The complete process of labor and birth is divided into three separate stages, the first of which is divided into two stages of its own: early labor and active labor. The second stage of labor is known as the "pushing" stage, beginning once you're full dilated and ending with the birth of your baby, and the third stage begins immediately after the birth of your baby and ends when the placenta is delivered. All women are different, which means every pregnancy is different too. For many first-time moms, labor typically takes between ten and twenty hours, while the process usually progresses much more quickly for women who have already given birth vaginally.
The first stage of labor begins when you first start having contractions that cause progressive changes in your cervix, and ends when your cervix is fully dilated. It is sometimes difficult to differentiate between early labor contractions and inefficient Braxton Hicks contractions that sometimes come right before, contributing to what is often called false labor. During early labor, your contractions will gradually become stronger, longer and closer together, eventually occurring every five minutes and lasting 40 to 60 seconds each near the end of early labor. In most cases of early labor, you can talk through them, and you may even feel like taking a brief walk. You may also notice an increase in vaginal discharge at this point, which is sometimes tinged with blood, called the "bloody show." Early labor ends when your cervix is about four centimeters dilated and your progress starts to accelerate. If you are at least 37 weeks pregnant and your healthcare provider hasn't advised you otherwise, you can expect to sit out early labor at home.
Active labor begins when your contractions become increasingly intense and you are no longer able to talk through them. Your cervix will dilate quickly until it is fully dilated at ten centimeters. In general, once you've had regular, painful contractions every five minutes for an hour, it's time to call your healthcare provider and head to the hospital. In most cases, the contractions become even more frequent and eventually occur every 2.5 to 3 minutes, although some women may never have them more often than every five minutes. For many first-time mothers, active labor will last between four and eight hours, although it can be longer or shorter. Towards the end of active labor your baby may begin to descend, which brings you into the "transitional" period of active labor. The transitional stage is the most intense part of labor and can last anywhere from a few minutes to a few hours. During this time, your cervix will dilate from eight to a full ten centimeters, marking the shift to the second stage of labor.
Once your cervix is fully dilated, the second, or "pushing" stage, begins, marked by the final descent and birth of your baby. At the beginning of this stage, your contractions may be a less frequent, giving you the opportunity for a little bit of rest. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. This descent may occur quickly or gradually, as the force of your uterus combines with the force of your abdominal muscles if you're actively pushing, with each contraction. After a period of time, your perineum, which is the tissue between your rectum and vagina, will begin to bulge with each push. Before long, your baby's scalp will become visible, and with each contraction, more and more of the baby's head will be exposed. Once your baby is delivered, he will be kept warm and the healthcare provider will clamp the umbilical cord in two places and then cut between the two clamps. The entire pushing stage can last anywhere from a few minutes to several hours. Without an epidural, the second stage of labor averages close to an hour for a first-time mother and 20 minutes if you've had a previous vaginal birth. If you receive an epidural, the second stage typically lasts longer.
Within a few minutes after giving birth, your uterus will begin to contract again. The first few contractions typically separate the placenta from the uterine wall. When your healthcare provider sees indications of separation, he or she may ask you to gently push to help expel the placenta. On average, the third stage of labor takes about five to ten minutes and is usually not painful at all. Once the placenta is delivered, your uterus should contract and get very firm. Your healthcare provider will monitor you to make sure that your uterus remains firm, and will massage it if it doesn't. This is important because the contraction of the uterus helps cut off the open blood vessels at the location where the placenta was previously attached. If your uterus fails to contract properly, you will continue to bleed from these blood vessels.