What major event occurs during the first stage of labor?

• Overview

Overview

What are the stages of labor?

Labor (childbirth) is the process of a baby leaving your uterus through your vagina or a cesarean birth (c-section). It usually happens between 37 and 42 weeks (9 to 10 months) of pregnancy. There are three stages of labor:

• Stage 1: Labor.
• Stage 2: Pushing and birth.
• Stage 3: Delivery of the placenta.

All people experience the stages of labor and delivery differently. Some stages last longer than others. People who’ve had children before may go through the stages more quickly than a person giving birth for the first time.

What is the first stage of labor?

The first and longest stage of labor can last anywhere from 12 to 19 hours, though people who’ve had children before may go through this stage much faster, anywhere from four to 12 hours. During this stage, your contractions become strong and regular. During a contraction, muscles in your uterus tighten and relax to help push your baby out. Your cervix dilates (widens) and effaces (thins). Your baby progresses within your birth canal with the help of these stronger and more frequent contractions,

This first stage has two phases: early labor and active labor.

Early labor

Early labor lasts anywhere from six to 12 hours. It mostly happens at home, but you should be ready to go to the hospital. During early labor:

• Contractions are five to 15 minutes apart and last for about a minute each. Go to the hospital once they’re five minutes apart for one hour or more.
• Your vaginal discharge might be clear, light pink or bloody. Go to the hospital if you notice heavy bleeding.
• Your cervix dilates to about 4 to 6 centimeters.

Contractions don’t always mean you’ve gone into labor. Some people have “false labor,” or Braxton Hicks contractions in the weeks or days leading up to labor. They’re your body’s way of getting ready for birth. Braxton Hicks contractions are irregular, while true labor contractions are at regular intervals. This is the best way to tell the difference between the two types.

Active labor

Active labor typically lasts between four and eight hours. When this phase starts, you should already be in the hospital. During active labor:

• Contractions become strong and regular, about three minutes apart.
• Your baby begins moving into your birth canal.
• You may feel the urge to push.
• You might experience pain, cramping or pressure in your lower back or legs.
• Your water may break during active labor, which is when the amniotic sac around your baby ruptures.

What is the second stage of labor?

The first stage of labor ends and the second stage begins when your cervix is 10 centimeters dilated. This is usually the most difficult stage of labor because you start trying to push your baby out. It can last anywhere from half an hour to several hours.

You can expect:

• Contractions get slower and come every two to five minutes, lasting about 60 to 90 seconds.
• You’ll need to push when you have contractions but can rest between them. Your healthcare provider will tell you when it’s time to push.
• Your baby crowns, which is when their head begins to show.
• Your healthcare provider delivers your baby by guiding it out of your birth canal. Sometimes they use tools to help the baby out, such as suction or forceps.
• Once your baby is born, your provider cuts the umbilical cord.

Some people have their baby by a planned or unplanned cesarean birth (c-section). Instead of pushing your baby out through your vagina, a healthcare provider makes a cut in your belly and uterus to remove your baby.

What is the third stage of labor?

The third stage of labor is the shortest. It doesn’t usually last longer than 20 minutes. You push out the placenta (afterbirth), which is the organ that develops in your uterus during pregnancy. It supplies your baby with oxygen and nutrients and removes waste from your baby’s blood.

During the third stage of labor:

• Contractions begin again about five to 30 minutes after birth. These contractions help the placenta separate from your uterus. They’re not as painful as they were in earlier stages.
• You might need to push, or your healthcare provider will press on your belly to move the placenta forward.
• You might have heavy vaginal bleeding for a short time during or after the delivery of the placenta.
• Some women experience chills or feel feverish. Tell your healthcare provider if you experience these symptoms.

If you have a c-section, your provider removes the placenta when they remove your baby from your uterus.

Is there a fourth stage of labor?

