Three distinct stages of labour

Childbirth includes three stages of labour; they are called the first, second and third stages. The first stage is actually two parts, the latent phase and the active or established phase. Once labour is ‘established’ (labour is active), each stage continues on from the preceding stage; this means that, for most women, once labour begins it will continue through each stage until the baby is born and the placenta is delivered.

Once in labour, a woman may have difficulty communicating her wishes about care preferences, so during pregnancy, it is a good idea to write down care preferences for labour and what ideally you’d wish to be avoided (for example, stating a preference for epidural analgesia and a wish to avoid an active third stage approach). This is called a birth plan. You may want to discuss your birth plan with those who will provide support to you in labour, your partner or friends, and with your midwife or doctor. It is important to remember, however, that you can change your mind about what you’ve chosen and written in your birth plan; labour and birth does not always go according to plan and unforeseen events may occur that require a different approach to the one you may have originally chosen.

The first stage of labour

The first stage of labour actually consists of two stages: the latent stage and active stage.

Latent first stage of labour

This is the time when your body is preparing for labour. There will be some painful contractions but these contractions are often irregular, may vary in strength and duration, and may stop and start. These are to prepare your cervix for active labour. In fact, the cervix may thin down (efface) or dilate up to 4cm during this time.

The latent phase is very variable and can last anywhere from a few hours to several days. For this reason, if you attend hospital during the latent phase, you may be asked to return home again. This can be disappointing but there is no way to predict how long this phase can take so you don’t want to be waiting around in the hospital until the next stage. Research also shows that labour progresses better for women who remain at home.

During this time you may notice passing the mucus plug which may also be bloodstained (a “show”). However, any fresh blood loss at this time is not normal and should alert you to seek medical advice. Additionally, your waters may break (the membranes around the baby break and the amniotic fluid is released). If this happens you should contact your hospital or midwife for advice and they may ask that you attend for assessment. Again, you may be asked to return home at this point.

The latent phase can be tiring and it’s important to get as much rest as possible before the next stage of labour. Relaxation can shorten this stage. Some women find water can be soothing, and you may find benefit in taking a bath or shower (but do not have a bath if your waters have broken). You may also find breathing exercises to be beneficial. Your partner can provide support by rubbing your back or offering a massage. Activity such as walking or sitting on an exercise ball and rotating your hips can help to speed up the latent phase.  Simple pain relief medication like paracetamol can also help.

Active first stage of labour; “established labour”

Labour is established when contractions become regular and painful, usually every 2-3 minutes, and the cervix is at least 4cm dilated. However, this is only a guide; each woman is different, and how many children a woman has had and how she responds to pain will also play a part. All of this makes it difficult to say whether labour is established without examining a woman’s cervix.

In this stage of labour, the regular contractions cause the cervix to progressively open (dilate) up to 10cm to allow the baby to leave the womb. The time taken for the cervix to open differs for each woman. If this is your first baby, expect to see a change of 0.5-1cm each hour. This will be faster if you have already had a baby.

During this time you will receive one-to-one care. This means that you will have your own midwife who will stay with you for the remainder of your labour. Depending on the time you go into labour or if your labour is long, the midwife might change due to shift patterns. The midwife will make regular examinations of your cervix (usually every 4 hours in the first stage) and monitor the baby, either intermittently or continuously (see fetal monitoring in labour).

You will have a variety of pain relief methods available to you in labour. It’s a good idea to know in advance what your preferences are and to note these on your birth plan. You will be supported in your choices and you can change your mind as your pregnancy or labour develop.

The end of the first stage is when the cervix is fully open. Towards the end of the first stage, you may feel a lot of pressure as the baby’s head exits the womb into the vagina. It may feel like you need to open your bowels or you may start to feel the urge to push or “bear down”. It can feel quite uncomfortable and you may feel unwell or worried during this time. This is sometimes referred to as the transitional phase (when you transition from the first to the second stage).

