Medical City Healthcare - January 17, 2018

During a typical, full-term vaginal birth, there are three stages of labor. Because every pregnancy and delivery is different, there’s no way to tell how long each stage will last. One of the most frequently asked questions by pregnant women, especially first-time moms-to-be is: How will I know when labor begins?

Look for one or more of these signs of labor:

• Hardening of the abdomen
• Feeling as if the baby has dropped (lightening)
• Mucus plug dislodging (also called the show), which may be clear or tinged with blood
• Water breaking, which means the fluid-filled amniotic sac (also called membranes) has ruptured
• Irregular contractions that become regular and more frequent and intense over time (as opposed to irregular and infrequent Braxton Hicks contractions)

“Expectant mothers should go to the hospital as soon as they begin experiencing signs of labor,” said Steven Seligman, MD, an OB/GYN specialist at Medical City Arlington. “Getting the appropriate medical attention is necessary to keep the mother and baby safe.”

Dr. Seligman said that pregnant women who are full-term (after 37 weeks) should go to the hospital if:

• They are having contractions every 5 minutes for 1 hour
• They have ruptured, leaking membranes or active vaginal bleeding

Dr. Seligman said that in addition to signs of labor, it’s also a good idea for moms-to-be to understand the stages of labor.

Stage 1 of labor:

True labor begins when regular contractions start and is considered to be the start of the first stage of labor.

Early labor:

During the first part of stage 1 labor, called early labor, the cervix will dilate (open) and efface (become softer and thinner) to allow room for the baby to move into the birth canal. Contractions may increase in intensity, coming every 5 to 20 minutes and lasting from 30 to 60 seconds. When the cervix is dilated to 3 centimeters, the next phase of stage 1 labor begins.

“Understanding the difference between early labor and active labor can be a challenge for pregnant women, especially first-time moms,” Dr. Seligman said. “That’s why it’s important to not only be educated on the different stages, but to not second-guess symptoms and seek medical attention when any new signs or symptoms happen during the pregnancy.”

Active labor:

The second part of stage 1 labor is called active labor and it will last until the cervix is fully dilated to 10 centimeters. Contractions will become stronger and more frequent and intense. The water may break if it hasn’t already and there may be pressure and pain in the back. The active labor phase is when many women ask for pain relief, such as epidural anesthesia. On average, a women’s cervix dilates at approximately one centimeter per hour, so active labor can last four to eight hours or longer.

Stage 2 of labor:

The second stage of labor begins when the cervix is fully dilated to 10 centimeters and is fully effaced. This is the stage when the baby is born!

Stage 2 is the pushing stage and can last from a few minutes to several hours or more. First time moms and women who’ve had an epidural typically spend more time in this stage. The attending healthcare provider will give instructions for when to push.

In a normal, uncomplicated birth, the baby will be head-down in the birth canal, facing backward. If the baby is in any other position, the physician may deliver the baby in that position, try to rotate the baby or perform a C-section for the safety of both mother and baby. Stage 2 is complete when the baby is delivered and the umbilical cord is cut.

“It is our hope that every mom-to-be makes it smoothly through every stage of labor for the grand finale of welcoming her newborn into the world,” said Dr. Seligman. “It’s a beautiful and rewarding experience, and those of us who take part in delivering babies enjoy sharing it with patients and families.”

Stage 3 of labor:

The hard part is over. All that remains is to deliver the placenta, an organ created by the body during pregnancy to provide nutrients to the developing baby. (Read more about the science behind body changes during pregnancy.)

Delivering the placenta should be a breeze compared to delivering the baby! Mild contractions and a single push may be all that is needed. Contractions will continue to help the uterus begin to return to its normal size, which typically takes about six weeks.

Now that you’re an expert on the stages of labor, check out our helpful tips and videos in Infant Instruction Manual: How to Swaddle a Baby and More.

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Revised 1/29/2019