STAGES OF LABOR

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

The third stage of labor begins after the baby is born and ends with pushing out the
placenta through the vagina. Typically, this occurs between 5-30 minutes
after childbirth.
  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.

These contractions are hastened by breastfeeding, which stimulates the production of

 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.