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Stages of Childbirth

Stages of Childbirth

Writers: Osher Ben Or, Certified Midwife
5 July 2024

The latent (passive) stage

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