What You Need to Know About Labor

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Labor is the process of your baby leaving the uterus. In a full-term pregnancy, this occurs about 40 weeks from the first day of your last menstrual period. The majority of births happen vaginally, but sometimes there is a need for surgical intervention. Approximately 31.7% of babies in the United States are delivered by cesarean section.

As you get closer to your due date, learning the signs of labor can help you feel prepared for the event.

Shot of a young woman giving birth with her husband supporting her in the background

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Signs of Labor

For most people, labor begins sometime between week 37 and week 42 of pregnancy. Labor that occurs before 37 weeks of pregnancy is considered premature, or preterm.

Look out for these signs that labor may be imminent:

  • Your baby drops (the baby's head moves lower into your pelvis): This is called lightening. It means that your baby is getting ready to move into position for birth. It can happen a few weeks or even a few hours before your labor begins.
  • You have an increase in vaginal discharge that’s clear, pink, or slightly bloody: This is called show or bloody show.
  • At a prenatal checkup, your healthcare provider tells you that your cervix has begun to dilate and efface: As you get closer to labor and delivery, your cervix may begin to open and thin. 

You know you’re in true labor when:

  • You have strong and regular contractions: A contraction is when the muscles of your uterus tighten up like a fist and then relax. Contractions help push your baby out. When you’re in true labor, your contractions get stronger and closer together over time.
  • You feel pain in your belly and sometimes in your lower back: This pain doesn't go away when you move or change positions.
  • Your water breaks (rupture of the membranes): Your baby has been growing in amniotic fluid (the bag of waters) in your uterus. When the bag of waters breaks, you may feel a big rush of water. Or you may feel just a trickle. 

True Labor vs. Braxton-Hicks

If you're full-term and start feeling contractions irregularly, but your water has not broken, you might be experiencing Braxton-Hicks contractions.

As you get closer to delivery, your uterus prepares for labor by mildly contracting from time to time but without causing the cervix to dilate. When your uterus makes a "trial run" for real labor, you may feel a tightening or spasming sensation in your abdomen.

There are ways of differentiating between true labor and Braxton-Hicks contractions.

True Labor
  • Contractions get closer together over time.

  • Contractions get stronger.

  • Contractions may be felt all over the belly.

  • Contractions become progressively longer.

  • Contractions don't go away with movement or change in activity level.

  • Contractions feel increasingly painful—and are strong enough to interfere with walking and talking.

Braxton-Hicks
  • Contractions are irregular and don't get closer together or stronger. 

  • Contractions tend to be felt only in the front of the belly.

  • Contractions may stop when you change positions or walk around.

  • Contractions often occur at the end of the day and/or after a lot of physical activity.

  • Contractions range from very mild to moderately painful.

When to Call the Doctor

​If you think you’re in labor, call your healthcare provider, no matter the time of day or night. Call your doctor even if it's weeks before your due date—you might be going into preterm labor. Your doctor or midwife can decide if it's time to go to the hospital or if you should be seen at the office first.

Stages of Labor

Every labor is different. But there are patterns to labor that are true for most people. Learning about the stages of labor and what happens during each one can help you know what to expect once labor begins.

First Stage of Labor

The first stage of labor is usually the longest part. This is when you are having contractions and your cervix is dilating. In your first pregnancy, it usually lasts from 12 to 19 hours but can be shorter. Labor may be shorter in subsequent pregnancies. 

The first stage is divided into two parts:

  • Early labor: The cervix will dilate and thin, with contractions getting stronger, lasting 30–60 seconds, and coming every 5–20 minutes. Many people spend the early part of labor at home.
  • Active labor: This is when you will be admitted to the hospital. Active labor usually lasts about four to eight hours, during which time the cervix expands from 6 to 10 centimeters and contractions become more intense and regular.

Second Stage of Labor

This stage usually lasts between 20 minutes and several hours.

In the second stage of labor, your cervix is fully dilated and ready for childbirth. This stage is the most work for you because your healthcare provider wants you to start pushing your baby out. The second stage ends when your baby is born.

During stage two:

  • You may feel pressure on your rectum as the baby's head moves through the vagina.
  • You may feel the urge to push as if having a bowel movement.
  • The baby's head starts to show in the vaginal opening (called "crowning").
  • The healthcare provider guides the baby out of the vagina. They may use special tools, like forceps or a vacuum device, to help your baby out. Rarely, they may make a small cut, called an episiotomy, to enlarge the vaginal opening.
  • After the baby is born, the umbilical cord is cut.

Third Stage of Labor

In the third stage of labor, the placenta is delivered. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. This stage is the shortest and usually doesn’t last more than 30 minutes.

During the third stage of labor:

  • You continue to have contractions even after the placenta is delivered. You may get medicine to help with contractions and to prevent heavy bleeding.
  • If you had an episiotomy or laceration (tear), your provider repairs it at this time.
  • You may have chills or feel shaky.

Postpartum Hemorrhage

Sometimes heavy bleeding occurs after the delivery of a baby and placenta. This is called postpartum hemorrhage (PPH) and is a potentially life-threatening condition.

