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This topic provides basic
information about normal labor and delivery. If
you need information on pregnancy, other types of childbirth, or the first 6 weeks after childbirth (postpartum), see:
At the end of the
trimester of pregnancy, your body will begin to show
signs that it is time for your baby to be born. The process that leads to the
birth of your baby is called labor and delivery. Every labor and delivery
includes certain stages, but each birth is unique. Even if you have had a baby
before, the next time will be different.
Giving birth to a baby
is hard work. It can also be scary, thrilling,
and unpredictable. Learning all you can ahead of time will help you be ready
when your time comes.
There are three
stages of labor. The first stage includes early labor and active
labor. The second stage lasts through the birth,
with the baby traveling down and out of the birth canal. The third stage is
after the birth, when the placenta is delivered.
Stage one. The muscles of the uterus start to tighten (contract) and then relax. These contractions help to thin (efface) and open (dilate) the cervix so the baby can pass through the birth canal.
Stage one has three phases:
Stage two. The cervix is dilated completely and the baby is born.
Stage three. This stage occurs after the baby is born. You have contractions until the placenta is delivered.
Having a support person, trying different positions, or using
breathing exercises may help you cope with labor pain. You also can listen to music or use imagery to distract you and help you relax. Some women labor in water or take a shower.
Many women ask for pain medicine, such as an epidural injection, which partially or fully numbs the lower
body. Even if you plan to not use pain medicine (natural childbirth), it can be comforting to know
that you can get pain relief if you want it.
Getting regular exercise during pregnancy will help you handle the
physical demands of labor and delivery. Try adding
Kegel exercises to your daily routine. They strengthen
your pelvic floor muscles. This helps prevent a long period of pushing during
In your sixth or seventh month of pregnancy, consider
taking a childbirth education class with your partner or support
person. It can teach you ways
to relax and the best ways for your support person to help you.
There are many decisions to make about labor and delivery. Before your
last weeks of pregnancy, be sure to talk to your doctor or nurse-midwife about
your birthing options and what you prefer.
You can write down all of your preferences as a birth
plan. This gives you a chance to state how you would most like things to be
handled. Just keep in mind that it is not possible to predict exactly what will
happen during labor and delivery.
Now you get
to hold and look at your baby for the first time. You may feel excited,
tired, and amazed all at the same time.
If you plan to
breast-feed, you may start soon after birth.
Don't be surprised if you have some trouble at first. Breast-feeding is
something you and your baby have to learn together. You will get better with
practice. If you need help getting started, ask a nurse or breast-feeding
specialist (lactation consultant).
In the hours after
delivery, you may feel sore and need help going to the bathroom. You may have
sharp, painful contractions for several days as your uterus
shrinks in size.
Learning about labor and delivery:
Learning about pain control:
Health Tools help you make wise health decisions or take action to improve your health.
your prenatal visits, talk with your doctor about your labor and
delivery options. You may want to write them
down as a birth plan. It's an ideal
picture of what you would like to happen.
But try to be flexible. No labor and delivery can be
predicted or planned. So give yourself permission to change your mind at any
time. And be prepared for your childbirth to be different from what you
planned. If an emergency arises, your doctor has a
responsibility to ensure both your safety and your baby's safety. You may still
share in decisions, but your choices may be limited.
When you are writing your birth plan, think about:
This is also a good time to decide whether you'll attend (if you haven't
childbirth education class, starting in your 6th or
7th month of pregnancy.
To help you get started on writing a birth plan, fill out the My Birth Plan formMy Birth Plan form(What is a PDF document?). Take it to your next appointment to discuss your wishes with your doctor or midwife.
You may feel more calm and prepared for labor if you know what is likely to happen when you get to the hospital.
Most hospitals and birthing centers have birthing rooms
where women can labor, deliver, and recover. Providing that you have an
uncomplicated birth, you can probably be in the same birthing room for your
entire stay. If your delivery becomes complicated, you can be quickly moved to
a delivery room equipped to handle the problem.
If you arrive at the hospital or
birthing center in early labor that is progressing quickly, you can expect some or all of the following:
Before your baby is born,
plan ahead about:
No one can predict when labor will start. One woman can have all
the signs that her body is ready to deliver, yet she may not have the baby for
weeks. Another woman may have no advance signs before she goes into active
labor. First-time deliveries are harder to predict.
Late in your pregnancy, your doctor or midwife will tell you what to do when you think you are in labor. Early labor can be different for every woman. At first, your contractions may not be regular, and they may happen only now and then.
You may have signs that early
labor is not far off.
The key to knowing when you're in labor is that the contractions start to get longer, stronger, and closer together. You will feel them even when you change positions and are walking or moving around. After a while, it will become hard for you to talk during a contraction. You may have to stop to focus on your breathing.
Many women stay at home during early labor. During this time, it's important to know when to call your doctor or midwife.
You or someone else should
call 911 or other emergency services immediately if you think you may need
emergency care. For example, call if you:
Call your doctor now or go to your hospital's labor and delivery unit immediately if you:
You can choose from several types of pain relief for childbirth. These include medicine or breathing techniques, as well as comfort measures. You also can use a combination of these choices.
There are many ways to reduce the
stresses of labor and delivery. "Natural" childbirth techniques (without medicine) may help reduce pain and help you feel a sense of control during
Other techniques that don't use medicine to control pain include:
Your options for pain relief with medicine may include:
Some pain-relief medicines aren't the type that you
would request during labor. They are used as part of another procedure
or for an emergency delivery. But it's a good idea to know about them.
Most babies are born in a vaginal delivery. But in some cases, other types of delivery occur by choice or because of an emergency.
During labor, the uterus contracts regularly to thin and open (efface and dilate) the cervix and push the baby out through the birth canal. It can take many hours or days for the cervix to open all the way so you can begin pushing.
