Stages of labor and delivery – Pregnancy

Stages of labor and delivery

Normal delivery occurs at the end of pregnancy, between the 37th and 42nd week of pregnancy. Below you will find a description of the different stages of labor.

We also invite you to read our Childbirth: Tips for each stage of labor. You’ll find tips to help you and your partner through this experience.

Stage 1: Labor

The first stage begins when regular contractions are felt and are accompanied by dilation or effacement of the cervix. It ends when the cervix is fully open to allow the baby to come out, which is when the opening reaches 10 cm.

The length of this stage is influenced by different factors. For example, during a first birth, labor will tend to be longer than for a second birth. Also, a woman who moves around and changes position, preferring upright positions, will tend to have a shorter stage 1, as this helps the baby descend and reduces pain. Many other factors can shorten or lengthen the duration of labor, such as the weight of the baby, its position in the pelvis, the shape of the pelvis, the quality of the contractions, the use of certain medications, but also the psychological state of the mother or the preparation for the birth.

The duration of the first stage therefore varies from one woman to another. It is difficult to determine the duration of labor in advance because each woman’s experience of childbirth is unique. However, the duration will generally be shorter for a woman who has already given birth.

Stage 1 has 3 phases: the latency phase, the active phase and the transition phase.

The latency phase

During the latency phase, contractions may be mild. They may feel like menstrual cramps and may occur in the lower back or belly. They are irregular at first, but then become regular but short (30 to 45 seconds). During this phase, the cervix will open up to 4 cm. If you have a normal pregnancy, however, it is not yet time to leave for the birthplace. If you are unsure, call your hospital or midwife, especially if you have lost amniotic fluid, the baby is not moving as much or you have a planned cesarean section. They will be able to guide you on the right time to come to the birthplace. For more information, see the When to Go to the Birthplace?

During this phase of labor, women experience different emotions such as excitement or nervousness that the baby will be coming soon. Some mothers are quiet, while others are cheerful and talk more. Most of the time you will be able to talk or walk during your contractions. However, you may be very tired if this stage is prolonged and you have trouble resting.

The active phase

During the active phase, the cervix dilates an average of half a centimeter per hour. However, the progression is slower up to 6 cm. In addition, women who are not in their first pregnancy tend to have a rapid progression after 6 cm. Contractions now become longer, closer together and more painful. They are less than 5 minutes apart and last about 1 minute. This allows the cervix to reach an opening of 8 cm. It is during this phase that many women’s waters break.

You may have more difficulty managing the pain and may need guidance to keep control during the contractions. It will also be more difficult to continue walking or talking during the contractions. Remember, however, that movement is still important to help the baby descend into the pelvis.

It is often during this phase that you will go to the hospital or birth center. The health care team will offer you various non-pharmacological methods of pain relief (walking, pressure point massage, various positions, birth ball, therapeutic bath). Take this opportunity to tell the people around you what makes you feel good during this period of painful contractions. Some women feel the need to retreat into their own bubble, while others want eye contact or physical contact (massage, hand holding, support when changing positions) during contractions. All of these behaviors are normal. Finally, your doctor may also suggest pharmacological methods of pain relief if you wish.

The transition phase

During this last stage of dilation, the cervix reaches its maximum opening, up to 10 cm. This is the shortest, but most difficult phase. Contractions are felt every 6 minutes at most, sometimes every 2-3 minutes, for 60-90 seconds. It may feel like there is no break between contractions.

Some women experience hot flashes and cold hands and feet. Others experience nausea and vomiting. You may feel out of control, restless or irritable. It may also be harder to concentrate. This is all normal. Your partner, caregivers and staff will be a great help in easing your doubts about your abilities and helping you through the pain. If you have chosen to have epidural relief, you will still need the staff to help you move and prepare for the birth.

Try to encourage yourself by congratulating yourself for braving one contraction at a time. Remember that with each contraction, your baby is getting closer to you. Focus on your breathing and get into a rhythm that feels good to you. You can also vary positions and alternate methods of non-pharmacological relief. What worked before may be less effective now and vice versa.