Some experts consider the two to three hours after the delivery of the placenta to be a fourth stage of labor. This is the time when parents may start to bond with their new baby. Your uterus also relaxes and healthcare providers monitor you for any abnormal bleeding.

Possible Causes

What makes you go into labor?

Experts believe that when your baby is ready for birth, they release a small amount of a substance that triggers your hormones to start the labor process. For most people, this happens naturally between 37 and 42 weeks of pregnancy.

In some cases, a healthcare provider will induce labor. This means you take a medicine that makes your body go into labor. Labor induction might be necessary if:

• You have health conditions, such as diabetes or high blood pressure, which could affect your health or that of your baby.
• Your baby is growing too slowly.
• Your baby is overdue (still in the uterus after 42 weeks).
• Your water has broken but labor hasn’t started.

Care and Treatment

How is each stage of labor managed?

Each stage of labor and delivery will be different for every person. There are some techniques you can use to stay more comfortable during labor. Your healthcare provider may also provide treatments to keep you and your baby safe during labor and delivery.

How is the first stage of labor managed?

During the first stage of labor, try and stay relaxed. You may feel better if you:

• Do gentle stretches.
• Practice deep breathing.
• Take a warm (not hot) bath.
• Walk around.

At the hospital:

• Don’t push until your healthcare provider tells you to do so.
• Drink water, but don't eat solid foods.
• Go to the bathroom to urinate (pee) as often as you need to.
• Move around and change positions.
• If it’s part of your birth plan, take pain relief medicine provided by your doctor.
• If you can’t tolerate the pain, ask for epidural anesthesia. Most people get this anesthesia, which providers inject into their lower spine, so it numbs their lower body.

How is the second stage of labor managed?

During the second stage of labor:

• You can change positions if you’re uncomfortable or it’s hard to push. Try squatting, sitting or kneeling.
• Your healthcare provider may perform an episiotomy. This is a small incision (cut) at the opening of your vagina to give the baby more room to exit your uterus.

How is the third stage of labor managed?

During the third stage of labor:

• Your healthcare provider makes sure you deliver all of the placenta. Retained products of conception can cause serious health problems.
• You might receive medicine if you have too much vaginal bleeding.
• If you had an episiotomy, your provider repairs it once the placenta is out.

When to Call the Doctor

When should I contact my doctor about labor?

Once contractions are every five minutes for at least one hour, call your healthcare provider or the hospital labor floor. If your water breaks, whether or not you notice contractions, call your healthcare provider or the hospital labor floor. Even if it’s early in the first stage of labor, or you think you’re having Braxton Hicks contractions, let your care team know what’s going on.

Get help right away if you experience:

• Chest pain.
• Dizziness or fainting (syncope).
• Severe nausea and vomiting.
• Shortness of breath (dyspnea).
• Swelling (edema) in your legs, arms or face.
• Heavy bleeding.
• Significant decrease in baby movements.

A note from Cleveland Clinic

All people experience the three stages of labor differently. Knowing what to expect during each phase can help you stay calm. Making a detailed birth plan with your healthcare provider is a great way to prepare for labor and delivery. Consider having a designated birthing partner to offer support and encouragement during the process. Your partner might be a spouse, friend, family member or doula.

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Last reviewed by a Cleveland Clinic medical professional on 04/01/2022.

References

• March of Dimes. Stages of Labor. (https://www.marchofdimes.org/pregnancy/stages-of-labor.aspx) Accessed 4/1/2022.
• National Institutes of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. What are the stages of labor? (https://www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/stages) Accessed 4/1/2022.

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Related Institutes & Services

Ob/Gyn & Women's Health Institute

Cleveland Clinic’s Ob/Gyn & Women’s Health Institute is committed to providing world-class care for women of all ages. We offer women's health services, obstetrics and gynecology throughout Northeast Ohio and beyond. Whether patients are referred to us or already have a Cleveland Clinic ob/gyn, we work closely with them to offer treatment recommendations and follow-up care to help you receive the best outcome.