Signs and Symptoms of Labor

The process of childbirth can be divided into three distinct stages. Understanding the signs and stages of childbirth will help you be prepared and have a healthy birthing experience.

First-stage Childbirth: Labor and Transition

The first stage of childbirth begins with labor, the rhythmic contractions that open the cervix and press the baby through the birth canal. This stage of childbirth, from the onset of progressing labor contractions until the cervix is completely dilated, is almost always the longest. It usually starts slowly and then speeds up when the dilation of the cervix reaches about 4 to 5 centimeters (full dilation is 10 centimeters).

But what signs indicate when labor has begun? That's what every expectant mother wants to know!

Labor does not begin suddenly, it evolves gradually. It can take hours, even days, to figure out whether the sensations you're feeling are labor or prelabor (also called false labor). Some subtle signs and symptoms that you are beginning first stage childbirth include a vague backache that may cause restlessness, several soft bowel movements accompanied by flulike feelings, and a nesting urge--an unusual burst of energy, particularly related to cleaning and getting your home ready for the baby.

­As childbirth nears, there are some more specific symptoms that may occur. You may pass some blood-tinged mucus, called the bloody show, from the vagina. This is associated with thinning of the cervix, and it can occur days before other signs of labor or not until after labor contractions are progressing. You may notice a leakage of fluid from the vagina, which indicates that there is a small break in the amniotic sac (also called bag of waters) surrounding the baby. This occurs in 10 to 12 percent of childbirths, but it may not be associated with spontaneous labor. Leaking can continue on and off for hours before childbirth begins, and you will not have any contractions.

There are two absolutely clear signs that you are in labor: contractions that become longer, stronger, and closer together with the passage of time and the breaking of the bag of waters.

When you're in true labor, you'll feel the contractions in the abdomen, the back, or both, and they will be painful and strong. The best way to be sure whether your contractions are progressing is to time them. On a sheet of paper, list the times contractions begin and how long they last. Keep track for an hour or two. If they are not progressing, stop for a while and then time them again to see if there's been any change. Contractions are dilating the cervix by the time they average one minute long and five minutes apart.

If your bag of waters breaks, you may hear a popping sound, and you'll experience a gush or leak followed by contractions. Labor usually speeds up after the bag of waters breaks.

Each woman's labor is different. And even in the same woman, each labor will be different. Some labors start slowly and then speed up unexpectedly, while others start rapidly and then slow down. Some labors are very fast, lasting only a few hours. Some are very long, lasting a day or two. The average length is about 15 to 16 hours for first-time mothers and 7 or 8 hours for women with previous childbirths. How painful the labor is, and how tired you become, also vary greatly. It's best, then, not to have any specific expectations but to prepare yourself for a wide range of possibilities.

The final phase of first-stage childbirth is called transition, and it is particularly intense. This is the time during which your cervix will dilate from 7 to 10 centimeters. You may feel the urge to push during this phase, but you'll be advised to resist. Pushing before your cervix is fully dilated can injure it and the perineal tissues, and it may lead to heavy bleeding.

Second-stage Childbirth: Pushing and Birth

The second stage of childbirth, the pushing stage, culminates in the birth. This stage lasts from 15 minutes to 3 hours or more. The nature of your contractions may change during this stage. They will likely be spaced farther apart, and they'll be accompanied by a reflex need to strain or grunt, which comes and goes three to five times per contraction. The combination of the uterine contraction and your bearing-down effort pushes the baby closer to the outside. It is hard work and it hurts, but it is also an exciting time. And this childbirth stage comes with a reward: the birth of your baby!

Third-stage Childbirth: Expelling the Placenta

Your work isn't over, though, when the baby is born. There's one more stage of childbirth, one more job you have to do--and that's expelling the placenta. This stage usually lasts from 5 to 30 minutes. A nurse or other caregiver will keep a hand on your abdomen to determine when the placenta separates from the uterine wall. Then you will be asked to push it out. You may feel some cramps, but the discomfort is usually minimal. Once the placenta is passed, childbirth is over.

Factors Influencing Childbirth

Labor is primarily a phenomenon that is out of your control. But there are some things you can do to have a positive impact on your labor and childbirth experience. Here's what you can and can't control:

Childbirth factors you can control, to some extent:

Childbirth factors you cannot control: