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Stages of Childbirth

Osher Ben Or, Certified Midwife
5 September 2024

When you are pregnant, it is only natural if you want to know how long the birth will take, its course and how you will feel during the process. The truth is, however, that there is no way of knowing and childbirth can be an unexpected event. The good news is that it is possible to explain what you can expect in all stages of labor: the latent phase, which can last several days, before active labor begins, during labor itself and in the stage following delivery of the placenta. Knowing and understanding the stages can help you arrive at the delivery room a little calmer, more confident and with a better understanding of the stages of labor, and will help you decide when to go to the hospital before the birth.

Before childbirth, you are in a passive state known as the latent stage. In this stage, you will experience irregular contractions (brief, intermittent and irregular contractions) and the start of cervical effacement: the body prepares itself for childbirth, the cervix softens and possibly drops the mucous plug. The latent stage lasts until dilation of 2-3 cm is achieved. Once the opening expands, active labor begins.

Active labor has 4 stages:

  • The first stage: once the latent stage ends, and regular, frequent and painful contractions begin (3 contractions in 10 minutes), active labor begins. This stage lasts until the cervix is fully effaced and dilated, approximately 10 cm.
  • The second stage: the baby’s head drops and pushing begins, followed by the birth of the baby. This stage lasts from full dilation until birth of the baby (congratulations!).
  • The third stage: after the baby’s birth and until the delivery of the placenta and its membranes. In this stage, the midwife or the partner cuts the umbilical cord.
  • The fourth stage: following delivery of the placenta and up to two hours following the childbirth you begin the recovery stage and bonding with your newborn. In this stage, you will still be in the delivery room under the observation of the midwife, who will monitor blood pressure and uterine height, quantity of vaginal blood and urination. The midwife will encourage parents to bond with the newborn, for example by skin-to-skin contact.

If everything is normal, after approximately two hours of observation and recovery in the delivery room, the midwife will make sure to transfer you and the newborn to the department.

If you are pregnant and your due date is approaching, it is likely that you, as any woman about to give birth, want to know how long the birth will take. The truth is, however, that there is no way of knowing and therefore there is no definitive answer. The good news is that an explanation is available about what you can expect during labor itself, stage by stage. If you know what is about to happen in each stage, it may make you slightly calmer. Before we explain all stages of active labor, it is important to understand what is the latent stage.

The latent (passive) stage

This stage, which occurs before the delivery, is one in which the body prepares for the birth. The latent stage begins with the onset of contractions, and lasts until the cervix is approximately 3-6 cm dilated and with no significant dilation of the cervix. Contractions in this stage are irregular: they may occur regularly or irregularly, at longer or shorter intervals. Simultaneous with the contractions, the cervix softens and the mucous plug may drop. The latent stage lasts until dilation of 2-3 cm is achieved. Once the opening expands, active labor begins.

This stage may last several hours to several days, or even weeks before active labor begins.

When your contractions are regular, with fixed intervals of time - that is, for one hour to two hours, you have contractions every 5 minutes - it is time to get ready to leave home and go to the Obstetrics ER. When you arrive, you may discover that labor is far from starting but in any case, you should check. If, in this stage, the water breaks - you must immediately go to the Obstetrics ER.

Several physiological aspects in this stage will affect your physical sensations: contractions of varying intensity and regularity, irregular uterine contractions, fetal head descent into the pelvic area that is occasionally experienced as pressure being exerted on the vaginal area, cervical ripening, slow cervical dilation, beginning of cervical effacement (shortening), change in cervical position: shifting from a posterior position to a central and later to an anterior position. There may also be a viscous bloody secretion (mucus plug) from the vagina.

The more intense and regular the contractions become, the greater are the discomfort and pain.

To make things easier for you, you should keep active. Try to change positions, rely on pleasant water (shower or bath), use TENS machine (which can be rented). Massage and acupuncture, breathing and relaxation techniques can also help. In the delivery room, you can request laughing gas, and as labor progresses, and if you want, you can request epidural. Other options are available today to alleviate pain, such as alternative medicines, which are offered in some hospitals in Israel.

Active labor

Labor is divided into stages, each of which lasts for a specific period of time (see information about the stages below). One of the concerns of any mother-to-be pertains to the amount of time that labor will last. It is important that you know that this may differ from one woman to another, but the first childbirth typically lasts much longer than later births. All stages occur in all births. It is important to know that if a problem occurs in any of the stages of labor, the entire birth can change its course.

Cervix and contractions: during pregnancy, if the course of pregnancy is normal, the cervix is long and closed, protecting the uterine contents from the outside world. Contractions during childbirth cause changes in the cervix, as the cervix becomes shorter and opens, until it completely disappears, subsequently allowing the fetus to exit through the vagina into the world.

  • Uterine contractions, intensity and frequency of the contractions (measured by the number of contractions occurring in a ten-minute period) and the duration of every contraction.
  • Fetal characteristics (fetal size, presentation, position, and more).
  • Pelvic anatomy (of the mother).

  • Cervical effacement: a process measured in percentages, with the cervix shortening, possibly to the extent of being 100% effaced and paper-thin.
  • Cervical dilation: a process is measured in centimeters. When the cervix is no longer felt around the fetal head, the opening of the cervix to 10 cm is what is referred to as "fully dilated" or "completely dilated".
  • Change in cervical texture: the cervical texture softens as labor progresses, shifting from hard to soft.
  • Changes in cervical position: the cervix, which is initially posterior, as labor progresses, moves to the center and then the front. If this is the first childbirth of the mother-to-be, effacement occurs before cervical dilation. If the mother-to-be has delivered at least one child, the cervical effacement and dilation occur at the same time, with the dilation occasionally progressing faster than the cervical effacement.

The four stages of active labor

  • From the onset of contractions until the cervix is fully effaced and dilated
  • From full dilation until birth of the baby
  • After the baby’s birth and until the delivery of the placenta
  • Up to two hours following the delivery of the placenta

The first stage of labor is largely the longest of all stages of labor, primarily in women who deliver their first child, and it begins with intermittent tightening of the stomach you may experience. It is similar to menstrual cramps, or a lower back ache. Initially, contractions are not regular but occur intermittently, later becoming regular. At the start of the stage, contractions are irregular and as the stage progresses, become regular and stronger.

For more information about the onset of labor

Once the cervix dilates to 3-4 cm, the active stage of labor begins. In this stage, labor progresses more rapidly until the cervix is fully dilated and effaced.

Sensations during the active stage

Common physiological aspects of this stage may affect how you feel one or more of the following symptoms: regular and intensifying uterine contractions, strong pain, fetal head descent into the pelvis, increasing cervical dilation, tension of the amniotic membranes with the possibility of membrane rupture, cervical effacement until fully effacement, increased bloody vaginal discharges, increased sensation of pressure and fullness, nausea and leg cramps.

Coping with the active stage

Moving in general, and particularly in water, such as in a bath or shower (pool when available), massage, changing positions, guided imagination, use of laughing gas (Nitrous oxide), use of TENS machine and epidural. Alternative medicine can also help, particularly acupuncture, shiatsu, and so on. Before the end of the active stage and before you are fully dilated, there is a transition period in which the cervix is dilated at approximately 8 cm.

The transition stage

While for some women this stage can be imperceptible and quick, for others, the transition is a difficult, painful, occasionally long and discouraging stage. In this stage, the entire body prepares for the pushing that will ultimately result in the birth of the baby.

In this stage, contractions occur more frequently and become longer and more painful. The pressure you will feel in this stage in the lower back and rectum is due to the baby’s head descending into the birth canal, causing the sensation of pressure in these areas.

You may feel the need to push to deliver but the cervix has not yet fully dilated ahead of the birth. Pushing too early can cause you to unnecessarily tire as well as result in cervical edema.

Other physiological phenomenon you may experience in this stage include nausea and vomiting, shaking throughout the body.

Once the first stage of labor has ended, and once the cervix has dilated to 10 cm, the second stage of labor begins. This stage involves the descending of the baby’s head, pushing and eventually the birth of the baby. Many women want to know how long the pushing lasts. As we stated in the beginning, there is no way of knowing. The pushing may be brief or may take a long time. You should try to remain calm and patient so that you can focus on breathing deeply between contractions.

In this stage, the midwife will assess the height of the fetal head and will adjust it to a position in which the contractions can help the head descend into the birth canal. The sense of pressure will largely occur when the head presses on the vaginal opening. Your midwife will instruct you when to begin pushing.

You should know that contractions differ than those in the first stage. They are generally characterized by a sense of pressure on the pelvic floor muscles. This feeling of pressure occasionally begins even before the cervix has fully dilated, and the farther the head descends, the greater is the feeling of pressure. The midwife will help you cope with this stage and will instruct you when and how to push. The second stage ends with the birth of the child.

