Healthcare providers have documented the natural process of childbirth by identifying the various steps that women follow when giving birth. The following is an outline of the different stages and phases of labour. Remember that each laboring mother is an individual – some will not fit neatly into these definitions, and not everyone will experience the same signs and symptoms.
How do I know labour has started?
This is a question all pregnant women ask themselves! Some signs are quite clear, while others are harder to pin down.
- Rupture of membranes: only 10-12% of women have their membranes rupture before contractions have started. The majority will see their water break as the labour progresses, or even during the pushing stage.
- Mucous plug: this is a gelatinous substance that plugs up the cervix, and stops bacteria from getting into the uterus. It falls out at any point once the cervix starts dilating; so it can be a sign that labour is starting, or it can come out when the woman is in active labour. It can come out in one chunk, or it came come out in pieces and look quite stringy and mucousy.
- Bloody show: some women notice spotting (bright pink) or bleeding (dark red) as a sign of labour. Women will continue to bleed as labour progresses – this is due to blood vessels popping when the cervix is dilating. You should not be alarmed unless you see a considerable amount of blood, in which case a care provider should be notified.
- Contractions: most women will begin feeling contractions in their lower abdomen, and these are similar to menstrual cramps. As the contractions progress they will get longer, stronger and closer together. If these three things do not happen, the woman is likely experiencing pre-labour (or “false labour,”) and the contractions may slow or stop.
- Lower back pain/tightening: another sign the uterus is starting to contract
- Nesting: some women experience a surge of energy in the 24 hours prior to labour beginning. They may feel a strong urge to clean something in the home, or may obsessively organize materials or things they require for the birth or baby.
The entire labour and birth process is divided into three stages: stage one is when the woman is dilating from 0-10 centimetres (cm); stage two is when she is pushing her baby out; and stage three is the delivery of the placenta. Within the first stage there are three phases: early labour, active labour and transition. Confused? Remember three and three – three stages, and three phases.
- Anywhere between 12 – 24 hours in length
- Cervix dilates from 0-3 cm
- Woman feels excited or nervous; she is able to go about her daily activities
- Contractions are far apart and/or very short (5-20 minutes apart, and 30 – 45 seconds long)
- Approximately 6-8 hours in length
- Cervix dilates from 4-7 cm
- Woman is no longer able to walk and talk through contractions. She is feeling much more focused, and has now entered her primitive (instead of rational) brain. She will probably not feel like chatting, and will have a hard time making decisions
- Contractions are closer together and longer (2-5 minutes apart, and about 1 minute long)
- Rhythm and Ritual: if they are coping well, women in active labour have a specific ritual they follow for every contraction. Some may sway or rock their hips from side to side; others may vocalize in deep moans; some may do specific breathing patterns, or counting
- Women are usually not very hungry, but may feel like nibbling on dry crackers or fruit
- The shortest, but hardest part of labour (anywhere from several minutes to 1.5 hours)
- Women experience a surge of adrenaline as the body prepares to start pushing
- Contractions are very close together, and women do not get much of a break (2-3 minutes apart and 60-90 seconds long)
- Symptoms can include: sweating or chills, shaking, vomiting, panic (“I can’t do this!”), and pressure in the bum as the baby’s head moves lower in the pelvis
- Women will need lots of hands on support in this phase
Stage Two: Pushing
Once full dilation of the cervix is complete, women enter the pushing stage of labour. Contractions space out somewhat (3-5 minutes apart) but remain long and strong. The average length of this stage for first-time mothers is two hours, but pushing can last anywhere from several minutes to approximately three hours.
If the woman does not have an epidural she will experience spontaneous bearing down. This is when the body involuntarily starts to push the baby out. Many women describe this sensation as similar to the urge to have a bowel movement. Women tend to give shorter pushes, and can push anywhere from 3-5 times per contractions.
A woman who has an epidural will not feel an urge to push, and will require guidance from her support team. Directed pushing is when a nurse or midwife coaches a woman to push during contractions. The woman will give three big pushes for each contraction.
In the pushing stage, women are working very hard. They will require cool cloths for their forehead, lots of water, and will need encouragement. It’s hard for women in this stage to hear what’s going on in the labour room, as they’re so focused on the task at hand. If guidance is required, it’s important to get close to the mother and speak to her in a clear voice.
Stage Three: Delivery of the Placenta
Once baby is born there is still some work to be done. A woman’s uterus will continue to contract attempting to expel the placenta. The placenta will come away from the wall of the uterus at some point between 5 and 30 minutes after birth. This process will be shorter if women are given a shot of Pitocin at the time of birth, as this helps the uterus to contract more efficiently.
Care providers will check for slack on the umbilical cord, and will instruct women to give one final push once they determine the placenta is ready to come out. Placentas have no bones, so it will not be painful for women to push out. Once the placenta is out, the care provider will check it to make sure that it is intact, and will continue to monitor a mother’s bleeding.
Once the entire process is done, it’s finally time to focus on your newborn and celebrate the birth of your little one. Make sure to stay hydrated and eat a healthy meal to replenish your energy. Finally, don’t forget to rest as a family and rebuild your strength after this incredible (but tiring!) journey.