The following is an excerpt from Natalia Hailes and Ash Spivak’s Why Did No One Tell Me This?: The Doulas’ (Honest) Guide for Expectant Parents. Reprinted by permission of Running Press, part of the Perseus division of Hachette Book Group. Copyright 2020 Natalia Hailes and Ash Spivak.
Rethinking the stages of labour
You’ve likely read about the “stages of labour” before based on the dilation of your cervix. We’d like to present them to you in a different light; after all, the numbers don’t give us that much information anyway, and you can’t do cervical exams on your own.
Instead, we want to turn your focus to the experience of labour—the key indicators of how the body and emotions may change throughout the process—so you can get a sense of where you are without focusing as much on the time or whether you’re moving fast enough.
Also keep in mind this is based on physiological birth. Things may feel different if and when interventions are introduced, though you may still be able to note some of these markers. Remember every body is different, so it may not happen exactly like this for you.
Getting prepped: “Is it labour now? Is it labour now?”
How long: A few weeks to a few days before the onset of labour. Or you may never experience it at all.
- Increased Braxton-Hicks or “practice contractions”
- Lightning-like sensation in your crotch
- Feeling that baby is “dropping” as baby moves down into pelvis
- Increased vaginal secretions, including losing your mucus plug
- Soft, loose stools, even diarrhea
- Backache, cramping, nausea
- Nesting instincts pick up.
- Highs and lows
- Is this it? Is it labour? Is this it? Is this labour?
Braxton-Hicks or “practice contractions” feel different from labour contractions. Braxton-Hicks contractions feel like a tightening and release: your belly becomes as hard as a rock, and then it is soft again. Labour contractions have a wave-like shape: building, peaking, and coming down. They will also become longer, stronger, and more consistent over time. Sometimes increased B.H. contractions can be a sign of dehydration, so drink up. While not everyone experiences B.H. contractions, if you do, it’s a great opportunity to practice taking nice long inhales and exhales as a way to cope with the sensation.While annoying, B.H. contractions also have a benefit! They help strengthen your uterine muscles to prep for labour. #gouterusgo!
Tip: Be sure to go to bed at a reasonable hour once you are at 37 weeks. You don’t want the one day you stay up till 1 a.m. to be the day labour starts!
A change has occurred! Labour Begins . . . dun dun dun.
- Your water breaks.
- You start having wave-like, semi-consistent contractions.
Phase 1: OK, it’s labour
(aka Early Labour)
How long: Can last for a few hours to a few days. For many, it starts in the middle of night.
– Irregular pattern with downtime between (could be seven minutes, 10 minutes, 20 minutes, who knows!)
– They’re short! Under one minute each.
– The sensations are manageable. You may be able to talk through them or you may need to pause momentarily, but they don’t take everything you’ve got to make it through.
- You might have an urge to eat a big meal.
- You might feel nauseous and icky.
- You are still social; distractible.
- It may be hard to let yourself rest or go about your day because you feel anxious or excited or both that labour has begun. Remember to try and ignore your labour during this phase!
A change has occurred! Eek! These contractions are picking up.
- Contractions are starting to last longer, come closer together, and be more intense.
- A definite, consistent contraction pattern is starting to show itself.
- You need to pause to breathe through and cope with your contractions.
- You can’t be as sociable anymore.
Phase 2: Is it time to go yet? Does the midwife come over?!
(aka transitioning to Active Labour)
How long: Lasts for hours, not days.
- Contractions: Clearly coming closer together, lasting longer, and feeling more intense.
- Finding a comfortable position is hard.
- Laying down is less comfortable.
- You may feel nauseous.
- You may vomit.
- You don’t want people talking to you during a contraction.
- You need to focus to get through your contractions.
- Shit . . . these are hard!
- Is it time to go to my birthing place yet?
A change has occurred! It’s likely “Active Labour.”
At least two of the following are happening . . .
- Contractions are coming every couple of minutes consistently, lasting for a full minute (fifty seconds doesn’t count!) and this has been happening for at least a full hour.
- You see bloody show—sort of like a period—not your mucus plug.
- You feel rectal pressure—like you have to poop.
Phase 3: OMG, these contractions are intense
(aka Officially Active Labour)
How long: Typically lasts for hours, in the single digits.
All of the above, plus:
- You may vomit.
- You may feel nauseous.
- You may feel hot, then cold, then hot again, then cold . . .
- You may have the shakes.
