There comes a time in every pregnancy when all that's left to do is wait. The books have been read, the nursery decorated, the car seat installed. "Once you get to 37 weeks of pregnancy, your baby could be born at any time," says Susan Cooter, RN, director of Prepared Childbirth Educators, an organization based in Hatboro, Pennsylvania.
But even though most women give birth between 37 and 42 weeks, there's no way to pinpoint exactly when labor will begin. "Not knowing makes some women very anxious," says Cooter, who is also a certified doula trained to provide emotional and physical support to women in labor.
If you're a first-time mom, you may not even realize when you're officially in labor. "Plenty of women head to the hospital only to be told to go back home," notes Cooter. It can be hard to distinguish Braxton Hicks contractions, also known as false contractions, from the real thing. But if your contractions gradually become stronger, last longer, and are getting closer together, chances are that labor has begun.
Even if you're in true labor, it may take a while before you're sure, so in the early stages of labor, you're better off at home where you'll be more comfortable. After all, a first-time mom can expect to be in labor for 12 to 14 hours, according to the American College of Obstetricians and Gynecologists. "Labor with subsequent pregnancies usually goes faster," Cooter says.
When it does come time to check in to the hospital or birthing center, keep in mind that things don't always (or more accurately, don't usually) go exactly as planned. You may not be able to get the epidural you wanted, or you may end up needing a cesarean. "It's fine to have an idea of how you'd like the birth to go, but you need to be flexible," says Cooter.
Keeping in mind that the stages of labor are different for every woman, and for each of her pregnancies, here's what you might expect.
First Stage of Labor: Dilation and Effacement of the Cervix
Your physician will likely have told you when to call her or go to the hospital, but it's typically when contractions happen at regular intervals, such as every 8 or 10 minutes, and get closer together. Other indications that you're in labor include the "rupture of membranes" (when your water breaks), losing the mucus plug, and passing bloody discharge called "bloody show." Remember that not all women experience all of these signs of labor, so if you're unsure, call your caregiver.
This first stage of labor can be further broken down into different phases: the early (or latent) phase, the active phase, and the transition phase.
Early (or Latent) Phase: Cervix dilates from zero to three or four centimeters
The early phase of labor is sometimes (lightheartedly) called "the entertainment phase," because it's often helpful to focus your mind on other things so that you can pass the time without worrying about what's coming. As long as contractions are still relatively mild and spaced farther than five or so minutes apart, most women spend the time at home, and maintain close contact with their practitioner.
In general, contractions can be mild and somewhat irregular, coming from 5 to 30 minutes apart, lasting 30 to 45 seconds. You might see some pinkish discharge and feel a bit of abdominal discomfort. The water may break (rupture of membranes) in this early phase, or this may happen later in the first or second stage, either on its own or with help from your practitioner.
How Long It Lasts: This first step in the journey toward childbirth lasts an average of 6 to 10 hours for a first-time mother, but can be much shorter (2 to 5 hours) if you've given birth before.
Contractions: During this phase, contractions usually last between 30 and 60 seconds; they generally start 20 minutes apart and move to about 5 minutes apart. Look for contractions that continue even if you move around, that get stronger, and that start in your back and move around to the front.
What to Do: Anything that helps you relax, says Cooter. "Rest, shower, eat a small meal, take a walk, and practice slow-paced breathing," she says.
Active Phase: Cervix dilates from four to seven centimeters
This phase is when the serious prep work for childbirth begins, and when most women begin to labor more intensely. During the active phase, contractions usually come steadily, gradually increasing in intensity and frequency, from three to five minutes apart.
Pains may be centered in the lower back, abdomen, or thighs, and they may be intense enough to make it hard for you to talk. You might also experience an increased amount of pinkish or brownish discharge, or what's sometimes called a "bloody show."
How Long It Lasts: This stage of labor lasts 3 to 6 hours for a first-time mom, and 1 to 3 hours for subsequent labors. If you've taken Pitocin, a drug that induces contractions, this phase may go more quickly, but if you've had an epidural, things can slow down.
Contractions: Contractions are increasingly more intense, last for 45 to 60 seconds, and are 3 to 5 minutes apart.
Other Signs: Some women feel discomfort in their back and hips and cramping in their feet and legs; this is the point when many women ask for an epidural. However, even with pain relief, active labor can unhinge some women's tempers. "I think this was about when I started to yell at my husband," says Kearney. "It hurt, and I had to take it out on someone."
