STAGES OF LABOR (DELIVERLY)

The process of labor and birth is divided into
three stages:

The first stage 

This begins when you start having
contractions that cause progressive changes
in your cervix and ends when your cervix is
fully dilated. This stage is divided into two
phases:

Early labor: 

Your cervix gradually effaces
(thins out) and dilates (opens).

Active labor: 

Your cervix begins to dilate
more rapidly, and contractions are longer,
stronger, and closer together. People often
refer to the last part of active labor as
transition .

The second stage 

This begins when you're fully dilated and ends with the birth of your
baby. This is sometimes referred to as the
"pushing" stage.

The third stage 

This stage begins right after the birth of
your baby and ends with the delivery of the
placenta.

Every pregnancy is different, and there's wide
variation in the length of labor. For first-time
moms, labor often takes between ten and 20
hours. For some women, though, it lasts
much longer, while for others it's over much
sooner. Labor generally progresses more
quickly for women who've already given
birth vaginally.

PHASE 1: EARLY (LATENT) LABOR
The first of the three stages of labor is
usually the longest, but (thankfully) it's
also the least intense, by far. Over a span
of time from several hours to several weeks
(often without noticeable or bothersome
contractions), or over a period of no-doubt-
about-it contractions, your cervix will dilate
(open) to 3 centimeters and efface (thin
out).
How to know you’re in early labor
You'll experience mild to moderate
contractions that last 30 to 45 seconds,
though they can be shorter, and can be
regular or irregular. They may be spaced 20
minutes apart, more or less, and become
progressively closer together, but not
necessarily in a consistent pattern (and you
may not even notice them until the final
two to six hours; if you're dilating gradually
over a period of days or weeks, you
probably won't feel them at all until labor
starts in earnest). During early labor you
also might experience any of the following
labor signs :
What you can do during early labor
You many feel excitement, relief,
anticipation, uncertainty, anxiety or even
fear. You might be relaxed and chatty or
tense and apprehensive. All of these
reactions are normal. It's important to try
to relax as much as you can during the
early phases of labor — you'll need to save
your strength for later on.
When to call your practitioner
You and your practitioner should have
discussed when to call (usually when you’re
in more active labor). However you should
definitely contact him or her right away if:

PHASE 2: ACTIVE LABOR
The active phase of labor usually lasts from
two to three and a half hours (with, again,
a wide range considered normal) as your
cervix dilates to 7 centimeters. You'll
usually be in the hospital or birthing center
by this phase (or if you're delivering at
home, your midwife should be with you by
now).
How to know you’re in active labor
Your contractions will grow more
concentrated and increasingly more intense
(in other words, painful). As they become
stronger and longer (typically lasting 40 to
60 seconds, with a distinct peak halfway
through) and more frequent (coming every
three to four minutes, though the pattern
may not be regular). You can expect to feel
all of the following (though you won’t feel
pain if you’ve had an epidural ):
What the healthcare staff will do
Assuming everything is progressing
normally and safely, the hospital staff will
leave you alone (or stay out of your way,
but in your room), checking and monitoring
you as needed, but also allowing you to
work through your labor with your coach
and other support people without
interference. You can expect them to:
What you can do during active labor
With fewer breaks in the action, there’s less
opportunity to rest between contractions.
Emotionally, you may feel restless and find
it more difficult to relax, and your
concentration may become more intense as
you become absorbed in your labor efforts.
Your confidence might waver along with
your patience, or you may feel excited and
encouraged. Whatever your feelings they’re
normal — just get ready to start getting
“active.” It’s all about your comfort now,
so:

PHASE 3: TRANSITIONAL (ADVANCED)
LABOR
During transitional labor — the last, most
intensive phases of labor — your cervix will
dilate from 7 to its final 10 centimeters.
Fortunately it’s also the shortest, generally
lasting from 15 minutes to an hour (though
it can sometimes take up to three hours).
How to know you’re in transitional labor
Suddenly, the intensity of contractions picks
up. They may become very strong and 60 to
90 seconds long, and with very intense
peaks that last for most of the contraction.
Some women, particularly those who have
given birth before, may experience multiple
peaks. Because they're spaced only about
two or three minutes apart, it may seem as
though you barely get to relax before the
next contraction begins. During transition,
unless you’re numbed by an epidural or
other pain relief, you may feel:
What you can do during transitional labor
This last of the three stages of labor is a
physically demanding and draining time.
You may feel exhausted, frustrated,
impatient, disoriented, restless or
overwhelmed. Hang in there, though —
baby’s almost here! By the end of this
phase, your cervix will be fully dilated and
it’ll be time to begin pushing baby out. Try
to focus on how far you’ve come.
When you’re a full 10 cm dilated, you’ll be
moved to the delivery room, if you aren’t
already there. Or, if you’re in a birthing bed,
the foot of the bed will simply be removed 
to prepare for delivery.

