The ABCs of Birth

Know almost as much as your doctor with our step-by-step guide to labor and delivery.
Pregnancy Month by Month: Preparing for Labor
Pregnancy Month by Month:  Preparing for Labor

In the weeks before your due date, you may think you're ready for your baby's arrival. You've packed the hospital bag, put the finishing touches on the nursery, and stocked up on diapers. But will you know what to expect when those contractions begin? Read on so you'll be fully prepared.

The First Stage

Experts don't know for sure what induces labor, but they think that the adrenal gland releases the hormone cortisol, which stimulates the placenta and causes the uterus to contract. At the same time, your cervix will thin, soften, and begin to dilate. This is the start of the first and longest stage of labor. It averages 12 hours for first-time moms, and it consists of three phases.

Latent Phase. Your contractions -- which start off short and infrequent -- will build in intensity and become more regular during this phase, which can last several hours. Most women are relatively comfortable at this time. You'll still be at home, and your doctor will probably recommend that you alternate between rest and light activity.

"If your contractions are consistently four to five minutes apart for an hour and they're intense enough that you can't comfortably talk or walk through them, let your obstetrician know," says John R. Sussman, M.D., chairman of obstetrics and gynecology at New Milford Hospital, in Connecticut, and coauthor of The Unofficial Guide to Having a Baby. Your doctor will probably want you to head to the hospital. You should also call if you experience heavy bleeding or if your water breaks. (The water may break at any time after labor begins, but for some women, the amniotic membrane won't rupture, so after you're fully dilated, your doctor will break the membrane manually by puncturing it with a small hook.) By the end of this phase, your cervix will be dilated three or four centimeters, and your contractions will be coming every five minutes.

Active Phase. At the hospital, your contractions will become more intense and occur every three to five minutes. Over the next few hours, your cervix will dilate eight to nine centimeters, and you'll feel discomfort and some pain as the contractions progress and become stronger. Many women find that it helps to move around: Take a short walk down the hall, try squatting with the help of your spouse, go for a dip in the tub if your hospital has one, or practice your breathing and relaxation exercises. This is also usually the time when your doctor will offer you pain medication, such as an epidural, to take some of the edge off your contractions.

Transition Phase. At this point, your contractions will be coming every two to three minutes, and your cervix will dilate from nine to ten centimeters. "This can be the toughest time for some women, who may become frustrated if their contractions slow down before they're fully dilated or if they feel the urge to push before it's time," explains Isabel Blumberg, M.D., an ob-gyn in New York City. The good news is that this phase usually lasts no more than an hour and a half.

The Second Stage

At this stage, you will be fully dilated, and your baby will be descending through the pelvis and birth canal. As your contractions continue, you'll feel an overwhelming urge to push. Depending on your baby's size and position, it can take anywhere from a few minutes to more than an hour of pushing before your baby is born. You may find that you're completely exhausted by this point. Changing positions, taking deep breaths, and trying to relax between contractions can help.

Finally, your doctor will let you know that the baby has crowned, which means that the top of his head is visible and about to come out. His head will then stretch the skin of your perineum (the area between the vagina and rectum), and soon after, his head will emerge, followed by one shoulder and then the other. The rest of your baby's body will slip out easily into your doctor's waiting hands.

The Third Stage

The hard part is over at this stage, but you're not done yet. After the doctor rests your newborn on your chest, he'll clamp and cut the umbilical cord -- or ask the baby's father whether he wants to cut it. (The clamp will stay on the cord for a few hours until it's dry; only a stump will remain until it falls off on its own in a week or two.) Then it will be time to deliver the placenta, also called the afterbirth. This stage usually lasts less than 30 minutes. While you may still have contractions, they won't be as intense as before. In fact, you may not even realize you're delivering the placenta or remember it later on, because you'll be focused on your newborn. After all, you've just gone through one of the most exciting -- and exhausting -- experiences of your life, and you now have a beautiful baby to show for it!

Baby's Busy First Minutes

Immediately after your infant's birth, the doctor or nurse will use a suction bulb to clear his mouth, nose, and throat of mucus and amniotic fluid. He'll be cleaned up quickly, then at one minute and again at five minutes after birth, the nurse will check your newborn's Apgar scores -- which are based on his muscle tone, heart rate, responsiveness, skin tone, and breathing. He'll be weighed and measured, then wrapped in a blanket. Finally, the nurse will put drops of antibiotic ointment or gel into your infant's eyes to prevent infection, and because babies are born with small amounts of vitamin K, a blood-clotting agent, he'll be injected with the vitamin to prevent excessive bleeding.

Copyright © 2004 Nicole Bokat. Reprinted with permission of Parents magazine May 2004 issue.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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