What to Do: By this point in labor, you have been admitted to the hospital or ensconced at your birthing center. If you have your epidural in place, you may not be able to get out of bed, but it's still a good idea to change position every half hour or so. If you can get out of bed, try walking up and down stairs for a few minutes at a time (if hospital policy allows it) or marching in place.
"This movement encourages the cervix to open and helps the baby rotate into the birth position," says Cooter. This is also a good time to use the relaxation techniques you learned in childbirth education class and to enlist your partner for emotional support. Your hospital may also want to monitor the baby's heartbeat with a stethoscope, a handheld Doppler device, or an electronic monitoring device.
Transition phase: Cervix dilates to eight to ten centimeters
Contractions during this phase are usually intense, spaced about one to three minutes apart. Increasing fatigue, shakiness, and nausea are all common in this phase, as your body does the hard work of reaching complete dilation and effacement.
You may feel a strong urge to push or bear down, along with pressure in the rectal area and stinging in the vaginal area as the baby's head moves down toward the vaginal opening. But you should NOT push—wait until your practitioner gives you the go-ahead, which will happen when the cervix is fully dilated.
How Long It Lasts: This is the shortest but most intense phase, typically lasting from 10 minutes to 2 hours.
Contractions: Contractions are increasingly intense and last between 60 to 90 seconds, and they're 1 1/2 to 2 minutes apart.
Other Signs: You may feel pelvic and rectal pressure, have hot flashes and/or chills, have cold feet, and feel nauseous or even vomit. You may feel overwhelmed, and it's also normal to feel discouraged, as though labor will never end.
What to Do: Imagine you're in a place that makes you feel safe and relaxed—lying on the beach, resting against a tree, or sitting in a rocking chair in your baby's nursery. Breathe deeply and develop the scene, filling in the details. What do you see? What do you smell? What do you hear? If you're in more pain than you expected, it's usually not too late to ask for pain relief at this point. However, whether you get any will depend on whether an anesthesiologist is available.
Second Stage of Labor: Pushing and Birth
The second stage of childbirth begins when the cervix is fully dilated. Your baby is moving down the birth canal. Contractions continue to be strong, lasting for about 60 seconds and coming 3 to 5 minutes apart. You will likely feel a strong urge to push.
The overwhelming urge to bear down continues, and as soon as your cervix is fully dilated, your practitioner will probably give you the go ahead to push. Contractions don't stop now, though they often come farther apart. Some women experience nausea and vomiting. As you begin pushing, you may become increasingly breathless and fatigued—you're getting what is likely the hardest workout of your life.
How Long It Lasts: The pushing and birth stage spans 1 to 2 hours for a first labor, and 15 to 30 minutes for subsequent labors. If your baby is in distress at this point, or if she doesn't seem to be making her way through the birth canal, your doctor may decide to deliver her by C-section or use forceps to help her out.
Signs: You may feel intense pain around your vaginal and perineal areas as the baby's head crowns, or protrudes at its widest part outside the vaginal opening. If you have an episiotomy (an incision made in the area between the vagina and the rectum to widen the vaginal opening) it will probably happen at this point. You may be asked to push more gently or slowly as the rest of your baby's head and body emerge. Finally, with one last push, your baby is out in the world!
What to Do: Take solace in knowing that you're almost there! Concentrate on pushing your baby down and out. Your partner can help by encouraging you to push and to rest in between pushes. Don't be afraid to try different positions —for instance, get on your hands and knees or kneel while your partner supports your upper body.
Third Stage of Labor: Delivery of Placenta
The incredible moment of your baby's birth is followed swiftly by the delivery of the placenta (sometimes called "the afterbirth"). You'll likely be so absorbed in getting to know your newborn that you won't notice much about this stage!
How Long It Lasts: Delivery of the placenta generally lasts 1 to 20 minutes for first and subsequent pregnancies.
Signs: Minutes after your baby is born, you feel contractions again. This usually causes the placenta to separate from the uterine wall. When your doctor sees signs of separation, she will ask you to push again to expel the placenta. In some cases, she may need to reach inside and help pull out the placenta.
What to Do: Be patient. As Davis notes, "I had a new baby, so it was pretty easy to deal with this last, relatively quick bit of discomfort."