Labor and birth

The stages of labor

First stage: the cervix opens.¹

Early (latent) labor. The cervix softens and starts to open. may be irregular. This is usually the longest part and can take hours or even days.
Established labor. From about 4 cm, contractions get stronger and more regular. The cervix needs to open to about 10 cm for the baby to pass through. For a first baby this usually takes 8 to 18 hours; for later babies, often 5 to 12.

Second stage: pushing. From full dilation until the baby is born. Pushing should usually last no more than 3 hours for a first baby and 2 hours after that.¹

Third stage: the placenta. After the birth, the uterus contracts and the placenta comes out, either with medicine to speed it up or on its own.¹

When to call

Call your midwife, doctor or hospital if you think labor has started, or come every 5 minutes or more often.¹ Call urgently if:¹

your waters break
you have vaginal bleeding
the baby is moving less than usual
you're under 37 weeks and think you're in labor

Pain relief

There are many options, and many people use more than one:²

Self-help: learning what to expect, relaxing, moving and changing position, a bath, and paracetamol in early labor.
TENS: small electrical pulses through pads on the back. It hasn't been shown to work once labor is established.
Gas and air: breathed through a mouthpiece. It takes the edge off but doesn't remove all pain.
Opioid shots: ease pain and help relaxation, but aren't recommended close to pushing, because they can affect the baby's breathing.
Epidural: usually gives complete pain relief. It can make the pushing stage longer, so forceps or a vacuum may be needed.

Cesarean birth

A cesarean delivers the baby through a cut in the belly and uterus. It can be planned, usually from 39 weeks, or done during labor if a vaginal birth becomes too risky.³ In the US, 32.4% of births in 2024 were cesareans.⁴ Recovery takes longer than after a vaginal birth.³

Many people who have had a cesarean can safely have a vaginal birth next time, called VBAC, sometimes with extra monitoring.³

A birth plan

Write down your preferences for pain relief, who you want with you, and feeding, and share them with your care team. Plans can change, and that's normal.

Recap

In the first stage, contractions open the cervix to about 10 cm. For a first baby this usually takes 8 to 18 hours once labor is established.
In the second stage the baby is pushed out. In the third, the placenta is delivered.
Pain relief options include movement and baths, gas and air, opioid shots and an epidural.
32.4% of US births in 2024 were cesareans. Many people can have a vaginal birth after one.

Words to know 5

cesarean birth (C-section)	Birth through a cut in the belly and uterus.
contraction	The uterus tightening, which opens the cervix and pushes the baby out.
dilation	The opening of the cervix. It reaches about 10 cm for birth.
epidural	Pain relief given through a thin tube in the lower back that numbs the lower body.
VBAC	Vaginal birth after a previous cesarean.