The stages of labour and delivery

A normal delivery occurs when the baby is full term, between the 37th and 42nd week of pregnancy. Below is a description of the different stages of childbirth.

We also encourage you to read our fact sheet called Childbirth: Tips for each stage of labour. It’s full of tips to help you and your partner have a positive birthing experience.

Stage 1: Labour

The first stage begins when you start having regular contractions. These contractions begin dilating and effacing the cervix. This stage continues until the cervix is fully open to allow the baby to come out, i.e., once the opening is 10 cm wide.

The duration of the labour stage depends on several factors. For example, labour tends to last longer in first births than in subsequent births. That said, women who move around and change positions, favouring upright positions, tend to have a shorter stage 1 since these actions help the baby descend and can help with pain management. Many other factors can shorten or lengthen the labour stage, such as the baby’s weight, its position in the pelvis, the shape of the pelvis, the quality of the contractions, the use of certain medications, the mother’s mental state, and prenatal preparation.

The length of the first stage varies from one woman to the next. It’s hard to predict how long labour will last, because each woman’s experience of childbirth is unique. However, the labour stage is usually shorter for women who have previously given birth.

Stage 1 has 3 phases: The latent phase, the active phase, and the transition phase.

• Phase 1: The latent phase
  During the latent phase, contractions may be mild. They can feel similar to menstrual cramps and may be felt in the lower back or stomach. They are irregular at first, then become regular but short (30 to 45 seconds). During this phase, the cervix opens to 4 cm. If you’re having a normal pregnancy, however, you won’t need to go to your birth location just yet. If you’re unsure, call your hospital or midwife, especially if you have lost amniotic fluid, if your baby is not moving as much, or if you’re having a planned C-section. They will be able to confirm when you should go to your birth location. For more information, read our article called When should you go to your birth location?
  
  During this phase, women experience all kinds of emotions, from excitement to nervousness at the thought that the baby will be here soon. Some mothers are quiet, while others are playful and chatty. You should be able to talk or walk during your contractions most of the time. However, you may become tired if this phase is drawn out and you have difficulty resting.
   
• The active phase
  During the active phase, the cervix dilates an average of half a centimetre per hour. However, progress is slower up to 6 cm. Women who are not first-time mothers tend to have rapid progression after 6 cm of dilation. Contractions become longer, more frequent, and more painful. They are less than 5 minutes apart and last about 1 minute. These contractions help open the cervix to 8 cm. In many cases, a women’s water breaks during this phase.
  
  You may find it more difficult to manage the pain and may need guidance to maintain control during contractions. It will also be more difficult for you to walk or talk during contractions. However, movement is still important as it will help your baby descend into your pelvis.
  
  It is often during this phase that you will go to the hospital or birthing centre. The nursing team will recommend a variety of non-pharmacological pain relief methods, such as walking, pressure-point massage, varying positions, sitting on a birthing ball, or a therapeutic bath. Be sure to tell your support team what makes you feel good during this period of painful contractions. Some women feel the need to retreat into their own bubble, while others want visual or physical contact (massage, hand-holding, support when changing positions) during contractions. All of these behaviours are normal. Your doctor may also offer pharmacological pain relief.
   
• The transition phase
  During this last stage of dilation, the cervix will open to its maximum width, up to 10 cm. This is the shortest but most difficult phase. Contractions come every 6 minutes or less, and sometimes every 2 to 3 minutes, and last 60 to 90 seconds. You may feel as if there is no break between contractions.
  
  Some women experience hot flashes, while their hands and feet are cold. Others feel nauseous or vomit. You may feel out of control, agitated, or irritable. It may also be more difficult to concentrate. These are all normal feelings. Your partner, caregivers, and the birthing staff will be a great help in soothing any doubts about your abilities and in helping you through the pain. If you opted for an epidural analgesia, you will still need the staff to move and prepare you for the birth.
  
  Cheer yourself on and congratulate yourself for braving each contraction as it passes. Remember that with each contraction, your baby is getting closer to being born. Focus on your breathing and find a rhythm that feels good. You can also vary positions and alternate methods of non-pharmacological relief. What worked before may be less effective now and vice versa.
  
  During this phase of labour, you may feel pressure on your rectum and an increase in vaginal secretions. You must not push until you are fully dilated, as this may cause your cervix to swell and slow down your labour. If you get the urge to push before you are fully dilated, try panting (“hee-hee-hee-hou”). This type of breathing helps relieve pressure and restrains the urge to push. However, it can also cause dizziness and numbness in the hands. These sensations will diminish with slower, more regular breathing.

Stage2: Delivery

Stage 2 begins when the cervix is fully open and ends when the baby is born. Contractions will continue at the same rate. This stage is longer for first-time mothers and can take up to 3 hours. For mothers who have already given birth, this stage is faster.

During this phase, you will feel a strong urge to push. There are two schools of thought regarding when to push.

According to the first, you should listen to your body and start pushing only when you feel the urge, following the instructions of the doctor, nurse, or midwife. If you received an epidural, the urge to push may be delayed. This allows for a natural progression.