A cesarean section is the delivery of a baby through a cut (incision) in the mother's belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward.
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. For more information, see the topic Cesarean Section.
In the past, a woman who had one C-section delivery had to have all of her other babies by C-section. But depending on the reason for your first C-section and the type of incision that was made, you may be able to deliver your next baby vaginally.
more information, see the topic
Vaginal Birth After Cesarean (VBAC).
The process of having a baby occurs in several stages over many hours or even a few days—from early labor through delivering the baby and the placenta. During labor, contractions in your uterus open your cervix and move the baby into position to be born.
Early labor is often the longest part of the
birthing process, sometimes lasting 2 to 3 days. Uterine contractions:
It's common for women to go to the hospital during early
labor and be sent home again until they are in active labor or until their
"water" breaks (rupture of the membranes). This phase of labor can be long and
The active stage of
labor starts when the cervix is about
3 cm (1.2 in.) to
4 cm (1.6 in.) dilated. This
stage is complete when the cervix is fully
effaced and dilated and the baby is ready to be pushed
Compared with early labor, the
contractions during active labor are more intense and more
frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is
the time to be at or go to the hospital or birthing center. If your
amniotic sac hasn't broken before this, it may now.
As your contractions get stronger, you may:
To learn more about pain medicine, see
The end of active labor is called the transition phase. As the baby moves down, your
contractions become more intense and longer and come even closer together.
When you reach transition, your delivery isn't far off. During
transition, you will be self-absorbed, concentrating on what your body is
doing. You may be annoyed or distracted by others' attempts to help you but still feel you need them nearby as a support. You may feel increasingly
anxious, nauseated, exhausted, irritable, or frightened.
in first-time labor will take up to 3 hours in transition, and a mother who has
vaginally delivered before will usually take no more than an hour. Some women
have a very short, if intense, transition phase.
The second stage is the actual birth, when the baby is pushed out by the contractions. This pushing stage can be as short as a few minutes or as
long as several hours. You are more likely to have a fast labor if you have
given birth before. During the second stage:
medical staff will be ready to handle anything unexpected. This is a time when your doctor or
nurse-midwife will be deciding what is best for you and your baby.
After your baby
is born, your body still has some work to do. This is the third stage of labor,
placenta is delivered. You will still have
contractions. These contractions make the placenta separate from the inside of
the uterus, and they push the placenta out. Your medical staff will help you
with this. They will also watch for any problems, such as heavy bleeding,
especially if you have had it before.
You may be given some medicine to help the uterus
contract firmly. Oxytocin (such as Pitocin) may be given as a shot or in a vein (intravenously) after the placenta is delivered. Oxytocin is given to make your uterus shrink and bleed less. (This is the same medicine that is sometimes used to make contractions more regular and frequent during labor.) Breast-feeding right away can also help the uterus shrink
and bleed less.
The third stage can be as quick as 5 minutes. With
preterm birth, it tends to take longer. But in most
cases, the placenta is delivered within 30 minutes. If the placenta doesn't
fully detach, your doctor or nurse-midwife will probably reach inside the
uterus to remove by hand what is left inside. Your contractions will continue
until after the placenta is delivered, so you may have to concentrate and
breathe until this uncomfortable process is complete.
In most cases, you don't have to lie in bed the whole time you're in labor. (If you have an epidural or have certain health problems, you may have to stay in bed.) You can choose whichever position feels most comfortable. You may want to walk, sit on a big rubber ball, or kneel. The position that feels best for you may change as you move through labor:
Moving around and changing positions during labor may help you feel more comfortable and might help reduce the length of labor.5
for pushing include squatting, reclining, or using
a birthing chair, stool, or bed. You may find that certain positions are more comfortable than others during the pushing stage. Speak to your doctor or midwife about different birthing positions before your labor begins.
In some cases, a woman may need medical help to give birth. For instance, labor may stall, or the baby may need help to get through the birth canal. Sometimes what starts as a routine vaginal birth may end in a cesarean delivery to make sure the mom and baby are safe.
Fetal heart monitoring and vaginal exams are standard practice during labor, but other procedures
are used as needed.
Sometimes your doctor may need to use different procedures to help deliver the baby.
You may feel excited,
tired, and amazed all at the same time after delivery. You may feel a great
sense of calm, peace, and relief as you hold, look at, and talk to your baby.
During the first hour after the birth, you can also expect to start breast-feeding, if you plan to breast-feed.
If you breast-feed,
don't be surprised if you and your baby have some trouble doing it at first.
Breast-feeding is a learned technique, so you will get better at it with practice.
You may have a breast-feeding specialist (lactation consultant) in the hospital to help you get started.
about getting a good start with breast-feeding and preventing problems,
You may have
shaking chills right after delivery. This is a common reaction in the hours
after delivery. A warm blanket may help you feel more comfortable.
During the first hours after the birth, your health professional or a
You may also have:
Hodnett ED, et al. (2012). Continuous support for
women during childbirth. Cochrane Database of Systematic Reviews (10).
Cluett ER, Burns E (2009). Immersion in water in labour and birth. Cochrane Database of Systematic Reviews (2).
Smith CA, et al. (2006). Complementary and
alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews (4).
Cunningham FG, et al. (2010). Forceps delivery and
vacuum extraction. In Williams Obstetrics, 23rd ed., pp.
511–526. New York: McGraw-Hill.
Lawrence A, et al. (2009). Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews (2).
Other Works Consulted
American College of Obstetricians and Gynecologists (2010). Your Pregnancy and Birth, 5th ed. Washington, DC: American College of Obstetricians and Gynecologists.
Kettle C, Tohill S (2011). Perineal care, search date March 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
November 13, 2013
Kathleen Romito, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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