Stages of labor: Baby, it's time!

Labor is a natural process. Here's what to expect during the three stages of labor — and how to promote comfort as labor progresses.

Every woman's labor is unique, even from one pregnancy to the next. In some cases, labor is over in a matter of hours — or less. In other cases, labor tests a mother's physical and emotional stamina.

When everything goes smoothly, the stages of labor unfold in three distinct parts.

Stage 1: Early labor, active labor and transition

The first stage of labor occurs when the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. This is the longest stage of labor. It's actually divided into three phases of its own — early labor, active labor and transition.

Early labor
During early labor, your cervix will dilate from 0 centimeters to about 3 centimeters. You may feel mild to moderately strong contractions during early labor. They may last 30 to 60 seconds and come every five to 20 minutes.

You may notice a thick, stringy, blood-tinged discharge from your vagina as the cervix begins to open. This is known as a bloody show. You may also experience a backache, upset stomach and, possibly, diarrhea. Some women report a sensation of warmth in the abdomen as labor begins.

How long it lasts: You may need to be patient. Early labor is unpredictable. It may last for hours or even days, especially for first-time moms. It's often much shorter for subsequent deliveries.

What you can do: Until your contractions increase in frequency and intensity, it's up to you. For many women, early labor isn't particularly uncomfortable. The biggest problem may be anxiety as you anticipate active labor. Choose comfortable activities that help distract you from the contractions. You may feel like doing household chores, taking a walk or watching a movie. Or you might simply continue your daily activities.

It may also help to:

Take a shower or bath.
Listen to relaxing music.
Have a gentle massage.
Try slow, deep breathing.
Change positions.
Drink water, juice or other clear liquids.
Eat light, healthy snacks. Avoid greasy foods, which can cause nausea.
Apply ice packs or heat to your lower back.

Active labor
Now it's time for the real work to begin. During active labor, your cervix will dilate to nearly 7 centimeters. Your contractions will become stronger and progressively longer. They may last 45 seconds to a minute or longer. They may be two to four minutes apart, leaving you less time to rest. You may feel increasing pressure in your back as well. If you haven't headed to your labor and delivery facility yet, now's the time.

Your initial excitement may wane as your labor progresses and the pain intensifies. Many women request pain medication during active labor. Don't feel like you're giving up if you ask for relief. Your health care team will help you make the best choice for you and your baby. Remember, you're the only one who can judge your need for relief.

How long it lasts: On average, active labor lasts between three and eight hours. For some women it's a lot shorter — especially those who've had a previous vaginal delivery.

What you can do: Look to your labor coach and health care team for encouragement and support. Try breathing and relaxation techniques to combat your growing discomfort. Use what you learned in childbirth class or ask your health care team for suggestions.

It may also help to:

Rock in a rocking chair.
Roll on a birthing ball.
Take a warm shower or bath.
Change positions.
Take a walk, stopping to breathe through contractions.

When trying a new position or activity, try it for at least three contractions. It might take that long for your baby and body to settle into it. Vary the comfort measures often as your labor progresses.

Transition
The last phase of the first stage of labor — when your cervix dilates from 7 centimeters to 10 centimeters — is called transition. It's often the shortest but most difficult phase of labor.

During transition, your contractions will increase in strength and frequency. You may have time for only a hurried breath between contractions. Your contractions may reach peak intensity almost immediately and last up to 90 seconds. It may feel as though the contractions never completely disappear. You may also feel plenty of pressure in your lower back and rectum. You may feel hot and sweaty one minute, cold and chilled the next.

If you haven't opted for pain relief yet, you may do so now. You still have safe options as delivery approaches — even if you had planned an unmedicated birth. At any point in labor, trust your health care team to help you decide which methods of pain relief are best.

How long it lasts: On average, transition lasts between 15 minutes and three hours. It's more likely to be quick if you've already had a vaginal delivery.

What you can do: Concentrate on getting through one contraction at a time. You may not want anything to distract you at this point, such as the radio, television or conversation in the room.

It may also help to:

Change positions.
Place a cool, damp cloth on your forehead.
Have a massage between contractions.

If you feel the urge to push, try to hold back until you've been told you're fully dilated and it's time to push. It may help to pant or blow. Pushing too soon may cause your cervix to tear or swell, which can delay delivery or cause troublesome bleeding.

Stage 2: The birth of your baby

It's time! You'll deliver your baby during the second stage of labor.

How long it lasts: It can take from a few minutes up to several hours or more to push your baby into the world. It often takes longer for first-time moms and women who've had an epidural.

What you can do: Push! You may be encouraged to push with each contraction to speed the process. Or you might take it more slowly, letting nature do the work until you feel the urge to push.

Many women choose to push while lying in a birthing bed. Squatting or sitting works well for others. Some women prefer to get on their hands and knees or kneel while a labor coach supports their upper body. Try different positions until you find one that feels best. When you push, don't hold tension in your face. Bear down and concentrate on pushing where it counts.

At some point, you may be asked to push more gently — or not at all. Slowing down gives your vaginal area time to stretch rather than tear. To stay motivated, you may be able to feel the baby's head between your legs or see it in a mirror.

After your baby's head is delivered, his or her airway will be cleared and your health care provider will make sure the umbilical cord is free. The rest of your baby's body will follow shortly.

Stage 3: Delivery of the placenta

After your baby is born, you'll likely feel a great sense of relief. You may hold the baby in your arms or on your abdomen. Cherish the moment. But a lot is still happening. During the third stage of labor, your health care provider must deliver the placenta and make sure your bleeding is under control.

How long it lasts: The placenta is typically delivered in about five to 10 minutes. In some cases, it may take up to 30 minutes.

What you can do: Relax! By now your focus has shifted to your baby. You may be oblivious to what's going on around you. You may even want to breast-feed your baby.

You'll continue to have mild contractions. Your health care provider may massage your lower abdomen to encourage your uterus to contract and expel the placenta. You may be asked to push one more time to deliver the placenta, which usually comes out with a small gush of blood.

Your health care provider will examine the placenta to make sure it's intact. Any remaining fragments must be removed from the uterus to prevent bleeding and infection. If you're interested, ask to see the placenta.

Your health care provider will also determine whether you need stitches or other repair work. If you do, you'll receive an injection of local anesthetic in the area to be stitched if it's not numb already. You may also be given medication to encourage uterine contractions and minimize bleeding.