Labor and Birth

Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). 

The first stage begins with the onset of labor and ends when the cervix is fully opened. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center.

At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby's position and station (location in the birth canal). Most babies' heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up, towards the mother's abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own.

As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. 

The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last, few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters.

The second stage involves pushing and delivery of the baby. It usually lasts 20 minutes to two hours. A woman can give birth in many positions, such as squatting, sitting, kneeling, or lying back. 

When the baby's head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy, to enlarge the vaginal opening. Most women in childbirth do not need episiotomy. Sometimes, forceps (tool shaped like salad-tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After the baby is born, the umbilical cord is cut. 

The third stage involves delivery of the placenta (afterbirth). It is the shortest stage, lasting five to 30 minutes. Contractions will begin five to 30 minutes after birth, signaling that it's time to deliver the placenta. Labor is over once the placenta is delivered. 

Contact your doctor when contractions become regular and stronger, your water breaks, or you notice bloody discharge. Seek care urgently for heavy bleeding, severe pain, a baby moving less than usual, or contractions before 37 weeks.