The first stage of labor is the preparation phase. For months, your body has been working to keep the baby in. And now it's time for your baby to come out. Your body does this through contractions. Contractions help dilate (open) and efface (thin) the cervix, which is what connects your uterus to your vagina (birth canal). What happens during the first stage of labor?

The first stage of labor is distinguished by how dilated the cervix is and the characteristics of the contractions. Within this first stage, there are three phases: early, active and transition. If it’s your first-time giving birth, the first stage of labor may take several days to complete:

• Early phase: Up to 24-48 hours
• Active phase: Up to about eight hours
• Transition phase: Up to about three hours

Early (latent) phase

In the latent phase, contractions start out mild and irregular, typically lasting for less than a minute. They’ll gradually become stronger and more frequent as your cervix dilates. During this phase, you may notice thick pink or red vaginal discharge – this is the mucus plug that helped keep bacteria from passing through the cervix during pregnancy.

Active phase

Once your contractions last for around a minute and have been occurring at least every 5 minutes for an hour (or 7 minutes if it’s not your first baby), you may have reached active labor. This is when it’s time to call your provider or hospital, as you have been instructed. Other signs that it’s time to go to the hospital include:

• Your water breaks. This can feel like a sudden gush or a slow trickle from your vagina. It’s possible for your water to break before you reach active labor – call your care provider if it does.
• Intense contractions that you can’t walk or talk through.
• Bloody discharge that’s more watery than the mucus plug.

During active labor, you may also experience:

• Nausea or vomiting
• Leg cramps
• Pain and pressure in your lower back

Transition phase

The end of active labor is sometimes referred to as the transition to the second stage of labor. It’s when the cervix completely dilates to a full 10 centimeters and is the shortest – but considered the hardest – part of labor. If this is your first-time giving birth, transition may take up to a few hours, or it may progress quickly. Contractions will be the longest, strongest and most frequent so far.

During the transition phase, you may also feel:

• Pressure in the lower back and rectum
• An urge to push (tell your care provider if you do, as they’ll want to make sure you’re fully dilated first)

Inducing labor

There are some cases where labor has to be started manually (induced). Labor induction may be recommended for reasons such as:

• Labor hasn’t started naturally around two weeks after the due date.
• Your water has broken but the contractions haven’t started for several hours.
• There’s not enough amniotic fluid.
• You have an infection or other pregnancy complication.

Pain relief

If you choose to labor at a hospital or hospital-based birth center, you’ll likely have some flexibility around pain management once you reach active labor. If you’ve been unsure whether to try for an unmedicated birth or use an epidural, this may be when you make your final decision – only you will know how much pain relief you need.

Unmedicated methods like hydrotherapy and massage may work great for you, or you may choose medication like an epidural to provide a strong numbing sensation. Generally, you can expect to have a few different options for managing labor and delivery pains, but it can be helpful to research them ahead of time as you write your birth plan.

The second stage of labor

The second stage of labor begins once your cervix is fully dilated, and ends when your baby is born. It may take anywhere from a few minutes to a few hours. It’s possible that this stage could take longer if you find it harder to push from the numbness of an epidural, or if it’s your first-time giving birth.

What happens during the second stage of labor?

The second stage of labor is all about pushing. Your doctor or midwife will guide you through how and when to push – you may be instructed to push when you feel the urge, or when you’re having a contraction. Contractions could remain as intense as they were at the end of stage one, but they may be a little less frequent.

The third stage of labor

Once your baby has been born, you’re in the third stage of labor. This stage is considered complete once the placenta has been delivered, which generally happens within 30 minutes of childbirth.

What happens during the third stage of labor?

You’ll continue to have contractions, but they’ll be milder. These contractions will move the placenta out of your uterus, and over the next few days, help your uterus return to its normal size. If necessary, your care provider will remove any remaining tissue from your uterus.

The first hours of recovery

It’s finally time to meet, hold and celebrate your baby! Most babies are ready to breastfeed shortly after birth. Breastfeeding releases the hormone oxytocin, which encourages helpful, mild “post-birth” contractions and reduces bleeding. If your baby’s ready and you’re having trouble getting started, you can ask for help from a nurse or breastfeeding consultant. And if you or your baby don’t want to breastfeed, you’ll still get to hold them skin-to-skin to begin bonding unless your baby needs medical attention.

These first hours after birth mark the start of your recovery and are sometimes referred to as the fourth stage of labor. During the rest of your hospital stay, your care team will monitor your blood pressure and other vital signs, and make sure you aren’t bleeding too much. They may also give you a shot of oxytocin and abdominal massages to promote contractions and control bleeding. You may find that you get chills or shakes during this stage, so ask for a blanket if you need one. If you had an epidural, the tube will be removed from your back, and if you had any small tears during delivery, you’ll be given local anesthetic and stitches.

And before you go home, you’ll receive plenty of tips for continuing your postpartum recovery and information about what to expect now that you’ve given birth.

What to know about the possibility of a C-section

Not every parent goes through all the stages of labor and delivery as they’re described above. A cesarean delivery (C-section), which involves surgically delivering a baby through the abdomen, isn’t something many people think about as they approach their due date, unless it’s planned. However, C-sections account for up to 20-35% of births in the United States.

The most important thing to know is that a C-section is only recommended when it’s the best choice for you and your baby. One may be scheduled in advance if there’s a clear medical reason for doing so, but often the need for a C-section doesn’t arise until closer to, or during, labor. For example, one of the most common reasons for an unplanned C-section is stalled labor, in which the cervix stops opening despite continued contractions.

Start preparing for labor and delivery

Everybody’s big day is different. But if you’re reading this, you’re already doing two of the best things you can to get ready: learning and planning. In addition to becoming familiar with the process of giving birth, here are a few other tips:

• Take a class: Childbirth classes can teach you everything from tools for staying relaxed during labor to what to expect from different forms of pain relief, and more.
• Prepare a birth plan: Writing a birth plan to give to your care team will help them support your labor, delivery and postpartum care according to your preferences.
• Strengthen your pelvic floor: Your pelvic floor muscles are going to go through a lot during labor. Practicing Kegels (flexing the muscles that stop urination) and other exercises can help reduce your risk of pelvic floor dysfunction after birth.

Finally, talk with your care provider. Whether you’re working with a doula or a midwife, they’ll be able to answer questions and walk you through anything you might be unsure about. Take advantage of their expertise – they want to help.