SECOND STAGE
SH
During this stage, your contractions should
be more regular than the contractions in
transitional (advanced) labor. They are still
about 60 to 90 seconds each but are
further apart (usually two to five minutes)
and possibly less intense, though
sometimes they’re more intense. You should
now notice a well-defined rest period
between them, though you may still have
trouble recognizing the onset of each
contraction.
Common in the second stage (though you’ll
definitely feel a lot less — and you may feel
nothing at all — if you’ve had an epidural ):

WHAT YOU CAN DO: PUSHING TIPS
You may now feel relieved that you can
start pushing (though it’s totally normal to
feel embarrassed, inhibited, scared or even
frustrated, if it’s taking longer than you
anticipated). It’s time to get this baby out.
To get going, you'll move into the pushing
position of your choice and, following the
instructions of your practitioner or the
hospital or birthing center staff, you'll push
at regular intervals, usually three times with
each contraction, or as you feel the urge.
You might want to rest for one contraction
if you're getting tired.
Here are some pushing tips:

WHAT YOUR MEDICAL TEAM IS DOING
While you’re pushing, the nurses and/or
practitioner will give you support and
direction while continuing to monitor baby’s
heartbeat (with a Doppler or fetal monitor).
They’ll also prepare for delivery by
spreading sterile drapes and arranging
instruments, donning surgical garments and
gloves, and sponging your perineal area
with antiseptic. If necessary — though these
procedures are performed rarely these days
— they’ll perform an episiotomy (fortunately
only in very rare instances) or use vacuum
extraction or forceps.
Once your baby's head is out:

WHAT’S NEXT FOR YOUR BABY
The nurses and/or a pediatrician will
evaluate your baby’s condition and rate it
on the Apgar scale at one and five minutes
after birth. Your baby will get a brisk
rubdown, and both you and baby will
receive an identifying band. Baby will be
weighed, have ointment placed in his or her
eyes (to prevent infection) and wrapped to
prevent heat loss. (In some hospitals and
birthing centers, some of these procedures
may be omitted; in others, many will be
attended to later, so you can have more
time to bond with your newborn.)
Then assuming all is well, you’ll get your
baby back and you may, if you wish, begin
breastfeeding (but don’t worry if you and/or
your baby don’t catch on immediately.
Later, it’s off to the nursery for baby for a
more complete pediatric exam and some
routine protective procedures (including a
heel stick , vitamin K injection and a
hepatitis B shot). Once baby’s temperature
is stable, he or she will get a first bath,
which you may be able to help give. If
you’re rooming-in, your baby will be
returned to you as soon as possible and
tucked into a bassinet next to your bed.

THIRD STAGE
This the stage of placenta delivery 

HOW THE PLACENTA IS DELIVERED
You’ll experience mild contractions that last
about a minute each (though you may not
even notice them, if you can believe it) that
will help separate the placenta from the
uterine wall and move it through the birth
canal so that you can push it out. Next,
your practitioner may:
Expect to feel hungry and thirsty (especially
if labor was long and you weren't able to
eat or drink) and a wide range of emotions
— especially relief, elation, and impatience
to get your hands on your baby. After
delivery you'll notice bloody vaginal
discharge (called lochia) that's comparable
to a heavy period, and you may experience
chills.

WHAT YOU CAN DO
Once the placenta is delivered, you'll be
free to enjoy your new baby:
Keep in mind that you may feel close to
your new baby and your partner, or you may
feel somewhat detached or even a little
resentful, particularly if your delivery was
difficult. No matter your response, you will
come to love your baby intensely. These
things just sometimes take time.

WHAT HAPPENS NEXT
All that’s left to do is for your practitioner
to stitch up any vaginal or perineal tears (if
you’re not already numbed, you’ll get a
local anesthetic) and clean you up. You’ll
likely get an ice pack to put on your
perineum to minimize swelling (ask for one
if it’s not offered).
The nurse will help you put on a maxi pad
or add some thick pads under your bottom,
since you’ll still be bleeding a bit. Once
you’re up for it, you’ll be transferred to a
postpartum room (unless you delivered in a
LDRP — a labor, delivery, recovery and
postpartum — room, in which case you’ll

get to stay put).