Recommended positions for the pushing stage

There are many different positions for childbirth in general, and particularly for the pushing stage. The position obviously depends on what you want and your ability to be in that position. You can try to determine what position is most comfortable. You can also consult the midwife based on her experience and your personal condition. If you receive epidural, you can largely push while lying on your side or on your back, but some women can remain active in this stage and successfully give birth in other positions. You should try other positions until you find the most comfortable one for you to push: semi-sitting position, kneeling, leaning forward. At this stage it is very important that you be alert and attentive to the feeling of pressure and the guidance of the midwife. Just before the baby’s head comes out, the midwife will ask you to stop pushing to regulate the birth.

Auxiliary devices for the pushing stage

The delivery rooms in medical centers across the country offer various accessories for the pushing stage, such as poles that you can grab, pull handles, a large mirror that can assist you while pushing, if you do not really feel the sense of pushing, and more. When you arrive in the ER or in the delivery room and meet the midwife, you can learn about your options. You can ask questions about these options in the prenatal tour or during a preliminary visit to the hospital.

You should know: studies did not find that standing or sitting positions, in comparison with lying down, significantly reduce the rate of instrumental births (vacuum-assisted births) or the duration of the second stage. In contrast, standing and sitting positions were found effective in reducing perineal tears.

Factors affecting the manner and rate of progress of childbirth

  • The number of births: the rate of progress of birth in women with repeated births will usually be faster than in women who give birth for the first time.
  • BMI: the higher the BMI of the mother-to-be (overweight), the greater are the chances of a longer delivery.
  • Fetal head position: the optimal position for childbirth is known as Occiput Anterior - when the head of the fetus is maximally tucked towards the chest face down (in relation to the mother lying on her back on a delivery room bed).
    Other presentations and positions can result in a longer birth, such as facial presentation or head position known as Persistent Occiput Posterior, which indicates that the fetus is face up (relative to the mother lying on her back on a delivery room bed).
  • Epidural: studies have found that epidural extends the first stage of labor, though not significantly. In contrast, there is no question that it prolongs the second stage of labor.

Once the baby has been born, you will feel a lowered intensity of contractions. The midwife will place the newborn on your stomach and then cut the umbilical cord, or if you prefer, you partner will cut the cord. After several minutes, the contractions will increase and cause the placenta to detach and eject into the uterus. You will then push and deliver the placenta.

This stage of labor is brief and largely takes 30 minutes from the end of the second stage (childbirth). The concern in a prolonged third stage is increased postpartum bleeding. To minimize the risk of bleeding and to encourage a quick separation of the placenta from the uterine wall, you will, at the end of the second stage, receive an injection of Pitocin (a substance that contracts the uterus and quickens the birth) intravenously or into the muscle. If the placenta does not spontaneously separate from the uterus after 30 minutes, the delivery room staff will hold a consultation to consider having a physician manually separate the placenta. Following the delivery of the placenta, the midwife will check to see if the placenta is intact on both sides: the maternal side and the placental side, the membranes as well as the number of blood vessels in the umbilical cord - one vein and two arteries.

This stage of childbirth refers to the first two hours after the placental delivery. Immediately after the placental delivery and the end of the painful stage of labor, you will begin your recovery and bonding with the newborn. In this stage, you are still in the delivery room under the observation of the midwife, who will monitor blood pressure and uterine height, quantity of vaginal blood and urination.

In this stage, the midwife will encourage bonding between you and the newborn and the newborn with the other mother or father, if any. The midwife will instruct you how to rest the newborn on the body in the skin-to-skin method and will help with breastfeeding, if you want help. After approximately two hours of observation and recovery in the delivery room, and provided that everything is normal, the midwife will transfer you and the newborn to the department, according to the rooming-in method you chose.

More on Rooming-In Options

Tips from an experienced midwife

  • Remember that all the information provided here is solely based on numerical and research data and that there are considerable differences between different women, and between different childbirths. Some women will give birth quickly in their first childbirth and for some, the second birth will take longer than expected. There is no way of knowing in advance how the birth will go. Therefore, on this exciting day, try to think positively and trust the professionals caring for you, but also take into account that things may not go exactly as planned.
  • Delays at different stages can be caused by various problems, such as ineffective contractions, a large fetus, a small pelvis, the head of the fetus descending into the birth canal in a less than optimal way, and so on. This is why it is important that you know what to expect in each stage and understand how important it is to diagnose and treat any problem that occurs during childbirth, and sometimes even consider a change in the delivery method.
  • The most important thing is not the childbirth method or the duration of labor, but only the health of the mother and the newborn. Flexible thinking and the understanding that changes may occur help us accept them and can make the birth experience better for you.

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