since the pelvic area and rectum are relaxed. You should push down towards your back passage while holding your breath, pausing every 10-20 seconds to take a fresh breath. With each contraction, the baby’s head moves further down in the birth canal. After each contraction, it then moves back a little, though not as far as before that contraction (“two steps forward, one step back”). When your baby’s head remains visible without slipping back between contractions, this is known as crowning, and means the baby will be born in the next few minutes.
There are usually no fixed limits to the duration of labour of the second stage. However, if after an hour or more, the baby’s head is not moving down in the birth canal with contractions or pushing, your obstetrician will consider whether to assist the delivery. If your contractions have become weak or if it is your first baby, your doctor may advise an oxytocin drip to strengthen the contractions and thus move the baby down in the birth canal to allow you to have a normal delivery. Sometimes this is all it takes to get things going again, and then you will feel the urge to push and go on to push your baby out on your own. If the baby looks like it will be a slightly tight fit through your pelvic canal, or if the baby is distressed, your doctor may decide to assist your delivery, by using either a vacuum device known as a ventouse, or forceps. You may also need to have your delivery assisted if you’re exhausted and unable to push anymore.
At the birth, you may feel a stinging sensation as your baby’s head stretches your vagina. When you feel this sensation, it’s important to stop bearing down (you may be asked to pant in short breaths or blow, instead) and allow the contractions of your uterus (womb) to do the work to push your baby’s head out of the vaginal entrance. This will allow the skin and muscles of your perineum to thin and stretch more slowly, otherwise there’s a risk of tearing that may be difficult to repair afterwards. If there’s a likelihood that your perineal tissues will not stretch enough and may tear, it may occasionally be necessary to undertake an episiotomy. An episiotomy is essentially a small cut to make the vaginal outlet bigger and prevent irregular tearing of the tissues. Except for difficult, assisted deliveries, episiotomies are not done very often these days; instead, your doctor or midwife will control the delivery of your baby’s head so that it comes out gently, and may also massage your perineum so that it stretches gently over the baby’s head. Using this approach, many women now get away without stitches, or at worst, have only a small tear and therefore only a few stitches. Don’t worry, however, if you do need to have an episiotomy. These are done where there’s considered a real chance that the perineum will tear severely at delivery, as a difficult tear can be harder to sew up again, and would be more painful than a carefully planned episiotomy.
After your baby’s head has emerged, it then rotates and realigns with its body. At this point, your healthcare professional will check to make sure that the umbilical cord is not wrapped around your baby’s neck. Your baby’s eyes, nose and mouth may also be cleaned, and any fluid from the nose and air passages will be cleared.
Subsequent contractions will allow your baby’s shoulders to emerge one by one, and then the rest of the baby will slide out of the birth canal (the area that includes the cervix to the vaginal opening). Delivery of your baby may be followed with a sudden release of amniotic fluid. After your baby has been delivered, he/she will normally be placed on your abdomen straightaway so that you can hold him/her and get to know each other for a few minutes, and then the umbilical cord will be cut and clamped.
In some hospitals, your baby may be put on your breast immediately after delivery to encourage suckling and bonding. This not only helps with breastfeeding later, but will also encourage the uterus to contract: seeing and touching your baby, and putting your baby on the breast, causes your body to produce oxytocin, a natural hormone that stimulates uterine contractions. Your baby will then be weighed and checked to ensure that all is well and that he/she is breathing properly.
The third stage of labour
The third stage of labour lasts from the point of delivery of the baby until the placenta, along with the cord and membranes (or afterbirth as it’s also commonly known), has been expelled. This is the shortest stage of labour, usually taking between 10 and 20 minutes, and is relatively painless. You may be asked to give a small push when the placenta is ready to come out, although this will be much easier than pushing the baby out (the placenta is soft and squishy, and only weighs about one-sixth of the baby’s weight).
Although your uterus will stop contracting once your baby is born, after around 15 minutes it will start to contract again, and the placenta will detach from the uterine wall and be pushed out from the vagina. You will normally lose about 300-500ml of blood at delivery.
In most hospitals, an injection is usually given into your thigh or vein at the very end of the second or at the beginning of the third stage of labour. This helps the womb or uterus contract, and thus prevents heavy bleeding. This injection is commonly a drug combination of synthetic oxytocin (a hormone, which you may know as syntocinon) and ergometrine, usually called by its trade name, Syntometrine, which is given either when the head is crowning or during delivery of your baby’s body. There are several different medications available, and the type of drug and its route of administration will vary from hospital to hospital. Syntometrine may cause vomiting as a side effect in a few women and, because of this, some hospitals use just syntocinon, although it’s not quite as good as Syntometrine at contracting down the uterus. This accelerates expulsion of the afterbirth and reduces the risk of postpartum haemorrhage (heavy bleeding): when the uterus is contracted, there’s less chance of bleeding occurring. Administration of this drug is known as active management. Rarely, the placenta gets stuck and may need to be removed by hand.
The placenta will then be examined to make sure that no piece of it has been left inside your uterus. If something has remained behind, it will need to be removed immediately to prevent bleeding at a later stage.
Any tears or incisions that you have are also cleaned and, if large, sewn up, at this point. You’ll be freshened up while your baby is being weighed, measured and examined (Apgar scores are done at one, five and 10 minutes after delivery). Your baby will also be washed, since he/she will be covered in the slippery waxy substance known as vernix caseosa (which facilitates delivery).
Your baby will then be dried, dressed and returned to you so that you can start, or continue, breastfeeding and bonding.