During this phase of labor, you may feel pressure on your rectum and increased vaginal secretions. However, you should not push until you are fully dilated, as this may cause your cervix to swell and slow down your labor. This type of breathing helps relieve the pressure and hold the urge to push. However, it can also sometimes cause dizziness and numbness in the hands. These sensations will subside with slower, more even breathing.
When labor slows down
Several signs may indicate that labor is not going as planned:
the cervix dilates less than half a centimeter per hour for more than 4 hours
the dilation and effacement process stops for more than 2 hours during the active phase of labor
the descent of the baby stops despite active pushing and effective contractions for more than 1 hour during the 2nd stage of labor.
Several factors may be responsible: ineffective contractions or pushing, a poorly positioned baby, a small pelvis, pain or anxiety. The doctor or midwife will assess the situation to determine the best way to intervene. The decision will depend on the condition of the mother and baby.

Stage 2: Descent and birth of the baby

Stage 2 begins when the cervix is fully open and ends when the baby is born. Contractions will continue at the same rate. This stage is longer for first-time mothers and can take up to 3 hours. For mothers who have already given birth, this stage is faster.

During this stage, you will feel a strong urge to push. There are two schools of thought about when to push.

The first is that you should listen to your body and start pushing only when you feel the urge, as directed by your doctor, nurse or midwife. If you have had an epidural, then pushing may be delayed. This is a delay that allows you to wait for the natural movement.

When the mother waits until she feels the need to push, it has been established that :

  • pushing is more efficient and the mother is less fatigued
  • there are fewer assisted births with forceps or vacuum;
  • There is less risk of perineal tears;
  • the baby is less stressed and fatigued because he or she is getting more oxygen.

As long as the baby continues to descend and the mother’s condition allows, it is possible to wait. After a certain time, however, it may be necessary to stimulate the descent to avoid complications. It is also important that the contractions are adequate and that the pushing is active to avoid a halt in the progress of labor that could be dangerous for the mother and the fetus.

The second approach is to push as soon as full dilation is confirmed. This is more common in patients without anesthesia at this stage of labor.

In both cases, first inhale, push for about 10 seconds, then release and empty the lungs completely. This exercise can be done 2 to 3 times per contraction. Between contractions, breathing can be done in a normal, relaxed manner.

The most commonly used breathing techniques

  • The exhaled push. This involves pushing with a trickle of air between the pursed lips, like blowing up a balloon. The air must leave with difficulty and the lungs are not completely emptied. This technique would ensure less accumulation of CO2 in the blood of the mother and the baby. However, it must be well understood and practiced before the day of delivery to be well done.
  • The push with retained air. This is a breath-holding push, while directing the effort towards the lower part of the body, i.e. towards the rectum and the perineum. This technique offers more power and may be necessary when the baby needs to come out more quickly. However, some experts are reluctant to use this technique because some studies have shown a negative effect on the perineum. However, it can be useful for some women.

The preferences and well-being of the birthing woman, as well as the context in which the birth takes place, should guide decisions about breathing.

An effective push ensures that both mother and baby get enough oxygen and allows the perineum to stretch gradually. Here are some tips for effective pushing:

  • Change positions regularly, i.e., every 3 to 4 contractions or every 15 minutes. You can push lying on your side, squatting, in a semi-sitting position or on all fours. The caregivers will be able to guide you through the position changes. The idea is that the most appropriate position can change as the birth progresses. This is the de Gasquet method.
  • Bend your elbows, grasp your legs or the support bar with your hands and keep your knees in line with your shoulders.
  • Lower your chin toward your chest and open your mouth slightly.
  • Relax your pelvic floor muscles (perineum) to let the baby down without pushing. This technique is also part of the de Gasquet method.
  • Be sure to stay focused as you make every effort to let your baby down.
  • Imagine that you want to give your baby as much space as possible. This visualization will help the baby descend.
  • Some women feel the need to grunt during the push. Grunting is an effective method because it lowers the diaphragm. This increases the force of expulsion directed at the perineum. However, screaming can interfere with effective pushing.
  • The practitioner who accompanies you will be able to inform you of the effects of your push on the descent of the baby. Express what you feel between contractions. The caregivers will inform you or modify their interventions according to your needs and those of the baby.
  • Push actively at the same time as the contractions, in 2 or 3 sustained efforts of about 10 seconds each. Remember to breathe well between active pushes. Rest and relax between contractions.
  • If you have had an epidural, you may not feel the need to push. In this case, the providers will tell you when to push.

