Four phases of labour

As a future parent, you’re surely curious about how long labour will take, how painful it will be and what it’s all going to be like. Unfortunately, it’s impossible to answer all these questions – every labour is individual and unique. You’ll have to leave the schedules and timesheets at home and let nature decide the pace. But what you can be sure of is that childbirth consists of four different stages that result in a new baby arriving in the world.

Four phases of labour

Childbirth is divided into four different stages, depending on where the body is in the process.

1. Latent phase
2. Active phase
3. Pushing phase
4. Afterbirth

It can be good to know that most people giving birth for the first time have a slightly longer labour, because the body is figuring out what feels natural. If you’ve had a baby before, the body knows what to do and it usually happens a little faster. The latent phase is generally where you’ll find the biggest time difference – a first-time mother opens about a centimetre per hour, but the pace is usually faster with the second baby. An early indication that the latent phase and childbirth are in progress is the infamous mucus plug: for some people, this looks like increased discharge; others will end up with a big mucus clump in their underwear.

Latent phase

Once those contractions start sneaking up, the latent phase has begun. This is a sign that your nine months of anticipation are coming to an end. At first, the contractions will be mild, irregular and varied in length. If this is your first baby, then the latent phase will usually be the longest phase, lasting from a few hours up to a whole day. If you’ve had a baby before, you might skip this phase altogether.
The contractions will gradually be closer and closer together – the muscles of the uterus are working at full force, while the cervix shortens and widens. The first five centimeters usually take the longest. The ligaments that hold the pelvic bones together stretch and tighten. Meanwhile, the cervix softens, moves forward and starts to shorten.

For much of this phase, you will be at home. It will hurt more and more as time passes – but it’s best to just try to relax. You can take paracetamol, and heat and massage will also help. When you feel that the contractions have started in earnest, contact the maternity ward so that they know and can plan for your arrival.

Active phase

It is now time for the cervix to open completely so that the baby can come out. It must expand to 10 cm, and at this point the contractions will start to feel stronger, and they will be longer and more regular. It is generally nice to go into the maternity ward now, because you might need help with pain management. If your water has not broken, it’s common for that to happen about now. Towards the end of the active phase, the baby’s head will pass a point in the pelvis called the ischial spines, an especially narrow passage. You are likely to feel a firm pressure against the pelvis; you might become nauseous and may even vomit.

This is when you may very well feel like you could lose control altogether: this is enough – the baby can stay in there; I will gather my things and go! You might beg to be put to sleep and awakened when it’s all over. You could feel angry, frustrated and irritated because the pain can feel completely unmanageable. Your partner might be the target of your ire, or maybe the midwife – possibly other innocent bystanders in the room. That is completely normal and completely okay! Try to breathe, receive soothing and supportive words from the people around you, and let the midwife help you find your strength again (because you can handle more than you realise), and the energy to get through the next phase, which will end with a baby in your arms.

Pushing phase

The baby is working their way down and out, and by changing birth positions, you can help them along their way. It still isn’t time to start pushing; this is more about facilitating – or tolerating, if we’re being honest – as the baby moves down into the birth canal. You won’t start pushing until the baby’s head is pressing against the pelvis, and it will feel like it’s time then – because the nature of the pain will change. It will feel like a mighty pressure backwards – kind of like you really have to poo – and your body will respond with a push.

How long you have to spend pushing the baby out through the vaginal opening varies – it depends on a variety of factors, like how much strength you have left or how relaxed you are. The midwife is there to support you, guide you, and tell you when it might be good to push even more. After the baby’s head has emerged, the rest of the body generally follows along one or two contractions later. So this phase concludes with the miracle of life! Your baby is born, their lungs fill with air, and at last, you can start life outside of your belly together. Crazily enough, almost all of the pain will disappear in that very moment, much to the surprise and relief of most people who have given birth.

Afterbirth

Soon after the baby has emerged, it’s time to push out the placenta. The uterus will contract and it will feel like another contraction is coming. The midwife will see when this happens and will tell you that it’s time to push out the placenta and the membranes that surrounded the baby. But this contraction generally feels like a summer breeze compared to the ones you’ve just been through. When the placenta releases from the uterine wall, there will be bleeding where it had been. The midwife will press on your belly to make sure the uterus is contracting properly. Then the placenta will be examined to make sure it has come out in its entirety, because remnants in the uterus could cause infection and bleeding later on.

When childbirth is complete, a midwife will examine you for vaginal tearing and sew up any tears, which is always done with some kind of anaesthesia. If there is a sizable tear, an obstetrician will sew it up. After this, you get to shower and change into fresh clothes, have a little snack and enjoy the magic that just happened – a baby was born, and so was a family.

Please note that all information above is based on Swedish recommendations.