The idea of childbirth and labor is intimidating for most of us. And a part of that may just be that a lot of us only concept of birth is from TV and movies. Contrary to what we see on TV, it’s not just a bunch of rapid breathing and five minutes of pushing. There are stages of labor, and each one is unique in its role in getting your baby ready to leave their first home.
In “Overdue,” our maternal health series made in partnership with Un-ruly and Gerber, doula and registered nurse Ebony Harvey gives an overview of what to expect when labor comes, from the very beginning all the way to when you get to finally cradle your newborn.
Let’s talk more about what labor looks and feels like. Keep reading to learn more, or click on a link in the table of contents to jump to a specific section.
Table of contents
- Why You Should Understand the Stages of Labor
- Signs Your Body Is Getting Ready for Labor
- Signs You’re Dilating
- Stages of Labor: The First Stage
- Stages of Labor: Second Stage
- Stages of Labor: Third Stage
- Stages of Labor: Fourth Stage
Why You Should Understand the Stages of Labor
It’s always important to know what’s going on in your body. This is also true while you’re in labor.
When you and your support team know what’s supposed to happen in each of the stages of labor, it makes it easier for you as a Black mom-to-be or expecting parent to advocate for yourself while you’re laboring.
And when you know what is happening during labor, you’ll understand what’s actually worrisome and what’s just a natural part of your body getting ready to bring your baby home.
That piece is especially important in light of the Black maternal health crisis, says Ebony. (Right now, Black women are three times more likely to die from pregnancy and birth complications than white women, according to the CDC.)
Yet some providers and hospital systems are not supportive of what is called “physiological birth,” or letting birth happen naturally.
“This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes,” a 2013 report in the Journal of Perinatal Education states. “Some women and/or fetuses will develop complications that warrant medical attention to assure safe and healthy outcomes. However, supporting the normal physiologic processes of labor and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant.”
The case for laboring at home
Sometimes there are barriers to having a physiological birth in a hospital.
In some settings, once you’re admitted into the hospital, you’re on their schedule. You may have heard stories of people feeling rushed or pushed into an intervention they ultimately didn’t want or need because a provider told them they were laboring “too long.” (In the aforementioned 2013 Journal of Perinatal Education report, one of the “factors that disrupt normal physiological birth … [was] time constraints, including those driven by institutional policy and/or staffing.”
If Black birthing people were allowed to labor naturally, [Ebony] says, ‘We would have a lot less maternal deaths.’
But labor does take time. And unless you or your baby are in danger, medical intervention isn’t necessary to speed it along. In fact, a 2014 report in the Journal of Perinatal Education have found that these type of interventions can actually increases the risk of poor birth outcomes.
Ebony puts it bluntly. If Black birthing people were allowed to labor naturally, she says, “We would have a lot less maternal deaths.”
So you may want to consider laboring at home for as long as possible before heading into the hospital, she says. Instead of going to the hospital as soon as you feel contractions, stay at home and use comfort measures to support you through your laboring. (This is another reason why it’s important to know the stages of labor—so you can know when’s the right time to head to the hospital.)
Ebony has had clients who’ve been able to birth vaginally without interventions because they’ve labored primarily at home before heading into the hospital. Once at the hospital, they were able to deliver in two hours, she says.
“Then I’ve seen people begin in the hospital get totally coerced into the whole cascade of interventions,” she says.
When you’re laboring at home, she adds, you don’t have to worry about those potential unnecessary medical interventions or upsetting interactions that happen so often to birthing people who look like us.
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Signs Your Body Is Getting Ready for Labor
Leading up to your labor day, your body—and your baby—will be doing a number of things to get ready for the big day. Let’s take a look at a few things that can happen before true labor begins.
Braxton Hicks contractions
Now it’s important to make the distinction between labor contractions and something else you may have heard of: Braxton Hicks.
Braxton Hicks contractions may start coming earlier in the pregnancy—usually after 20 weeks—and represent your body strengthening the uterus for labor. Unlike with true contractions, your cervix does not dilate during Braxton Hicks. (So there are no signs you’re dilating to look out for.)
It can be difficult to tell Braxton Hicks contractions from true contractions, but there are differences.
Braxton Hicks start as an uncomfortable yet painless tightening of the uterine muscles. When you have them, your stomach can get very hard and pointy.
They typically don’t come in regular intervals. These contractions also go away if you change your position or eat or drink something. (When labor begins and true contractions start, they won’t go away on their own.)
Also known as the baby “dropping,” lightening is when your baby descends from above your hips to your pelvis. This can happen “anywhere from a few weeks to a few hours before labor begins,” according to the American College of Obstetricians and Gynecologists (ACOG), and marks your baby beginning their transition Earthside.
