After nine months of pregnancy, the big day has finally arrived and a woman is experiencing signs that labor has begun. She may feel both excited and nervous about giving birth.
"There is a fear part associated with labor," said Leslie Ludka, a certified nurse midwife and the director of midwifery at Cambridge Health Alliance in Cambridge, Mass.
Since there is no way to predict labor — when it will begin, how long it will last, how much pain a woman might feel, and how she will cope with the process — childbirth education is important, Ludka said. She said that if a woman is educated about what to expect ahead of time, she is more likely to be successful in her birth plan.
A birth plan can be prepared in advance and is a tool to describe how a woman would like to see her labor and delivery go, Ludka told Live Science.
Such a plan contains a list of preferences for the baby's birth and is a guideline to communicate a woman and her partner's wishes and goals for labor and delivery. Some hospitals or birthing centers may have a form or checklist a woman call fill out to create her birth plan. A sample birth plan is available from the March of Dimes.
For example, in a birth plan a woman and her partner can discuss and decide on the following information:
- Preferences for managing labor pain
- Amount of movement desired during labor and desired positions for delivering
- The primary support person during labor and what role that individual will play
- Instructions in case of unexpected complications during labor or delivery, such as C-sections, use of forceps or vacuum extraction, episiotomies
- Post-birth baby care: cutting the umbilical cord, holding the newborn, breastfeeding, circumcision for a boy, saving umbilical cord blood or the placenta
If she decides to prepare a birth plan, a woman should review it with her health care provider weeks before she delivers to understand some of the risks and benefits of her choices. And it's fine for her to change her mind about these instructions when she is actually in labor as long as she communicates this to her labor and delivery team.
As long as there are no unexpected complications to mother or baby during labor, the team will try to honor that birth plan, Ludka said. Below, she discusses what typically happens during the three stages of labor.
Three stages of labor
The first stage of labor lasts the longest, anywhere between 12 and 19 hours, according to the U.S. Office on Women's Health (OWH). During the first stage, the cervix begins to open up (dilates) and thins out (effaces) to stretch and prepare for birth. Effacement usually begins during the ninth month of pregnancy, and a doctor or midwife can check and measure whether this process is underway with a pelvic exam.
Related: Signs of labor: 6 clues baby is coming soon
The first stage of labor consists of two phases: early labor and active labor.
Early labor, especially for a first-time mother, may last anywhere from six to 12 hours, according to the Mayo Clinic. Since many women aren't that uncomfortable during early labor they may spend this time at home, until their contractions increase in frequency and intensity.
During active labor, the cervix has dilated to 6 centimeters (2.4 inches) and contractions become more frequent and painful. Each contraction may last about one minute. By this point, most women have gone to the hospital, birthing center or location where they will deliver.
At the hospital, an electronic fetal monitor will be placed around a woman's abdomen to check the strength, length and frequency of her uterine contractions and keep track of the baby's heart rate in response to these contractions.
The second stage of labor is when a woman's cervix has fully dilated to 10 cm (4 inches). Her contractions will be stronger, longer, closer together and regular, Ludka said.
This is the stage during which a woman starts pushing to deliver her baby. She will push hard during contractions and rest in between them.
To increase a woman's chances of having a vaginal delivery instead of a C-section, newly released guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) recommend that first-time mothers are allowed at least three hours to push during the second stage of labor. If a woman has had a baby before, the guidelines recommend that mothers be given at least two hours to push during active labor.
The ACOG guidelines also suggest that women who have had an epidural, which is when a small tube is placed into the lower back to deliver pain medication, may be given an even longer amount of time in the second stage of labor since there's research suggesting that using epidurals may prolong labor more than previously thought.
A first-time mother will typically have a longer labor than her second or third deliveries, Ludka said. That's because the body has never labored before, and it's an entirely new process. Labor is usually shorter with subsequent normal and healthy pregnancies because the body has already had the childbirth experience, she explained.
The average amount of time a woman spends in labor is 12 to 24 hours for a first birth and eight to 10 hours for subsequent births, according to The Cleveland Clinic.
In the third stage of labor, which is the shortest stage, an obstetrician or midwife will deliver the placenta, also known as the afterbirth. This stage can last anywhere from five to 30 minutes.
Managing labor pain
For some women, the pain of giving birth is comparable to having menstrual cramps, while for others the pain might be excruciating, Ludka said. That's why childbirth education is so important; it helps women understand what to expect and to be prepared for it, she explained.
"Birth is really a natural body process and there are ways to deal with the pain," Ludka said.
The amount of pain a woman feels during labor can be affected by the size and position of the baby, the size of her pelvis, the strength of her contractions and even her emotions.
Tips during labor
What's most important when giving birth is "letting the body do what it needs to do," Ludka suggested. Here are her other tips to prepare for labor.
- During early labor, stay hydrated. Little sips of water, juice or a sports drink can help keep up a woman's stamina.
- "Relaxation is really the key," Ludka said. Staying relaxed as much as possible lets the body do what it needs to do during labor, she explained. Some women like to walk; others prefer soaking in a tub, doing breathing exercises, getting a back massage, or sitting in a rocking chair or on a labor ball. Ludka also recommends keeping things calm by lowering the lights and listening to soothing music.
- The mother should choose a team of trusted and supportive people to be with her during the delivery.