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The stages of childbirth

Heavily pregnant woman
Photo credit: Nathan Haniger for BabyCenter

What is childbirth like?

Every woman's experience of labour and birth is different. Nobody can predict what your labour will be like, or how long it will last.

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But there are plenty of things you can do to prepare yourself and, understanding what happens to your body and your baby during labour is an important first step.

What are the stages of labour?

Labour moves forward in three clear stages:

  • First stage: when contractions gradually open up the cervix, which is the neck of your womb (uterus). The first stage consists of early labour, active labour, and the transitional phase.
  • Second stage: when you push your baby out into the world.
  • Third stage: when you deliver the placenta.


There is also a phase called prelabour, or the latent phase, which is when your body gears up for the first stage of labour.

What happens in prelabour?

During pregnancy, your cervix is closed and plugged with mucus, to keep out infection. Your cervix is long and firm, giving a strong base to your womb. It's also in a position that points slightly towards your back (posterior position).

Before labour can start properly, your cervix has to go through some changes. It has to move forward (anterior position), soften and shorten (Simkin and Ancheta 2011). The softening of your cervix is often called ripening.

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Prelabour changes may take hours, days or even weeks (APA 2018, Simkin and Ancheta 2011). You may not notice anything happening. Or you may be aware of contractions that may range in intensity and disturb your sleep, even though labour has yet to get going properly (Simkin and Ancheta 2011).

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What happens in the first stage of labour?

In the first stage of labour, your cervix has to open (dilate), so your baby can be born. The muscles of your womb tighten with each contraction and then release, gradually drawing your cervix up into the lower section of your womb.

In the early phase of first stage labour, your cervix may open gradually. It may seem as if no changes are happening at all. Early labour can be slow and your contractions may not last for long and have lengthy gaps between them. They may even stop for a while before starting again.

As you enter the active phase of first stage labour, when your cervix has dilated to about 4cm (NICE 2014), the contractions usually last longer, and become more frequent and powerful.

Towards the end of the first stage, your labour may become much more intense. This phase of labour is called transition (Downe and Marshall 2014). By the end of the first stage your cervix will be fully dilated or you may get the urge to push (Downe and Marshall 2014).

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Read more about the first stage of labour.

What happens in the second stage of labour?

This is the stage when your baby is born. During the second stage of labour, your baby will start to move down your vagina (the birth canal).

You may not feel the urge to push with your contractions straight away. Midwives call this the passive second stage. When your baby has descended enough that your midwife or birth partner can see him, and you have the urge to push your baby out, you're in active second stage (NCCWCH 2014, RCM 2012a)

During the active second stage, you’ll feel the pressure of your baby's head low down in your pelvis, and with each contraction, you may feel strong urges to bear down. Listen to your body, and push in response to the urges (Lemos et al 2017, NCCWCH 2014). Take a few breaths between pushes if that's what feels right (RCM 2012a).

With every push, your baby will move further through your pelvis, but at the end of the contraction, he'll probably slip back a little again. This is normal and gives the muscles of your pelvic floor time to stretch gradually (Downe and Marshall 2014). As long as your baby keeps gradually moving down, you're doing fine (RCM 2012a).

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Keeping upright can help you and your baby to progress through the active second stage (Gupta et al 2017, NCCWCH 2014).

When your baby's head is visible at the entrance to your vagina and stays there when the contraction has ended, it's called crowning.

Your midwife will tell you when she can see your baby's head, and may ask you to stop pushing and blow or sigh out your breaths (Downe and Marshall 2014). This helps you to resist the urge to bear down for two contractions or three contractions, so that your baby is born gently and slowly.

Taking this approach may help to protect your perineum (the area between your vulva and your anus)(Downe and Marshall 2014). You'll probably feel a hot, stinging sensation, as the opening of your vagina starts to stretch around your baby's head (Capogna et al 2010). Your midwife may use warm compresses to support your perineum as it stretches to help prevent a tear (Aasheim et al 2017).

Once you've birthed your baby, the second stage is over (NICE 2014, RCM 2012a). Your midwife may wipe your baby with a clean towel and then place him on your tummy or chest for a skin-to-skin (Downe and Marshall 2014, NICE 2014) cuddle.

