Labour: The three stages

This article describes the three stages of labour in pregnancy . Labour has been divided into 3 different stages, although in reality they merge seamlessly together. It is helpful to have an understanding of the changes that are taking place for you and your baby, during the normal progress of labour.

Below is a brief summary of each stage, followed by a more in-depth description of what you may experience.

Check out our 52 Weeks of Pregnancy series now, to get expert weekly pregnancy advice from professional midwives, to help guide you on your pregnancy journey.

Overview of the three stages of labour

The first stage of labour

The first stage of labour is the dilatation of the cervix. The cervix is the neck of the womb (or uterus) which opens into the vagina. This is closed throughout and at the end of pregnancy, but needs to open to allow the baby to pass through into the vagina in order to be born.

Stage 1 of labour, commonly called “early labour”, begins when the woman experiences regular, rhythmic contractions and it is complete when the cervix has fully opened to around 10 cm dilated.

The second stage of labour

The second stage of labour begins when the cervix is fully dilated and is complete when the baby has been born. During this time the woman will add her effort of pushing and bearing down to the expulsive contractions to birth the baby.

The third stage of labour

The third stage of labor begins directly after the birth of the baby and involves the separation and the delivery of the placenta and membranes (the afterbirth). The third stage of labour is complete when the mother has successfully passed the placenta and membranes.

The first stage – onset of labour

This usually occurs between week 37 – 42 of pregnancy (since the last menstrual period). It is not known what exactly causes the onset of labour – it is thought to be a combination of:

• hormonal factors such as the increase in prostaglandins and oxytocin
• mechanical factors such as the pressure applied on the cervix by the baby’s head low in the mother’s pelvis.

In stage one, the woman will experience a variety of signs, such as irregular abdominal pains or the passing of the ‘show’ (or mucus plug)  as the cervix starts to stretch. For more information read our article on How do I know I am in labour)

So what does the first stage of labour feel like for the mother and for the baby – and how can we help?

If this is your first baby, then your cervix will be completely closed at the end of pregnancy and it will also be 2 – 3 cms long. Before the cervix can open it needs to flatten and this process is known as effacement. Once the cervix has flattened then it can begin to dilate or open.

The effacement (flattening) of the cervix may take place over several hours or days – the cervix softens as a response to hormonal changes and mild irregular contractions.

Once the cervix is ready to open the contractions become regular and more painful – this is known as ‘established labour’. Initially the contractions may be every 10 minutes or so, lasting 30 seconds; they will become stronger and eventually they will come every 2 – 3 minutes, lasting for up to 60 seconds. Meanwhile your cervix will be stretching and opening and the baby’s head will be moving lower down in your pelvis.

This stage will usually last anything between 6 – 12 hours if it is your first baby. If you have birthed a baby before then your cervix will efface and dilate (open and flatten) simultaneously – and your labour will usually be shorter. Your muscles have stretched in this way before and this usually speeds up the whole labour and birth.

During the first stage of labour women experience regular pains and this is extremely tiring. She will need great support to help her through this time, which can be frightening and overwhelming. As well as having family/ whanau present, in New Zealand many women have an LMC who support them throughout labour and all women will be supported by a health professional in labour.

(Read Choosing an LMC for more information on the types of maternity care available in New Zealand.)

The baby also has to work hard and they are squeezed and pushed down during contractions. Also at this time their blood supply from mum, via the placenta, is reduced due to the contractions of the womb every few minutes. Babies born at ‘term’ have had many weeks to prepare for this and have laid down fat stores to help them through this time; also the midwife or doctor will be monitoring baby’s well-being during labour, by listening to their heart rate continuously or intermittently to ensure they are coping well with the contractions!

The second stage of labour

Your experience of labour will begin to change – the contractions may space out to every 5 minutes for a while, you may get an overwhelming feeling that you ‘don’t want to do this anymore’, that you are unable to cope. Increasingly when you have a contraction you will be feeling pressure in your back passage as the baby moves down your vagina and presses against your rectum – giving you the sensation that you need to move your bowels. Many women worry about this, but usually nature dealt with this when you went to the toilet many hours earlier! This is baby’s head moving down and the pressure becomes overwhelming, until you begin to push down when you have a contraction.

Your midwife or doctor will be able to confirm that you have moved into the second stage of labour by doing an internal vaginal examination to check whether your cervix has completely opened. They may also advise you on how to push effectively to aid the birth of your baby – or simply support you and encourage you if all is going well. Again the midwife / doctor will also be ensuring that baby is coping well by continuing to check baby’s heart rate every few minutes.

If this is your first baby you may push for about 1 hour, with your subsequent births (if any) being usually a lot less than this. As the baby’s head stretches the vaginal opening there is a strong burning feeling – your midwife will coach you through these last few minutes, encouraging you to pant / blow to prevent tearing of the skin and muscles and allow a calm gentle birth of your baby’s head.

Once baby’s head is born, the midwife feels around baby’s neck, in case the cord has looped around baby’s neck. (If so, she will slip the cord back over baby’s head before the body is born.) After a minute or two the baby turns around inside you to allow the shoulders and body to be born, and then one last push from mum enables baby to be born.

The third stage of labour

Baby is safely in mum’s arms, everyone is delighted with the new arrival! But for mother and her health professionals there is still the very important task of delivering the placenta and membranes that have nourished and protected the baby. This can happen in 2 ways:-

Physiological third stage of labour

The mother maintains an upright position, feeds her baby and waits until she feels further contractions and an urge to push (this usually takes 15 – 45 minutes). The placenta and membranes are then delivered by mum’s effort.

Active management of the third stage of labour

The mother is given an injection of syntometrine or syntocinon, at the time of the baby’s birth. It can be given into the leg muscles or into an intravenous luer if you have one in your hand/arm. This contains synthetic hormones that cause the womb to contract strongly, to aid separation of the placenta from the wall of the womb.

The midwife or doctor will clamp and cut the umbilical cord, then grasp the cord that is still attached to mum and gently pull the placenta and membranes out. This usually takes around 5 minutes. The placenta and membranes are soft, therefore this stage of labour is not usually painful, although mum is feeling tender and very tired, following the birth.

The placenta and membranes are checked by the midwife, to ensure they have been completely passed and then the family/ whanau can then choose to take them home or leave them to be disposed of at the hospital.

When labour and birth are complete:-

• The midwife or doctor will check your vagina and perineum (the muscles between the vagina and the back passage) to see whether you need any stitches – if you do these will be done as soon as possible, to prevent swelling.
• You will be encouraged to feed your baby as soon as possible; your baby will also be checked head to toe to ensure that everything appears normal and healthy, and your baby will be weighed.
• You will also be encouraged to have some refreshments and helped to the shower.
• The midwife will check that you are recovering well and that your blood loss is normal.

Finally now mother, baby and all the family can have a well deserved rest together.

Check out our 52 Weeks of Pregnancy series now, to get expert weekly pregnancy advice from professional midwives, to help guide you on your pregnancy journey.