Overview

Every labor and birth experience is unique, but most follow a familiar journey. This episode guides you step by step from the onset of labor through birth and bringing your baby home. You’ll gain a clear understanding of each stage of the process, along with practical tips to help you navigate labor confidently and make informed decisions for a smoother experience.

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Article and Resources

When Will Labor Start?

Your due date can be calculated based on your last menstrual period, date of conception if known, or by measurements on an ultrasound. Any calculation is an estimate, not an exact science. For a deep dive into the evidence and implications of your due date, see this article. 

According to the most recent data available from the CDC: 

• 10.38% of babies were born preterm (before 37 weeks) 
• 29.31% of babies were born early term (37-38 weeks six days) 
• 55.32% of babies were born full-term (39 weeks-40 weeks six days) 
• 4.73% of babies were born late-term (41 weeks)
• 0.26% of babies were born post-term (42 weeks+) 

Keep in mind that in the United States, the cesarean rate is 32.1%, which could affect these figures. The takeaway is that most expecting mothers go into labor between 37-41 weeks.

Signs of Labor

As your baby and body prepare to start labor, you may see one or more of many signs of labor. If you are near your due date, this can be exciting that you are close to meeting your baby. If you still have a ways to go before your due date, these could be signs to watch out for and flags that you should contact your doctor or midwife.

Your Baby Drops (AKA Lightening) 

Your baby may drop lower into your pelvis in the weeks or days leading up to birth. This happens right before labor for some expecting moms, especially the second time.

Your Cervix Dilates and Effaces 

Your cervix must thin out and widen to allow your baby to pass through. Dilation is measured in centimeters, and effacement is measured in percentages. The only way to tell whether your cervix is dilated or effaced is with a vaginal exam performed by a doctor or midwife. If you opt for this intervention, you may hear you are 2 cm dilated and 25% effaced. This may lead you to believe you are close to labor. The truth is that there isn’t a concrete timeline on which labor progresses. You could be slightly dilated for days or longer before labor starts. Cervical measurements from a vaginal exam may be instrumental when considering an induction, but there is no evidence that these measurements can predict when labor will start. As with any intervention, there are pros and cons. See this episode for the evidence on vaginal exams.

You Lose Your Mucus Plug

When pregnant, you have a thick mucus plug in your cervix that keeps bacteria out. The plug may fall out when your cervix starts to thin and dilate. You will likely notice this when you go to the bathroom, and it could be pink or reddish and looks like a thick discharge. If you start losing your mucus plug, you could be days or hours away from starting labor, but it is a sign that labor is coming.

Diarrhea 

Your body releases prostaglandins, which will help your cervix soften. These prostaglandins can also trigger contractions in your bowels, which can mean loose stools or diarrhea before labor. A bright side is that some people believe this will prevent you from having a bowel movement during labor. Many women, indeed, do poop during labor. For more information on the possibility of pooping during labor, see this episode. 

Nausea 

Digestion stops when you go into labor as your body focuses energy on labor. It is thought that your body will want to clear out your digestive system before going into labor. You may be nauseous and even vomit in the early stage of labor. 

Your water breaks 

In the movies, labor almost always starts with someone’s water breaking and is always very public and embarrassing. Only about 8% of labor starts with water breaking. For the majority of expecting moms, this is something that happens during labor. It can be a sudden gush of fluid or a slow leak. There are a few things you want to pay attention to when your water breaks and you can use the acronym COAT to remember them: 

• Color 
• Amount 
• Odor 
• Time 

You will likely want to let your care provider know when your water breaks and any details about it. Your water breaking may set a clock for your care provider. See this episode for information on the 24-hour rule. It is also possible that your water never breaks. It is rare, but some babies are born en caul, which means they are born still inside an intact amniotic sac.

Cramping and Lower Back Pain 

Some expecting moms will feel crampy before labor starts. Think of this as period cramps or milder. You may also have some lower back pain. This can be the early stages of contractions and a sign that you will be in labor soon.