Both the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists (ACOG) recommend giving Pitocin, a synthetic form of oxytocin, after delivery to prevent and treat PPH, which occurs in around 3% of U.S. births.

Complications

Each pregnancy and delivery is different, and problems may arise. If complications occur, providers may assist by monitoring the situation closely and intervening, as necessary.

Some of the more common complications are:

  • Preterm labor: This starts before the 37th week of pregnancy. Sometimes, it can start as early as 20 weeks. According to the Centers for Disease Control and Prevention (CDC), about one in every 10 births was preterm in 2018.
  • Labor that does not progress: Sometimes contractions weaken or the cervix does not dilate enough or in a timely manner. You may be given medications to increase contractions and speed up labor, or you may need a cesarean delivery.
  • Perineal tears: A woman's vagina and the surrounding tissues can tear during the delivery process. Sometimes these tears heal on their own. If a tear is more serious or you have had an episiotomy, your provider will help repair the tear using stitches.
  • Problems with the umbilical cord: The umbilical cord may get caught on an arm or leg as the baby travels through the birth canal. Typically, a provider intervenes if the cord becomes wrapped around the infant's neck, is compressed, or comes out before the infant.
  • The baby shows signs of distress: Fetal distress is an uncommon complication of labor. It typically occurs when the baby has not received enough oxygen. Usually, doctors identify fetal distress based on an abnormal heart rate pattern in the fetus. In this situation, the woman is more likely to need an emergency cesarean delivery.
  • Shoulder dystocia: In this situation, the infant's head has come out of the vagina, but one of the shoulders becomes stuck. Your provider will try to move your body and your baby into a better position to help get the baby out.

Cesarean Delivery

Cesarean delivery, also called C-section, is surgery to deliver a baby. Some C-sections are planned. But most C-sections are carried out when problems happen during delivery. Even so, there are risks of delivering by cesarean section. The benefits of having a C-section may outweigh the risks when:

  • The mother is carrying more than one baby (twins, triplets, etc.).
  • The mother has health problems including HIV (human immunodeficiency virus) infection, herpes infection, and heart disease.
  • The mother has dangerously high blood pressure.
  • There are problems with the placenta, umbilical cord, or position of the baby.
  • The baby shows signs of distress, such as a slowed heart rate.

Pain Relief During Labor

Worrying about how you will cope with the pain of labor and delivery is perfectly normal. The amount of pain you feel during labor depends on a number of factors, including:

  • The size and position of your baby
  • The size of your pelvis
  • The strength of the contractions

There are two general ways to relieve pain during labor and delivery: using medications and using "natural" methods (no medications). Some people choose one way or another, while others rely on a combination of the two.

Pain-Relieving Medications

In general, there are two types of drugs for pain relief: analgesics and anesthetics. Analgesics lessen pain without loss of feeling or muscle movement. Anesthetics relieve pain by blocking most feeling, including pain. Details of the two include:

  • Analgesic medicines can be injected into a vein or a muscle to dull labor discomfort. Analgesic medicines do not completely stop the pain, but they do lessen it. Because analgesic medicines affect your entire body and might make both you and your baby sleepy, they are mainly used during early labor to help you rest and conserve your energy. Nitrous oxide—a tasteless and odorless gas—is an example of an analgesic medicine used during labor. It reduces anxiety and increases a feeling of well-being so that pain is easier to deal with.
  • Regional anesthesia (also called epidural, spinal, or systemic anesthesia) is the most common and effective pain relief. Regional anesthesia greatly reduces or eliminates pain throughout the birthing process. It is administered by an anesthesiologist during labor to reduce discomfort.

Prevalence of Epidurals

Many people choose to have an epidural while giving birth. In fact, studies show that around 60% of people in the United States get epidurals for pain relief in labor.

Natural Methods of Pain Relief

Many natural methods help people in labor to relax and make pain more manageable. Steps you may wish to take to ease labor pain include:

  • Relaxation techniques, such as deep breathing, music therapy, or biofeedback
  • Moving and changing positions frequently
  • Using a birthing ball
  • Massage
  • Taking a bath or shower
  • Hypnosis
  • Acupuncture or acupressure
  • Applying small doses of electrical stimulation to nerve fibers to activate the body's own pain-relieving substances (called transcutaneous electrical nerve stimulation, or TENS)

You should discuss the many aspects of labor with your healthcare provider well before labor begins to ensure that you understand all of the options, risks, and benefits of pain relief during labor and delivery before making a decision.

Writing Down Your Labor Plans

Many people find it helpful to put all their labor decisions in writing to clarify their preferences for all those who might be involved in delivering the baby, including nurses and other hospital staff. While it's comforting to have a plan, also be prepared for your plan to pivot, if needed.

A Word From Verywell

As you approach your due date, your doctor or midwife will give you guidance on when to call them or when to go directly to the hospital. Depending on your medical history and what your pregnancy has been like, you may have special rules to follow.

In general, the goal is to head to the hospital when you've reached the stage of active labor (spending the hours of early labor at home). There are a few ways that your body will signal that you're heading toward active labor.

If you’re not sure whether you’re going into labor (or you think you might be but are worried that it’s too soon), call your doctor or midwife.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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