- Clinically you’re considered to be in active labour when you’re 6 cm dilated.
Tip: This is typically a good time to go to your birthing place, ensure your midwife is at your home, or get an epidural if you are choosing one.
- You need to use your coping techniques—and your support team—to make it through the contractions.
- You might feel overwhelmed, scared, tired, and/or like labour sucks.
- You may be surprised by the sensations you are feeling—they are different than you expected!
- You may feel like finally you made it! Things are moving!
Tip: If at any point you feel like something is off, see green or brown in your fluids, or (and remember, this is very rare!) see excessive bleeding, feel stillness (you will likely feel your baby move less at this point—this is normal), or aren’t sure, trust your gut. Check in with your provider.
A change has occurred! I think I’m gonna poop my pants! (Nah, that’s just baby.)
- Feeling like you’re going to poop yourself during contractions
- Making involuntary grunting sounds
- Sweating/feeling very hot
- I’m done! Give me that epi! (If you don’t have one yet.)
Phase 4: Transitioning to pushing
How long: Minutes to a few hours
- Contractions: Similar to active labour, but contractions are feeling even more intense and lasting a little bit longer—a bit over one minute each.
- An irresistible urge to push
- More blood
- Involuntary grunting sounds
- Oh man, this is INTENSE!
- A feeling like you are so completely done and you want that epidural (if you don’t have one).
A change has occurred! (Now I really think I’m gonna poop.)
- The rectal pressure is constant and doesn’t go away between contractions.
- You’re pushing involuntarily.
- You’re fully dilated!
Phase 5: Pushing
The average for first-time pushers is at least two hours. If this isn’t your first time, it may move more quickly. Regardless, we are talking a few hours in the single digits, tops.
1. Snooze break
How long: 10–30 min, or not at all
Body: Some people experience this “resting phase” right before pushing. Though you are fully dilated, your contractions may slow down and space out.
Emotions: You may feel energized, more aware of your surroundings, or perhaps scared of pushing. Take advantage of this period as much as you can. Rest up!
2. Prairie-dogging it
How long: Minutes to a few hours
Body: Remember that pubic bone? Well, getting baby’s head to come down and under it is usually the longest phase of pushing. Baby’s head has to “prairie-dog” it for a while, meaning the head comes down under the bone when you push, and then gets sucked back up as soon as you stop pushing. That bone is really in the way! While this can certainly feel frustrating, it’s good to remember that you are moving forward. Even though it can be a slow process, you are moving two steps forward and one step back until baby makes it past that pubic bone for good. It’s typically smoother sailing from there.
Emotions: Determination and also WTF?! Why is it taking so long?! Get outta there baby!
3. Ring of fire
How long: Minutes
Body: You made it past the pubic bone! Yahoo! Next comes the sensation of your perineal area stretching as baby’s head crowns. Remember the sensation is actually protective—it allows you to slowly stretch before baby’s head plops out.
Emotions: Holy shit. Holy shit. Holy shit.
4. Half in, half out
How long: Seconds to minutes
Body: Generally, there’s a brief break once baby’s head makes it through—if you stare down between your legs, you’ll literally see baby’s head just chilling out there, but their body is still inside you! What a wild reminder that you are passing a human being through your body. Take it in! Baby’s body generally slips out pretty quickly from here.
Emotions: These are your final pushes, and they won’t be nearly as intense as the ones that came before. You may feel excited to finally meet your baby, excited for it all to just be over, a little anxious that you’re about to officially be a parent, and/or totally out of it and not very conscious of what you’re feeling at all. When baby is born, some people are ready straightaway to bring their baby to their chest and snuggle, and other people need a second. You do you!
5. The placenta
How long: It typically takes between 5 and 45 minutes before the placenta is ready to be born. Once it is, birthing it usually takes only a few minutes.
Body: You will still feel contractions once baby is born (albeit they won’t feel nearly as strong as labour contractions and you’ll likely be quite distracted by your baby). For the most part, birthing the placenta is a pretty easy breezy process in comparison to everything else you just went through—remember placentas don’t have bones! But sometimes, the placenta needs a little help being born. In this case your provider may need to put their hands inside of you to help the placenta detach and massage your uterus externally to help it contract. This kind of sucks, but usually moves quickly. (Just a warning!) Once that placenta is born, you will feel the sweet, sweet relief of emptiness inside you.
Emotions: OMG, I had a baby!