(It’s referred to as lightening “because the fetus isn’t pressing on your diaphragm, you may feel ‘lighter,'” ACOG states.)
When the baby drops, you may feel more pressure in your pelvis (leading to that well-known pregnancy waddle), and pelvic pain, too. You may also have more discharge and need to go to the bathroom more often, Healthline reports.
Losing your mucus plug
Another sign of labor can be losing your mucus plug. This is a collection of mucus, which your body forms at your cervical opening to protect your baby from infection.
When you lose your mucus plug, it literally looks like small pieces of mucus coming out of you. Losing your mucus plug isn’t a guarantee of immediate labor, though—it may happen a couple of days or even a week before labor officially begins.
This is the main difference between the bloody show and the mucus plug—losing your mucus plug can come before labor officially begins.
Signs You’re Dilating
Before we break down the stages of labor, we want to talk about something that you may have heard in other people’s birthing stories: cervical dilation.
Your cervix dilates (opens) and effaces (thins) to make way for the baby to pass. A fully dilated cervix is 10 cm wide, or the size of a bagel.
While other labor pains like contractions are easy enough to spot (and we’ll talk about them more in a bit, promise!), the signs you’re dilating may be more subtle.
One sign you’re dilating is an intense shooting pain, sometimes referred to as “lightning crotch.” This happens when the baby moves into a position that applies pressure to the cervix. This movement may also cause cramps in the stomach, lower back, or butt, similar to those experienced during menstruation but more intense. It’s important to note that these symptoms, while often associated with dilation, can occur earlier in pregnancy as well as during labor.
Another sign you’re dilating is the bloody show, a spotting that often comes with mucus. The bloody show is a result of blood vessels breaking as the cervix expands.
Finally, when dilation becomes more pronounced (between three to five centimeters), people are often unable to speak in complete sentences because the contractions are so intense. You may switch to moaning or grunting to express feeling, and that’s totally normal.
A note on cervical checks
Some providers may suggest doing what’s called a cervical check in order to measure how much you’re dilating. This is done by inserting gloved fingers into you to check the cervix. It’s also used to check the baby’s position.
If you’re planning a hospital birth and a cervical check indicates you aren’t dilated enough, your doctor may send you back home until labor becomes more active.
Cervical checks throughout the final weeks of pregnancy and in labor have been traditionally thought of as the best way for birth staff to gauge how far a labor has progressed.
“But what we’ve learned is that these signs alone are not always a good indicator of how close someone is to going into labor,” writes Dr. Stephanie McNally, an OB-GYN at Katz Institute for Women’s Health. “One patient could have a closed cervix today and deliver tomorrow, while another patient might be walking around at 3 centimeters dilated for three weeks.”
They also come with their own risks. Cervical exams can be painful due to increased sensitivity from extra blood flow. They can even reverse dilation or slow contractions if the birthing person releases stress hormones.
That’s why some doctors and patients are passing on cervical exams as a good barometer for labor management. Some people may choose to have in their birth plan that they don’t want this exam, and would instead to prefer to let their body labor as it was designed to.
It’s entirely up to you whether or not you’re ok with cervical checks. Just make sure to tell your provider your wishes.
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Stages of Labor: The First Stage
Alright, let’s get into it!
Labor officially begins when contractions become consistent, according to the Mayo Clinic.
Contractions are when your uterine muscles tighten and then relax. They’re part of your body preparing you to deliver your baby. That’s a signal you’re in the first stage of labor.
Now you may be wondering, “What do contractions feel like?”
Typically, contractions take the form of:
- an ache or discomfort in the lower back or stomach;
- pressure in the pelvis; and
- sometimes a literal pain in the butt, thighs, and sides.
Some people compare the feeling to menstrual cramps or the cramps that come with diarrhea. Contractions are one of the main signs of labor and will increase in intensity and frequency throughout the first stage of labor.
During the first stage of labor, you’re going to need emotional support—whether that comes from a partner, a doula, a medical professional, or any other helper. This first stage can be exciting but also stressful, so support is crucial.
The first stage of labor is typically the longest and can be broken into three phases: early, active, and transitional.
Early labor begins with consistent contractions that are typically mild in severity and occur at intervals of five to 30 minutes a part.
During early labor, the cervix thins and dilates, usually between zero to six centimeters.
Early labor often lasts from six to 12 hours. In some cases, it can last for a day or longer.
When early labor begins, tell your birth team. Registered nurse and doula Ebony Harvey says that it’s important to let them know a few things:
- when the contractions started,
- how long they are,
- the amount of time between your most recent contractions, and
- how they feel.
From that information, your doula, midwife, and/or doctor should be able to gauge the next steps for you to take. That could mean getting your hospital bag together and heading to the hospital, preparing for your home birth, or (more likely during early labor) getting as comfortable as possible while you wait.