Contractions 

Contractions are the hallmark that you are in labor. The key to differentiating between real labor contractions and Braxton Hicks contractions is that true contractions will continue to get longer, stronger, and closer together. For more in-depth information on Braxton Hick’s contractions, see this article. 

Urge to Nest or Restlessness 

Some pregnant moms experience an urge to nest right before starting labor. This can be a sudden burst of energy to finish a project around the house. You may feel like you need to organize everything for your baby’s room. It could even manifest as going on a baking or cooking spree. If labor is truly around the corner, you want to be well-rested when your labor starts. Please don’t skip out on sleep to tackle projects around your house. 

Intuition 

Intuition isn’t scientific or evidence-based. Anecdotally, many women have some intuition about when they will go into labor. With my first baby, I knew he would be born on a specific day. It was a full moon, but otherwise, there was nothing unusual about that date. I don’t know why. I just felt like that would be the day for months before. My son was born on the exact date I thought he would be, a week before my due date. Maybe you have a feeling about a particular day, or perhaps you just feel like you will go into labor. Trust your gut. We cannot always explain these feelings, which may be inaccurate, but they are worth paying attention to.

Tips When Labor Starts

As soon as you think you are in labor, ensure everything is ready to go to the birth center or hospital. If you have other children or pets needing care, implement those plans. If you can rest in the earliest part of your labor, please do.

When to Call Your Doctor or Midwife

You and your partner should have contact information for your doctor or midwife programmed into your phones. You should also know how to get in touch with them after hours. If you are debating whether or not to call your care provider if you think you are in labor, call. Please inform your care provider immediately if you are not near your due date and have any labor signs. 

Stages of Labor 

Three stages of labor span from the start of labor through the birthing of the placenta. According to the American College of Obstetricians and Gynecologists, for a woman having her first baby, labor typically lasts 12 to 18 hours. For women who have given birth before, it typically lasts 8 to 10 hours. Even though your labor experience will be unique for you, labor and birth usually follow a pattern that can be described in three stages.

First Stage

The first stage of labor starts when labor begins and ends when your cervix dilates (widens) to 10 centimeters and effaces (thins). This stage is primarily letting your body do what it needs to do, and you are just along for the ride. Your job is to find ways to manage contractions and let your body work. This is generally the longest stage and can be broken down into the latent and active phases.

The Latent Phase

The latent phase is from the start of labor until you are dilated to 6 cm. This stage is considered prolonged if it lasts more than 20 hours for a first-time mother. If this is not your first baby, it will likely be shorter and is considered prolonged after 14 hours.

Tips for the Latent Phase

You will likely be home for much of the latent phase. Labor is a marathon. If you can, rest and try to get some sleep. This also goes for your birth partner. They need to be there 100%, so they should be rested too. This is also an excellent time to eat something. You will expend a lot of energy, and your body needs fuel.

The Active Phase

The active phase is from 6 cm to 10 cm. In this phase, your cervix changes more rapidly and predictably. Typically, at a rate of around 1.2-1.5 centimeters per hour. If this is not your first baby, dilation will likely be faster. During the active phase, if your cervix doesn’t change in four to six hours, it is considered an arrest of labor. If your labor is not progressing, your care provider may recommend additional interventions or a cesarean.

Tips for the Active Phase

Contractions do get longer, stronger, and closer together as labor progresses. How you manage contractions depends on what techniques you have learned or practiced and what works best for you. The more tools you have in your toolbox, the better. You can set up your birth room environment to be a calming, safe environment for you to be in during labor and birth. You may utilize hydrotherapy, different breathing techniques, or hypnobirthing. Evidence suggests that some upright or squatting positions can speed up labor. I encourage you to try different strategies to find what works best. You may discover that you are a screamer or that sitting on the toilet is comfortable. Maybe your plan changes, and you end up using some interventions you hadn’t planned.

When to Go to the Hospital or Birth Center

Your doctor or midwife should specify when they want you to call or come in during labor. They will generally advise that you do not go to the hospital or birth center until you are in active labor. Call your care provider if you are unsure whether you should come in. Often, they will be able to tell a lot just from talking to you on the phone about whether you should go in now or wait it out at home longer. In the worst-case scenario, you go in early, and it is a false alarm. You certainly would not be the first expecting mom to go into the hospital or birth center early.

