The Stages of Labor and What To Expect

At last your day has come! Regular strong contractions started and they are different from Braxton Hicks contractions. Every labor is divided into 3 stages:

-          First stage: Early  and active labor

-          Second stage: The birth of the baby

-          Third stage: Delivery of the placenta

What happens during the first stage?

It is very difficult to know when early labor starts. Real labor contractions can be mistaken with Braxton Hicks contractions. You will notice that they become regular, stronger and frequent. You might see a vaginal discharge of tinged mucus with blood. Some women will experience membranes rupture and discharge of the amniotic fluid. Your cervix will start dilating and effacing. The length of early labor, going from zero dilatation till 4cm, depends on how many your contractions are frequent and strong and how much was your cervix ripen before the contractions. Having your first baby makes this first stage go around 6 to 12 hours.

Active labor starts when things gets quicker. Your contractions are stronger and longer, your cervix will dilate quicker to reach 10cm diameter. Transition period happens when the cervix reaches 8 to 10cm.

During early stages, your doctor will recommend that you go to the hospital. The midwife will test your blood pressure, your urine and temperature. She will perform a vaginal test to check the cervix status and would place the monitor around your belly to check the baby’s status and the contractions. Some hospitals will suggest an enema to clean your bowl and make it easier for you to push during the second stage. You may be allowed to walk around during this period. When active labor starts, the monitor will be attached to your belly and the epidural will be performed if you have requested it. An intravenous will be put in place with oxytocin to regulate the contractions. Your doctor may allow keeping you free and walking around if there are no complications. Active labor lasts from 3 to 5 hours and the cervix dilates from 4 to 7cm.

If the membranes are not yet ruptured, the midwife will perform a harmless technique to rip them. She will insert a clamp between her fingers into the cervix and will twist it against the membranes. Once the membranes are ruptured, she will keep her fingers inside guiding the water outside and making sure that the umbilical cord is not sliding outside in front of the head. She will be monitoring the baby cardiac rhythm during this procedure.

The last stage is the transition phase when the baby descends into your pelvis and your cervix has dilated to 10cm. You will feel a pressure on your rectum and will start feeling the need to push. Some women will get nauseated during this period. If you have the epidural, you might not feel the pressure and the midwife will guide you when to start pushing. Contractions will become stronger and happen every 2 minutes. This period may go from few minutes to an hour.

The second stage: The birth of the baby

Once the baby descends and your cervix is fully dilated your doctor will see the head of the baby emerging. He will know the baby’s position just by examining the fontanel position.

You will have an urge feeling to push and your doctor will ask you to take a deep breath, hold it and push when the contraction arrives. With each contraction, the baby moves down further in the birth canal. At a glimpse the baby scalp is visible. At this time, the doctor will evaluate if you need an episiotomy or not. He will guide you when to push and when to stop to prevent your perineum from tearing out. Your baby’s head emerges slowly and the doctor will check his neck to make sure that the umbilical cord is not around it. In case the umbilical cord is around your baby’s neck, the doctor will clamp it and cut it to free the baby’s neck. At this time the doctor will ask you to push one last time to free your baby’s shoulder followed by his body. Congratulations, your baby is born!

Your baby will be covered by a towel and the midwife will suction his nose and mouth from extra mucus. The doctor will clamp the umbilical cord from both sides and cut it. Your partner will be invited to cut the umbilical cord if he desires. He will be wrapped in a towel and given to you to hold him in your arms if there are no complications.

The third stage: Delivering the placenta

Your baby will be taken by the midwife to check him and score his Apgar test. Your uterus will start contracting again to separate the placenta from the uterine wall. You will feel the descent of the placenta and your doctor may ask you to push it out. This stage will take five to ten minutes until the placenta is separated. Once out, the doctor will examine it to make sure that no parts are left inside.

The midwife will check your uterus frequently to make sure it is firm and will massage it. Those last contractions are very important to help closing the vessels where the placenta was attached. If they don’t cut off, you will continue bleeding. You’ll be given oxytocin to help your uterus to contract.

Your doctor will fix the episiotomy if you had one. He will inject a local anesthesia and will perform the stitches. The anesthesiologist will remove the epidural catheter from your back if you had one. You will stay in the recovery room for half an hour. The midwife will monitor your uterus closer and makes sure that you are fine. Your baby will be given to you during this time. If you are willing to breastfeed, you can start immediately.