There are four stages of labor during vaginal birth. Not all will be readily apparent to you during labor but your clinician might use these descriptions to explain what is happening.
The first stage
The first stage starts with the onset of labor and ends with the fully dilated cervix. It is divided into two phases, latent and active. The latent phase consists of early cervical dilation (widening of the cervical opening) and effacement (shortening of cervical length) that takes place at a slow rate until the cervix is 3-4 centimeters wide. During the active phase, cervical dilation continues at a faster rate until the cervix is fully dilated (10 cm). Duration of the first stage of labor is highly variable. Generally, first time mothers can expect it to last 6-18 hours, while those with prior deliveries should expect 2-10 hours in the first stage.
As long as you and the baby are physically stable during the first stage, you will be allowed to walk around, shower, use tubs if available, sit, rock, and have sips of clear fluids, ice and popsicles. You may have either an IV or an IV access plug (heplock) for IV medications. This is a precaution/safety net in case of a medical emergency, but also is helpful in giving pain medications and extra fluids. Your pulse, blood pressure, temperature, respiratory rate and the baby’s heart sounds will be monitored periodically to make sure things are going well. Examination of the cervix will be periodic according to how labor progresses.
The second stage
This stage begins when the cervix is fully dilated and you feel the urge to push. Each contraction moves the baby’s head, and body as it bends and flexes to get through the birth canal. Sometimes the baby even needs to rotate from back to front to achieve a headfirst, face down position. For first time mothers, this stage can last from 30 minutes to three hours, while for those with previous deliveries it may take only 5-30 minutes.
During this stage you will be pushing with each contraction. The baby’s heart rate will be monitored to make sure there is no distress during contractions. Crowning means that the baby’s head has begun to emerge from the birth canal. When necessary, an episiotomy (surgical incision to widen the vaginal opening) may be performed to allow extra space for the head to pass through the perineum (area between the rectum and vagina). After the head is delivered the baby’s nose and mouth will be suctioned to remove any fluid and mucus. The mucus protected the baby while it was surrounded in amniotic fluid. A check is done to make sure that the baby’s neck is clear of the umbilical cord.
Shortly thereafter the rest of the baby will be delivered and the cord will be cut ending the second stage of labor.
The third stage
The third stage involves delivery of the placenta. After the baby emerges, you will be examined for any tears that need to be repaired; local anesthetic will be used to numb the area. Within 5-10 minutes the placenta starts to separate and will be delivered by gentle pulling of the umbilical cord and pressing down on the uterus. You will feel contractions as the uterus clamps down to stop the bleeding.
The fourth stage
This stage lasts for one hour following delivery of the placenta. As the uterus contracts to begin returning to its normal size, there will be bleeding. During this stage you will be closely monitored to assure your recovery from delivery. Your pulse and blood pressure, uterine size and tone, and bleeding will be checked closely for 6-10 hours after delivery.