The second stage of labour

The second stage of labour begins when the cervix is fully open or 10cm dilated and ends with the birth of the baby. During this stage, the baby travels down the birth canal. Contractions may feel stronger and you may feel the urge to bear down. Contractions squeeze in a wave-like motion from the top of the uterus (womb) downwards and help to move the baby.

The passive second stage of labour

This is after your cervix is fully dilated but before any involuntary or active pushing. Sometimes it is recommended that the passive second stage lasts 1-2 hours to allow the contractions to move the baby lower down the birth canal before the effort of pushing is started. Sometimes the urge to push is so stong that there is no passive stage and pushing is started straight away.

The active second stage of labour

This is when pushing is started, either consciously or involuntarily, and ends with the delivery of the baby.

Overall, the second stage can last from just a few minutes to as long as a few hours. Certain factors influence the length of the second stage – for example, women who have had a baby before may have a shorter second stage than a first-time mum, and women who have an epidural for pain relief may have a longer second stage. However, as a guide, birth is expected to take place within three hours of the second stage for first-time mums and within two hours for mums who have had at least one previous baby.

Third stage

The third stage of labour begins once the baby is born and ends with the expulsion of the placenta and membranes, marking the end of the labour journey. This stage generally lasts a few minutes but can last up to 60 minutes. There are two main approaches to “managing” the third stage: a physiological third stage or an active/managed third stage. If a physiological approach is followed, the placenta is allowed to detach from the uterine wall naturally (through the action of contractions). During an active third stage, an injection of a drug is given to help strengthen contractions. This injection speeds up the third stage and has been shown by research studies to lessen the amount of blood loss.

Immediately following the third stage is the time when mum (with partner/birth supporter) and baby ideally would spend time together in a quiet environment getting to know one another – this is sometimes known as the “fourth stage”, and although not an official stage, it is one of the most important and special.  Skin-to-skin contact between mum and baby is good to do during this time because it helps bonding and keeps baby warm, and if your choice is to breastfeed, it is good to try breastfeeding during these initial hours following birth. The baby will also be weighed in these first few hours and, if you’ve agreed, vitamin K will be given to the baby.

Main Points

• Labour is divided into three main stages: the first, second, and third.
• The latent first stage is your body preparing for labour. During this phase, you may pass the mucus plug from the cervix (a ‘show’), your waters may break, and contractions may start (although they may be irregular and vary in strength).
• The latent stage can last from a few hours to several days.
• If you go to the hospital during the latent phase, you may be told to go home again.
• The first stage of labour is “established” when your contractions become strong and regular and the cervix dilates beyond 4cm. A midwife or doctor will examine your cervix to assess the onset and progression of labour.
• Once active labour has begun, it may be difficult to communicate your care preferences to your maternity team, which why it’s important to write down your preferences beforehand in your birth plan (remember that you can change your mind about what you’ve written in your birth plan and that unforeseen complications may mean your birth does not go according to plan).
• The second stage of labour begins when the cervix is fully open and ends with the birth of the baby. Contractions are stronger during this stage, and you’ll have more of an urge to push as your baby moves down the birth canal.
• The length of the second stage can vary – from a few minutes to a few hours – based on several different factors such as the form of pain relief used and whether you’ve had a baby before.
• The third stage begins once the baby is born and ends with the delivery of the placenta.
• You will have a choice between a physiological third stage, where the placenta is allowed to detach from the uterine wall naturally, or a managed third stage, where an injection is given to speed up its delivery. This usually lasts a few minutes, but it can last up to 60 minutes, and complications, such as a retained placenta, could mean it lasts longer.

Further information

Editors: Macdonald S, Johnson G. (2017). Maye’s Midwifery (Fifteenth edition). London, Elsevier.
Editors: Symonds I M, Arulkumaran S. (2013). Essential Obstetrics and Gynaecology (Fifth edition). London, Elsevier.