Understanding the Stages of Labor

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Expectant first-time mothers are often surprised to learn that it might be difficult to pinpoint the exact moment when labor begins.  Unlike the climactic scene in many movies when a woman’s water suddenly breaks and forceful contractions begin, labor is often a long process that begins very slowly and intensifies over time.  Dr. Emanuel Friedman, a now retired obstetrician, pioneered the characterization and categorization of the stages of labor starting with his research published in the 1950s that included the analysis of data collected from thousands of women during delivery. Based on his teachings and more recent research, labor is now divided into three distinct stages.

The first stage of labor can be further subdivided into three phases – early, active, and transitionEarly labor is generally the longest part of labor, often lasting many hours and sometimes lasting a day or more.  The onset of the early labor phase marks the official start of labor (sometimes referred to as “true labor”), which is characterized by the appearance of regular contractions occurring at least 30-60 minutes apart. Because this phase of labor can last so long, it is generally advised that you remain at home, try to relax (which can be quite challenging amid the contractions and excitement!), stay hydrated, and try to consume small snacks.  When contractions become more frequent, around 5 minutes apart, and the cervix has dilated to 3cm, the active phase of labor begins. This phase is generally more uncomfortable than early labor, as the recurrent contractions are also increasing in strength.  If you haven’t already made your way there, now is the time to head to the hospital or birthing center.  The active phase of labor typically takes a few hours and lasts until the cervix is dilated to 8cm.  Once this milestone is reached, the transition phase of labor begins.  The shortest but most intense phase of the first stage, transition is marked by contractions every 1-2 minutes that last around 1 minute.  The end of the transition phase, also marking the end of the first stage of labor, occurs when there is complete cervical dilation.

The second stage of labor begins when the cervix is 10cm dilated… which means it’s time to push!  Regular contractions spaced out by a minute or more will continue during this stage.  Uterine contractions are designed to assist in the delivery of the baby, so you will push during the contraction and rest in between.  Some babies are delivered in just a few pushes, while some mothers must push for hours before the baby is delivered.  The second stage of labor ends with the arrival of your little one!

Fortunately the toughest part is over, but unfortunately there is still a bit of work to do after your baby is born. The third and final stage of labor lasts from the delivery of the baby until the delivery of the placenta.  The placenta, also called the afterbirth, was attached to the wall of your uterus and responsible for providing nutrients and filtering waste for your baby during pregnancy.  The third stage of labor can occur naturally, or it can be managed (i.e. assisted with hormone injections) to expedite the process.  The third stage generally lasts about 30 minutes, and many women report lower levels of pain than during childbirth.

Many expectant mothers find comfort in educating themselves on the stages of labor prior to the big day.  Most hospitals and birthing centers offer classes for prospective parents, which can give a more comprehensive overview of labor, suggest some techniques or positions that might help during the labor and delivery process, discuss pain management options, and even educate as to how your facility handles logistics like check-in and visitor policies.  It’s important to remember, however, that the labor process can vary widely from mother to mother. How your friend or family member experienced labor and delivery might be extremely different from the experience you will have. Some women have precipitous labor, which is when a baby is born only three hours after regular contractions begin, while others (particularly first-time mothers) might experience labor that lasts over a day.  Therefore, it’s best to try to keep an open mind and a positive attitude.

Although it might be one of the most physically and mentally challenging experiences of your life, the reward of a beautiful new baby at the end of the process makes it all worthwhile!

Kristen Hollinger
Dr. Kristen Hollinger has a Ph.D. in molecular and cellular biology from Pennsylvania State University. She currently resides in Maryland and works as an Instructor in the Departments of Psychiatry and Neurology at Johns Hopkins University School of Medicine. Her research focuses on neurological diseases including depression and multiple sclerosis.

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