If you plan a home birth, giving your midwife a heads up that you may be going into labor since they are on call for your birth is nice.

When You Arrive at the Hospital or Birth Center

When you arrive at the hospital or birth center, the medical staff will want to take your vital signs and confirm you are in labor. Vital signs include temperature, heart rate, oxygen saturation, respiratory rate, and blood pressure. Your doctor or midwife will monitor your baby’s heart rate and likely recommend a vaginal exam. Electronic fetal monitoring and vaginal exams are interventions that have risks and benefits. Prepare by checking out the Pregnancy Podcast episodes on these topics so you can make an informed decision on your options for these interventions.

In a hospital, once you are admitted to labor and delivery, you can request an epidural, nitrous oxide, a TENS machine, or other pain management tools. It is common practice for hospitals to routinely use IV fluids during labor, especially if you receive other interventions like an epidural or Pitocin.

Second Stage

The second stage of labor is from being fully dilated at 10 cm until your baby is born. Like the first stage, the second stage is usually quicker if this is not your first baby. An epidural also tends to make this stage longer. For first-time mothers, the second stage is considered prolonged if it lasts longer than three hours without an epidural or four hours with an epidural.

The second stage is the pushing stage. The best way to describe pushing is like you are bearing down to make a bowel movement. I wish there were a better way to describe it. You may have the opportunity to see your baby’s head as it is emerging in a mirror. Some women shy away from this because they are afraid to see it, but knowing that you are making progress can be very motivating. Pushing is often a process of taking two steps forward and one step backward. You may see or feel your baby’s head appear, only to disappear a second later. Once your baby’s head is out, the rest of its body is easier.

The first thing that should happen when your baby is born is it should go skin to skin on your chest. If you plan to bank your baby’s cord blood, the umbilical cord will be clamped and cut so that the cord blood can be collected. If you are considering cord blood banking, I urge you to listen to the evidence on that topic in this episode. You may delay umbilical cord clamping if you are not banking cord blood.

Third Stage

After your baby is born, you still have one labor stage. The third stage of labor starts when your baby is born and ends when you birth the placenta. After your baby is born, your uterus will continue to contract. These contractions are much milder than the contractions you experience during birth. During this time, you will be occupied with holding your new baby, and as your uterus begins to contract and shrink, your placenta will detach from your uterine wall. The blood vessels are closed off, and you push the placenta out. Once your placenta is out, your care provider will examine it to ensure everything looks good and is intact, meaning all of it is out. 

Some complications can arise during this process, and your care provider will monitor you closely to ensure everything goes smoothly. The main complications that can arise during the third stage of labor are postpartum hemorrhage, a retained placenta, and uterine inversion.  

Expectant management means that the cord is not clamped early, no medications are administered, and there is no pulling on the umbilical cord. Advocates of this method argue that any interference with the natural cascade of hormones immediately following birth impacts both you and your baby. Active management usually involves early cord clamping, administration of medication, and gently pulling the umbilical cord. It is also possible to combine these, sometimes called mixed management. An example of mixed management could be that you delay the umbilical cord clamping but then receive medications to aid in the delivery of the placenta. See the episode on the third stage of labor to examine the evidence on expectant and active management.

Birth Recovery

If you had an episiotomy or tearing, you may get stitches to repair your perineum. This can be done while your baby is on your chest, which can be a great distraction during this procedure. 

Labor is a marathon, and you will be exhausted and sore after your baby is born. If you had an epidural, you may not be able to walk. Your job is to cuddle your baby, breastfeed, and rest. You will have some postpartum contractions, called afterpains. These are particularly noticeable when you breastfeed, which triggers the production of oxytocin, the hormone that causes the contractions. The good news is that afterpains are short-lived, with the most noticeable contractions subsiding within a week. Just think of these cramps as a reminder that your uterus and body are returning to normal. Another part of your recovery is lochia. This is excess blood, mucus, and tissue from the uterus lining. Bleeding is quite heavy in the first three to ten days postpartum and will taper off over the next several weeks. Talk to your care provider if you have any questions about how you feel and anything going on with your body postpartum.