Finally, as the baby’s head begins to come out, the perineum swells and the skin stretches as the baby pushes. This causes a burning sensation, often called a “ring of fire”. Once the head is out, you will pause for a short time before pushing back to get the baby’s shoulders out. After the shoulders are out, the rest of the body comes out easily all the way.

Skin-to-skin contact

At birth, your baby will be put directly on your belly to do the first care. If he or she is doing well, cord clamping will be delayed so that the baby can get more iron and oxygen to recover. The doctor or midwife will tell you when to cut the cord. You will then be offered to hold the baby and put it directly on your bare skin.

This skin-to-skin contact with your baby at birth and in the hours following birth helps your baby to get to know you and makes him or her more secure. Skin-to-skin contact also helps your body release oxytocin (a natural hormone). This hormone helps your uterus contract, which reduces the risk of excessive bleeding. This contact is also beneficial for the baby, as it helps stabilize his breathing and heart rate after delivery, while keeping him warm.

Stage 3: The expulsion of the placenta

After the baby is born, the uterus contracts and the placenta begins to come off. You may be asked to push a few times to help push it out.

Generally, the placenta is expelled spontaneously 5 to 30 minutes after delivery. A hormone, oxytocin, is often administered to help the spontaneous expulsion of the placenta and decrease the risk of hemorrhage. Massage of the uterus is also often performed for the same purpose. If a certain amount of time has passed or if too much bleeding is putting the mother at risk, a doctor’s intervention may be necessary. The placenta is then removed manually or surgically.

Stage 4: The Recovery Period

The recovery period focuses on your comfort and monitoring your overall condition. This is a special time for you and your baby, as you are reunited as a family for the first time. It’s a time for each of you to get to know the other.

If you have a tear or episiotomy, your doctor may stitch the wound after the placenta is delivered. If necessary, medication may also be injected to help your uterus contract and prevent bleeding after delivery.

The nurse or midwife may also massage your uterus to keep it firm and contracted. You may feel some discomfort during this maneuver. If necessary, you can breathe as you did during labor.

While respecting your privacy as a family, the professionals will make sure that everything is going well.

  • The nurse will check your breathing, heart rate, blood pressure, temperature, uterus and bleeding regularly at the beginning and then more frequently.
  • She will clean your perineum, place a sanitary napkin and apply ice to reduce swelling.
  • You will be offered a clean hospital gown and a warm blanket. You’ll appreciate this, as you may feel cold after the birth, which is perfectly normal. It’s just like after a hard workout.
  • You may also want to eat or drink. You’ve just done a lot of physical work. Eat gradually according to your hunger and tolerance.
  • You will be given time to relax and bond with your baby.

This is also a good time to continue skin-to-skin contact with your baby, which will encourage breastfeeding. In fact, skin-to-skin contact can encourage the baby to latch on within the first hour after birth. During this time, the baby is alert and stimuli such as the sight and touch of the nipple or the smell and taste of colostrum can encourage him to latch on. If your condition does not allow for skin-to-skin contact, it may be done by the father or another loved one. You can hold your baby skin-to-skin later when you are able to do so.

Then, depending on where you were born, you will be transferred to the postpartum unit where you can bathe, continue learning, and continue resting. The team will also do a more complete examination of your baby, take his or her measurements, and give him or her medication.

To remember

  • Childbirth is divided into 4 stages.
  • The duration of each stage varies from one woman to another.
  • The person who accompanies you and the medical team will be present throughout the delivery to support you and meet your needs.

Scientific review: Amélie Guay, MSc, ICP(C), advanced practice nurse clinician – perinatality, CHUM

Pregnancy