What Are the Stages of Labor?
The fact of the matter is that for many women giving birth for the first time, it is common to see labors last longer than 12 hours (California Pacific Medical Center, 2014). At the same time, what you do in early labor may greatly influence your endurance and mental stamina for the duration of the birth. Later in this post, we will share an example of an 18-hour labor, to show how even 18 hours of consistent contractions may not seem so hard when it is all charted out! This post is not meant to scare you – the goal is quite the opposite. Our intention is to help put to rest fears around “long labors”, give you realistic expectations, and set you up for your best birth by giving you information and encouragement!
To begin, we know that the early first stage of labor can last 7 to 14 hours. Wow, that seems like a long time! And it is. So it's important to use your time wisely during this stage. In this early first stage of labor, contractions are likely to be sporadic and 10-15 minutes apart (or more), and last for around 30 seconds. These contractions are mild or moderate enough that you are able to talk through them – they don’t require great concentration to manage. This whole early first stage can last, as we've said, perhaps 7 to 14 hours and there is a LOT of variation of normal here. A lot of families get so excited when this stage begins, and they find it hard to relax, rest and take it easy; after all, they are going to be meeting their baby soon! But, now that you know that this stage can last quite a while, and is usually conducive to sleeping or resting (especially if it occurs at night time, and statistically it often does), it may be best for you to rest if at all possible. You want to save your energy reserves for when labor really demands your attention. Ideally, you would try to sleep through this stage if it is nighttime, and if it is daytime, go about your day as normally as possible.
Active labor (or later first stage) usually lasts 3 to 11 hours. Again, there is a wide range of normal here. Active labor means that contractions have become moderate to severe enough that they require your full concentration, they typically last approximately 1 minute long, and they are coming every 2 to 6 minutes. Because of this increased intensity, you will likely require pain management and comfort techniques to some degree (epidural, physical touch, massage, counter pressure, narcotics, laughing gas, whatever is best for you!). This is the part of labor when families often head to the place of birth. The length of this stage is reliant on several factors including, but not limited to: the baby’s position; what positions the mother is able to get into; the birthing environment; if her water has broken; if she has labor support; what the care provider's preferences are; etc.
Because this stage can last a long time and it usually requires mental and physical work to do it, that is why it is so important to rest and conserve your energy during early labor. During the later first stage of labor, your doula may encourage you to manage your labor the way that you want to. If you want to be in the pool, wonderful! If you want an epidural, fantastic! If you want to be on a birthing ball, great! We can also try to help you get on your hands and knees, especially if you are experiencing most of the labor sensations in your lower back. All of these position changes and the mentality to try them take endurance and longevity. Sometimes the pain isn’t the hardest part about labor – it is the required endurance. It is our wish that you go into active labor with a full range of available resources (mental, physical, and medicinal) ready to support you and make your birth journey the one that you desire.
The second stage of labor can take anywhere from minutes to a few hours. This will all depend on what number baby this is for you, what positions you have been laboring in, and what positions you are pushing in. Mothers often find that the pushing stage is a welcome change. After riding the waves of contractions for hours, pushing usually is an organic relief and it can feel great having an active role! Again, this is totally dependent on several factors and even women with similar circumstances can have varying pushing times. This stage ends with baby being born!
Most women are gazing at and loving on their baby and barely notice the third stage of labor, which is when the placenta is delivered. Placentas typically come out within minutes and your care provider will have their preference of the ideal time for this. The best part is that it usually doesn't hurt because there are no bones in a placenta (making it easier to deliver) and you can talk to your care provider about pain management options for this part.
When you hear birth stories that say “Oh, I had a 24 hour labor, it was horrible!”, that is that person's experience and should be absolutely be validated. At the same time, now you know that this is often normal, especially for first time mothers, and that it usually isn’t all back-to-back strong contractions with no break in between (if it is, that is highly unusual and extreme). We want you to understand and have realistic expectations for your labor and we want you to be comfortable and ecstatic about your birth! As we mentioned earlier, here is a sample example of an 18 hour labor for a first time mother:
7 hours early labor
- Mild contractions averaging 15 minutes apart and lasting 30 seconds
- 7 hours of this pattern = 14 minutes of contractions total
11 hours active labor
- 9 hours of moderate to severe contractions averaging 6 minutes apart and lasting 1 minute
- 2 hours of moderate to severe contractions averaging 2 minutes apart and lasting 1 minute
- 11 hours of these patterns = 2.5 hours of contractions total
Total time of contractions before pushing = approximately 3 hours
So, for this mother’s 18 hour labor, the total time for her contractions in early labor was 14 minutes. This is why resting is incredible! If you can try to rest during that time, you are building up and saving your energy for when you will really benefit from it most. And the total time for contractions during active labor was 2.5 hours. We hope this chart helps put into perspective how an 18 hour labor isn’t always incredibly unmanageable, and in fact, is pretty normal.
Studies about trained doulas show that “emotional and physical support significantly shortens labor and decreases the need for cesarean deliveries, instrumental deliveries and use of Pitocin.” (The Obstetrical and Postpartum Benefits of Continuous Support during Childbirth, 1999). We want you to have as much physical support and love around you during labor as possible. We want this birth experience to be the best possible start for your parenting journey!
To learn more about the doula services that Doulas of Denver offers, visit us online at www.doulasofdenver.com
Birth professionals: Please feel free to share this with your clients. If you share our work please give credit where it is due. We are happy to send a PDF with our watermark if you would like this for a handout.
References:
Kennel, John, Marshall Klaus, Susan McGrath, Steven Robertson , and Clark Hinkley, "Continuous Emotional Support During Labor in a US Hospital," The Journal of the American Medical Association 265: 2197-2201, Web, 18 June 2014.
Priest , Ginnie. "Labor and Delivery," Ginnie Priest, LM, CPM , n.d., Web, 18 June 2014, http://birthwithmidwife.com/delivery.pdf.
Scott, Kathryn, Phyllis Klaus, and Marshall Klaus, "The Obstetrical and Postpartum Benefits of Continuous Support during Childbirth," Journal of Women's Health & Gender-Based Medicine 8: 1257-1264, Web, 18 June 2014, http://online.liebertpub.com/doi/abs/10.1089/jwh.1.1999.8.1257
Sosa, Roberto, John Kennell, Marshall Klaus, Steven Robertson , and John Urrutia, "The Effect of a Supportive Companion on Perinatal Problems, Length of Labor, and Mother-Infant Interaction," The New England Journal of Medicine , 11 Sept. 1980, Web, 18 June 2014, http://www.nejm.org/doi/pdf/10.1056/NEJM198009113031101.
"The Stages of Labor," Labor Stages |CPMC San Francisco, California Pacific Medical Center, 1 Jan. 2013, Web, 18 June 2014, http://www.cpmc.org/services/pregnancy/information/labor_stages.html.