Studies have shown that the spontaneous pushing approach has the following benefits:

• Delivery is more efficient and the mother is less tired.
• The mother is less likely to need a forceps- or vacuum-assisted birth.
• There is less risk of perineal tearing.
• The baby receives more oxygen, leading to less fetal distress.

As long as the baby continues to descend and the mother’s condition allows, it is safe to wait. At a certain point, however, the baby’s descent may need to be stimulated to avoid complications. It’s important that contractions are productive and pushes are active enough to keep labour from stalling, which can be dangerous for both the mother and the fetus.

The second approach is to push as soon as the cervix is fully dilated. This is more common in patients without anesthesia at this stage of labour.

In both cases, the mother first inhales, pushes for about 10 seconds, then releases and empties the lungs completely. This can be done 2 to 3 times per contraction. The mother can breathe normally between contractions.

An effective push ensures that both mother and baby receive enough oxygen and allows the perineum to stretch gradually. Here are a few tips for effective pushing:

• Change positions regularly, i.e., every 3 to 4 contractions or every 15 minutes. You can push lying on your side, squatting, semi-seated, or on all fours. Your care team can help you decide what’s best. The most appropriate position may change as the birth progresses. This approach is called the Gasquet method.
• Bend your elbows and grab your legs or the support bar with your hands, keeping your knees in line with your shoulders.
• Lower your chin toward your chest and open your mouth slightly.
• Relax the pelvic floor muscles (perineum) to let the baby down without pushing. This technique is also part of the Gasquet method.
• Help yourself stay focused by putting all of your energy into helping your baby descend.
• Imagine that you want to give them as much space as possible. This visualization will help your baby drop.
• Some women feel the need to grunt as they push. Grunting is effective because it lowers the diaphragm. This, in turn, strengthens the pressure that’s being directed toward the perineum. Yelling, however, can interfere with effective pushing.
• Your care team will update you on your baby’s progress as you push. Let them know how you’re feeling between contractions. They’ll also keep you informed and ensure that any interventions are adapted to your needs and those of your baby.
• Actively push during your contractions, in 2 to 3 sustained pushes of about 10 seconds each. Remember to breathe well between pushes. Rest and relax between contractions.
• If you’ve had an epidural, you may not feel the need to push. If this is the case, your care team will tell you when to do it.

As your baby’s head begins to emerge, the perineum swells and the skin stretches. This causes a burning sensation, often called a “ring of fire.” Once the head is out, you will pause for a moment before pushing the baby’s shoulders out. Once the shoulders are out, the rest of the body will come out easily.

Stage3: Delivering the placenta

After your baby is born, the uterus contracts and the placenta starts to come away. You may be asked to push a few times to help expel it.

The placenta is usually delivered spontaneously 5 to 30 minutes after the birth. A hormone called oxytocin is often administered to help expel the placenta spontaneously and decrease the risk of hemorrhage. Often, a uterine massage is also performed for the same purpose. If the placenta does not come out on its own within a certain time limit, or if excessive bleeding is putting the mother at risk, intervention may be required. The doctor will then remove the placenta manually or surgically.

Stage4: Recovery

The recovery period is focused on your comfort and monitoring your overall condition. This is a special time for you and your baby, as you are reunited as a family for the first time. It’s a time to bond and meet each other.

If you experienced a tear or had an episiotomyduring labour, your doctor will stitch the wound once the placenta has been delivered. If necessary, medication may also be injected to help your uterus contract and prevent bleeding after delivery.

The nurse or midwife can also massage your uterus to keep it firm and contracted. This manoeuvre may cause some discomfort. Try some labour breathing techniques if this is the case.

Health care professionals will make sure that everything is going well while also respecting your family’s privacy.

• The nurse will check your breathing, heart rate, blood pressure, temperature, uterus, and bleeding regularly at first, then less frequently.
• They will clean your perineum, place a sanitary napkin, and apply ice to reduce swelling.
• You will be offered a clean hospital gown and a warm blanket. The warmth should feel good, as you may be cold after the birth, like you are after intense exercise.
• You may also want to eat or drink. You’ve put in some serious physical effort. Start small and eat according to your hunger and tolerance.
• You’ll be given time to relax and bond with your baby.

This is a great time to continue skin-to-skin contact with your baby, which will promote breastfeeding. In fact, skin-to-skin contact can encourage the baby to latch on within the first hour after birth. During this time, your baby is alert, and stimuli such as the sight and touch of the nipple or the smell and taste of colostrum may encourage them to latch on. If your condition makes skin-to-skin contact impossible, it can be done by the father or another loved one. You can try skin-to-skin contact later, once you are able to do so.

Depending on where you gave birth, you will be transferred to the postpartum unit where you can bathe, learn to care for your baby, and rest. The team will examine your baby more thoroughly, take their measurements, and give them medication.

Things to keep in mind

• Childbirth is divided into 4 stages.
• The length of each stage varies from woman to woman.
• Your support person and the medical team will be with you throughout the delivery for support and assistance.

Scientific review: Amélie Guay, M.Sc., PNC(C), perinatal advanced practice clinical nurse, CHUM Research and copywriting:The Naître et grandir team Updated: January 2021

Photo: Shutterstock/Tyler Olson