Your Baby After Birth

There are a lot of procedures and interventions for your baby shortly after labor. Most importantly, you get skin-to-skin with your baby and initiate breastfeeding within the first hour. Many procedures can occur while your baby is on your chest, or you can delay them.

Your doctor or midwife will evaluate your newborn and give your baby an Apgar score. APGAR is an acronym and stands for 

• Appearance (skin color) 
• Pulse (heart rate) 
• Grimace (reflexes) 
• Activity (muscle tone)
• Respiration (breathing effort) 

Each category is scored from 0-2 with a total possible score of 10. If a baby scores six or lower, it may need medical attention. A score of 7-9 is the most common. Your care provider will also record weight, height, and head circumference measurements for your baby.

A Heel Stick is a quick blood test that checks for rare genetic conditions. This takes a few drops of blood from your baby’s heel to send to a lab. 

There are many routine procedures and interventions for your baby shortly after birth or before you leave the hospital or birth center. Remember that just because something is a routine procedure does not necessarily mean it is mandatory. With a few exceptions, you have an ultimate say regarding what procedures occur. By learning about these interventions ahead of time, you can discuss them with your doctor or midwife and make an informed decision on what is best for your baby.

Erythromycin Eye Ointment

Ophthalmia neonatorum is a newborn eye infection in the United States that occurs in 1-2% of newborns. This infection can be caused by sexually transmitted infections, viruses, and bacteria. Administering erythromycin eye ointment to newborns is a standard procedure in the United States to prevent ophthalmia neonatorum. As with any intervention, there are pros and cons to consider. This episode examines the evidence on the efficacy and safety of erythromycin eye ointment so that you can make an informed choice for your baby.

Vitamin K

At birth, babies naturally have low levels of vitamin K. The danger of low levels of vitamin K is the risk of bleeding from vitamin K deficiency. This is a rare but severe complication. You can decrease the risk of vitamin K deficiency bleeding with the vitamin K shot. Administering the vitamin K shot to newborns is standard in the United States and many other countries. As with any intervention, there are pros and cons to consider. This episode examines the evidence on the efficacy and safety of the vitamin K shot so you can make an informed choice for your baby. 

Hepatitis B Vaccine

The first dose of the Hepatitis B vaccine is a standard procedure before your baby leaves the hospital or birth center. You can opt-in or out of this vaccine or delay it until a later appointment with your pediatrician. You can learn more about vaccines for your baby in this episode. Please discuss any questions or concerns with your doctor, midwife, or pediatrician.

Going Home

How long you stay in the hospital or birth center depends on how you and your baby are doing after birth. Most hospitals will have you stay at least one night. A birth center may send you home the same day you have your baby. If you have a home birth, your midwife will stay for several hours to ensure you and your baby are doing well.

Your care provider will cover a lot of information before you go home. It would be helpful to have your partner present for that conversation to help you remember everything. Your care provider should go over procedures to take care of yourself as you are healing and take care of your baby’s umbilical cord. They will go over what you can expect for the next few days and any warning signs you should keep an eye out for.

Cesarean Birth

Hopefully, this article gives you a better idea of what to expect in labor and birth. There is always the possibility that complications arise and your labor does not go as planned. Thankfully, you are working with a doctor or midwife, nurses, and other medical staff who will ensure you and your baby are healthy. Every expecting mother should have an idea of what is involved in a cesarean birth. You do have options if you know what those options are. There is an episode on cesarean birth and an episode on options to make a cesarean more mom- and baby-friendly.

Additional Resources

There are a lot of additional episodes of the Pregnancy Podcast that go into more detail on interventions and pain relief options. You can learn more about having a baby at a birth center, hospital, or at home. Check out the episode guide for all of the Pregnancy Podcast episodes.

Thank you to the amazing companies that have supported this episode.