It’s important to rest as much as possible during early labor, since later stages will require more energy. This is actually the stage that, if you can, is best to do at home to avoid unnecessary interventions or stress.
If you can, Ebony recommends eating and drinking water*, too. You’ll need all your energy for what’s ahead, she says.
You can also start using comfort measures like breathing techniques or rolling your hips on a birthing ball to get you through the discomfort.
* The literature on eating and drinking while laboring is varied, with some providers and organizations restricting birthing people from having anything other than clear liquid due to concerns about anesthesia and surgery. However, according to a report on unwarranted routine interventions in the Journal of Perinatal Education, these concerns are based on outdated information and largely unwarranted. Speak to your care provider to help you make your decision on whether or not you’d like to eat and drink during labor.
The second phase of the first stage of labor is called active labor. This when contractions start to become more uncomfortable, more frequent, and longer. They can last from between 45 to 60 seconds and happen three to four minutes apart.
At this point, the cervix is typically dilated to between six and eight centimeters. Active labor typically lasts for between three and five hours.
If you’re birthing at a hospital or birthing center, stay in contact with your provider and let them know how you’re doing. At this point, if you’re in active labor, your provider will probably tell you it’s time to come in to deliver your baby!
Transitional labor is the third and final phase of the first stage of pregnancy. In transitional labor, contractions last from 60 to 90 seconds and come every one to three minutes. The cervix dilates to 10 centimeters during this phase.
Transitional labor and the intense contractions that it brings are often incredibly painful. They may bring on hot flashes, or make you feel like you need to vomit or poop.
Think of [pain] as a temporary discomfort that leads to the ultimate goal: meeting your baby.
While childbirth is painful, Ebony suggests reframing the pain of labor. Think of it as a temporary discomfort that leads to the ultimate goal: meeting your baby. If you reframe the pain as a choice you’re making for your baby, it might help balance the severity of it, she says.
This will require you to really tap into your mental reserves and your birth team, but you can do it! This is what you’ve been preparing for and this is why you’ve built the birth team you built. To support you
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Stages of Labor: Second Stage
When your cervix is fully dilated, that’s a sign that you’re about to deliver! And that means the second stage of labor can start.
Now you’re ready to push the baby out—in fact, this stage is also known as the “pushing stage.”
The second stage of labor lasts from between 30 minutes to two hours and, at the end of it, your baby will be here.
If you’ve gotten an epidural, you might be numb from the injection site down and unable to know when to push. In this case, you’ll have to rely on your birth team to tell you when to push. In some cases, the doctor may have to use forceps or a vacuum to help get your baby out.
This stage is labor intensive (pun intended) and requires a lot of effort on your part. Here’s some advice on how to push during labor.
How to push during labor
To prepare for the second stage of labor, you’ll need to know the best way to push. For starters, the pushing you’ll be doing while giving birth isn’t all that different from the pushing you do when you’re having a bowel movement. It’s obviously a bit more intense, but you’ll be working a lot of the same muscles.
It helps to bring your chin down to your chest when you push, as this puts more focus on your lower body.
Steady breathing is also critical while pushing during labor. It helps to have a specific breathing pattern you stick to no matter what happens. That way, not only are you getting enough air, but you’re also focusing on something besides the intensity of the pain.
Finally, don’t waste your energy being self-conscious. This is the time to let go, says Ebony. Whether that means screaming, groaning, or making any other noise that comes naturally during the process, do it. It’s all helping you get your baby here.
You may also feel the need to fart or poop while pushing. Friend? If it happens, it happens. Childbirth isn’t always pretty (though the end results are beautiful!). Getting in your head about the way you look or sound during it may stress you out, which can stall your labor.
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Stages of Labor: Third Stage
Your baby is here, but you’re not done laboring yet! You still need to deliver your placenta.
This typically happens between 30 and 60 minutes after delivering your baby. Contractions are likely to continue during this point. They’ll be doing the work of pushing out the placenta, but they should be less severe.
The good news is that this won’t be as difficult as delivering the baby—in fact, it should just happen naturally as you relax.
However, if your placenta doesn’t deliver naturally, you may need medical intervention to expel it. This is best to avoid if possible, since the umbilical cord could break, leaving fragments of it in the body that would require surgery.
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Stages of Labor: Fourth Stage
While you may commonly hear there are only three stages of labor, Ebony includes a fourth one.
Just like the fourth trimester, the fourth stage of labor involves bonding with your baby: skin-to-skin contact, breastfeeding (if you choose to), and rest. If you had a hospital birth, you’ll likely be transferred from labor and delivery to the postpartum unit to start your healing and bonding
This is your time to rest and get to know your baby, but also to congratulate yourself. Childbirth isn’t easy, but you did it! Make sure to give yourself all the shine you deserve as you recover.
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