What is labor?
Labor is a series of continuous, progressive contractions of the uterus which help
the cervix open (dilate) and to thin (efface). This lets the fetus to move through
the birth canal. Labor usually starts 2 weeks before or after the estimated date of
delivery. However, no one knows exactly what triggers the onset of labor.
What are the signs of labor?
Signs of labor vary from woman to woman, as each woman experiences labor differently.
Some common signs of labor may include:
Bloody show. A small amount of mucus, slightly mixed with blood, may be expelled from the vagina
indicating a woman is in labor.
Contractions. Contractions (uterine muscle spasms) occurring at intervals of less than 10 minutes
are usually a sign that labor has begun. Contractions may become more frequent and
severe as labor progresses.
Rupture of amniotic sac (bag of waters). Labor sometimes begins with amniotic fluid gushing or leaking from the vagina. Women
who experience a rupture of the amniotic sac should go to the hospital immediately
and contact their healthcare provider. Most women go into labor within hours after
the amniotic sac breaks. If labor still has not begun after 24 hours, a woman may
be hospitalized for labor to be induced. This step is often taken to prevent infections
and delivery complications.
If you are unsure if labor is beginning, call your healthcare provider.
What are the different stages of labor?
Each labor is different. However, labor typically is divided into 3 stages:
First stage. This is the onset of labor to complete dilation and is divided into the latent phase and the active phase. Women can have very strong, painful contractions during the latent phase. The cervix
dilates (opens approximately 3 or 4 centimeters) and effaces (thins out). Some women
may not recognize that they are in labor if their contractions are mild and irregular.
The latent phase is when contractions become more frequent (usually 5 to 20 minutes apart) and somewhat
stronger. This is usually the longest and least intense phase of labor. The mother-to-be
may be admitted to the hospital during this phase. Pelvic exams are done to determine
the dilatation of the cervix.
The active phase is signaled by the dilatation of the cervix from 6 to 10 centimeters. Contractions
become regular, longer, more severe, and more frequent (usually 3 to 4 minutes apart).
Most women feel the urge to push during this phase. In most cases, the active phase
is shorter than the latent phase.
Second stage. The second stage of labor starts when the cervix is completely opened and ends with
the delivery of the baby. The second stage is often referred to as the "pushing" stage.
During the second stage, the woman becomes actively involved by pushing the baby through
the birth canal to the outside world. When the baby's head is visible at the opening
of the vagina, it is called "crowning." The second stage is shorter than the first
stage, and may take between 30 minutes to 3 hours for a woman's first pregnancy.
Third stage. After the baby is delivered, the new mother enters the third and final stage of labor--delivery
of the placenta (the organ that has nourished the baby inside of the uterus). This
stage usually lasts just a few minutes up to a half-hour. This stage involves the
passage of the placenta out of the uterus and through the vagina.
Each labor experience is different and the amount of time in each stage will vary.
However, most women will deliver their baby within 10 hours after being admitted into
the hospital, if the labor is not induced. Labor is generally shorter for subsequent
Induction of labor
In some cases, labor has to be "induced," which is a process of stimulating labor
to begin. The reasons for induction vary. Labor induction is not done before 39 weeks
of pregnancy unless there is a problem. Some common reasons for induction include
The mother or fetus is at risk
The pregnancy has continued too far past the due date
The mother has preeclampsia, eclampsia, or chronic high blood pressure
Diagnosis of poor growth of the fetus
Some common techniques of induction include the following:
Inserting vaginal suppositories that contain prostaglandin to stimulate contractions
Giving an intravenous (IV) infusion of oxytocin (a hormone produced by the pituitary
gland that stimulates contractions) or similar drug
Rupturing (artificially) the amniotic sac
Care at the hospital during labor
When a woman arrives at the hospital in labor, the nursing staff may do a physical
exam of the abdomen to determine the size and position of the fetus, and an exam of
the cervix. The nursing staff may also check the following:
IV fluids are sometimes given during labor. The IV line, a thin plastic tube inserted
into a vein (usually in the woman's forearm), can also be used to give medicine. IV
fluids are usually given once active labor has begun, and also are needed when a woman
has epidural anesthesia.
The fetus, too, is carefully monitored during labor. A monitor may be placed over
the mother's abdomen to keep track of the fetal heart rate.
What are pain management options during labor?