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Read more about the second stage of labour.

What happens in the third stage of labour?

The third stage of labour begins once your baby is born and ends when you deliver the placenta and the empty bag of waters that are attached to the placenta (membranes). These come away as your womb contracts down after the birth.

Your midwife will offer you an injection for the third stage that helps your womb to contract down and the placenta to come away (managed third stage) (NCCWCH 2014).

The injection may cause side-effects such as nausea and vomiting, because of the drugs used (NCCWCH 2014). You won't have to do any pushing, as once the placenta is detached, your midwife will gently pull it out, along with the membranes from the amniotic sac (NICE 2014).

If all went well in your pregnancy and labour, you can choose instead to have a natural (physiological) third stage (NICE 2014, RCM 2012c). This is when you deliver the placenta without an injection.

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With a natural third stage your contractions will be noticeable, but weaker, when they begin again. The placenta will peel away from the wall of your womb and move down into your vagina. You may get the urge to push as this happens (Begley 2014, RCM 2012c).

Easing yourself into an upright position, cuddling your baby skin-to-skin, and starting to breastfeed him, may all help to stimulate your body to expel the placenta (RCM 2012c).

Whether you have a natural or a managed third stage, it's recommended that your midwife waits at least a few minutes before clamping the cord. While you're waiting to expel the placenta, the cord will continue to pulse with nutrient-rich blood. Waiting gives your baby a helpful boost of this blood (NCCWCH 2014). While all this is going on, you're likely to be cuddling and getting to know your newborn better.

As long as you and your baby are well, you should be left in peace to have special time together. Your midwife should let you have at least an hour of gazing at, and possibly feeding, your new baby. After that, your midwife will ask to carry out the standard newborn checks. These include weighing your baby, measuring his head size, and taking his temperature (NICE 2014).

Read more about the third stage of labour.

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BabyCentre's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organisations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

APA. 2018. Prodromal labour? American Pregnancy Association. americanpregnancy.orgOpens a new window [Accessed September 2019]

Begley C. 2014. Physiology and care during the third stage of labour. In: Marshall JE, Raynor MD. eds. Myles Textbook for Midwives. 16th ed. Edinburgh: Churchill Livingstone, 395-416

Capogna G, Camorcia M, Stirparo S, et al. 2010. Multidimensional evaluation of pain during early and late labor: a comparison of nulliparous and multiparous women. Int J Obstet Anesthesia 19(2):167-70

Downe S. Marshall JE. 2014. Physiology and care during the transition and the second stage phases of labour. In: Marshall JE, Raynor MD. eds. Myles Textbook for Midwives. 16th ed. Edinburgh: Churchill Livingstone, 367-93

Gupta  JK, Sood  A, Hofmeyr  GJ, et al. 2017. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews (5): CD002006. www.cochranelibrary.comOpens a new window [Accessed September 2019]

Lemos  A, Amorim  MMR, Dornelas de Andrade  A, et al. 2017. Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews (3): CD009124. www.cochranelibrary.comOpens a new window [Accessed September 2019]

NCCWCH. 2014. Intrapartum care: care of healthy women and their babies during childbirth. Updated Feb 2017. National Collaborating Centre for Women's and Children's Health, Clinical guideline, 190. www.nice.org.ukOpens a new window [Accessed September 2019]

NICE. 2014. Care of women and their babies during labour and birth: information for the public. Updated Feb 2017. National Institute for Health and Care Excellence. www.nice.org.ukOpens a new window [Accessed September 2019]

RCM. 2012a. Second stage of labour. Royal College of Midwives Trust, Evidence based guidelines for midwifery-led care in labour

RCM. 2012b. Care of the perineum. Royal College of Midwives Trust, Evidence based guidelines for midwifery-led care in labour

RCM. 2012c. Third stage of labour. Royal College of Midwives Trust, Evidence based guidelines for midwifery-led care in labour

Simkin P, Ancheta R. 2011. The labor progress handbook: early interventions to prevent and treat dystocia. 3rd ed. Chichester: Wiley Blackwell

Jenny Leach is an editor and writer specialising in evidence-based health content.
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