A woman has many options for pain relief that occur during labor and the birth of
her baby. Generally, mothers and their healthcare provider want to use the safest
and most effective method of pain relief for both mother and baby.
The choice will be determined by:
There are 3 main types of pain management for labor and birth:
Nonmedicated measures. These measures provide comfort and relieve stress, sometimes called natural childbirth.
Many women learn techniques to help them feel more comfortable and in control during
labor and birth. Some of these techniques include:
Relaxation. These techniques such as progressive relaxation, in which various muscle groups are
relaxed in series, can help a woman detect tension and be better able to release that
Touch. This may include massage or light stroking to relieve tension. A jetted bath or a
shower during labor may also be effective ways to relieve pain or tension. Ask your healthcare
provider before taking a tub bath in labor.
Heat or cold therapy. This is used to help relax tensed or painful areas, such as a warmed towel or a cold
Imagery. These technique of using the mind to form mental pictures that help create relaxed
Meditation or focused thinking. Meditation focuses on an object or task, such as breathing helps direct the mind away
from the discomforts.
Breathing. These techniques use different patterns and types of breathing to help direct the
mind away from the discomforts.
Positioning and movement. Many women find changing positions and moving around during labor helps relieve discomfort
and may even speed labor along. Rocking in a rocking chair, sitting in the "Tailor
sit" position, sitting on a special "birthing ball," walking, and swaying may be helpful
to relieve discomfort. Your healthcare provider can help you find comfortable positions
that are also safe for you and your baby.
Analgesics. These are medicines to relieve pain such as meperidine. Small amounts are generally
safe during labor and are commonly used with very few complications. However, if
given in large amounts or in repeated doses, analgesics can cause slowing of the breathing
center in the brain in mothers and babies.
Anesthesia. These are medicines that cause loss of sensation include pudendal block, epidural
anesthesia and analgesia, spinal anesthesia and analgesia, and general anesthesia.
Local block. Anesthesia injected in the perineal area--the area between the vagina and rectum-- numbs
the area for repair of a tear or episiotomy after delivery
Pudendal block. A type of local anesthesia that is injected into the vaginal area (affecting the pudendal
nerve) causing complete numbness in the vaginal area without affecting the contractions
of the uterus. The woman can remain active in pushing the baby through the birth canal.
It is used for vaginal deliveries.
Epidural anesthesia (also called an epidural block). This anesthesia involves infusing numbing medications through a thin catheter that
has been inserted into the space that surrounds the spinal cord in the lower back,
causing loss of sensation of the lower body. Infusions of medications may be increased
or stopped as needed. This type of anesthesia is used during labor and for vaginal
and cesarean deliveries. The most common complication of epidural anesthesia is low
blood pressure in the mother. Because of this, most woman need to have an intravenous
infusion of fluids before epidural anesthesia is given. A risk of epidural anesthesia
is a postpartum headache. It may develop if the epidural needle enters the spinal
canal, rather than staying in the space around the canal. The anesthesiologist will
discuss the risks, benefits, and alternatives to the various methods of pain relief
with the patient.
Epidural analgesia. This is sometimes called a "walking" epidural because the medication infused through
the epidural is an analgesic, which relieves pain but does not numb the body and allows
movement. Combinations of medications may be used in the epidural--part analgesic,
part anesthetic. The most common complication of epidural analgesia is low blood pressure
in the mother. This type of anesthesia is used during labor and for vaginal deliveries.
A risk of epidural analgesia is a postpartum headache. It may develop if the epidural
needle enters the spinal canal, rather than staying in the space around the canal.
Epidural analgesia may be used for pain relief in labor and for vaginal deliveries.
Spinal anesthesia. This type of anesthesia involves injecting a single dose of the anesthetic agent directly
into the spinal fluid. Spinal anesthesia acts very quickly and causes complete loss
of sensation and loss of movement of the lower body. This type of anesthesia is often
used for cesarean deliveries.
Spinal analgesia. This involves injecting an analgesic medication into the spinal fluid to provide pain
relief without numbing. Spinal analgesia may be used in combination with epidural
anesthesia or analgesia. This may be used during labor for pain relief or for postpartum
General anesthesia. This type of pain relief involves giving an anesthetic agent that causes the woman
to go to sleep. This type of anesthesia may be used in emergency cesarean deliveries.