How to Give Birth

You started your pregnancy countdown about nine months ago and are now so close to the finish: the birth of your baby. As you approach your due date, you may have many questions about labor and delivery. From pain management options to pushing positions, we asked board certified OB-GYN Dr. Phillips and midwife Annalee Reid to talk about the different labor stages and what you might expect as you prepare to welcome your little one into the world.

The stages of labor

Labor is a process that consists of three stages.

Labor stage 1

The first stage is when labor begins. It’s the longest labor stage and involves three phases: early labor, active labor, and transition.

• Labor phase 1: Early Labor

  During early labor, you may experience mild contractions that come and go. If you have been practicing breathing techniques for pain management, Dr. Phillips says this is the perfect time to start focusing on them.

• Labor phase 2: Active Labor

  The active phase is when the contractions become more intense. You’ll also start feeling the pressure of your baby’s head lower as they descend down the birth canal.

• Labor phase 3: Transition

  During the transition phase, your cervix will dilate to 10 centimeters. Dr. Phillips notes, “This is the most intense part of labor, but it's also the shortest.” Contractions will be strong and close together, and women often feel the need to push.

Labor stage 2

The second stage is when the cervix is fully dilated. It’s also the moment you’ve been waiting for: the delivery of your baby.

Labor stage 3

While stage 2 is the pinnacle of your journey, there is a third and final stage—when the placenta and umbilical cord are expelled.

What’s the difference between early labor and active labor?

In early labor, your cervix begins to thin out and dilates from 0 to 3 centimeters. This phase can last 8-12 hours. Contractions are usually mild, and you can typically be distracted by conversation, games, or television.

During active labor, your cervix will dilate from 4 to 7 centimeters. This phase can last about 3-5 hours or more, especially if this is your first baby. The contractions are stronger, longer, and closer together. Reid explains, “In active labor, you will want to be given the time and space with each contraction to really focus on each contraction. You will be drawn pretty inward to focus on your body with each contraction.” Now is the time to go to the hospital or birthing center if you haven’t already.

How to push during labor

Pushing takes place during the transition phase. While this phase is shorter than the early and active labor phases, it is the most challenging. Here are three tips for managing this phase:

• Listen to your body. When it comes to pushing, listening to your body is important. Reid notes, “You'll know when it's time to push because you'll feel a strong urge to bear down.” You should also refer to your doctor or midwife for guidance.
• Breathe deeply. Dr. Phillips recommends taking deep breaths and pushing with the contractions. She adds, “It's important to push effectively to avoid prolonging labor and exhausting yourself.”
• Visualize. Some women find it helpful to visualize pushing like they're going to the bathroom. “This can help you push with more force,” Dr. Phillips explains.

Pushing positions

When it is time to push, there are several positions you can try. They all have different benefits, from making you more comfortable to leveraging the advantages of gravity.

• On your back. The most common pushing position is lying on your back with your legs in stirrups. It can be comfortable for women who have had an epidural, and it gives your healthcare provider better access to the baby. While this is a popular position, Reid points out this position can “make it harder to push effectively because it's not as gravity-assisted.”
• Squatting. Pushing while squatting can help you use gravity to your advantage. It may also help open up the pelvic outlet.
• Kneeling. The kneeling position also leverages gravity, can help open the pelvis, and may potentially ease back pain.
• Hands and knees. This position may also help reduce back pain by taking pressure off your spine.

Keep in mind that you can switch positions during labor. Dr. Phillips recommends asking your healthcare provider to help you find the right position.

How long can pushing in labor last?

Pushing may take a few minutes to a couple of hours or more, but every woman’s labor experience is unique. Pushing may be longer if you’re a first-time mom or if you have an epidural, but your healthcare provider will help guide you through this second stage of labor.

How to push during labor with an epidural

If you choose to have an epidural, which can help relieve pain during labor, Dr. Phillips says that pushing may be more difficult as you may not feel the contractions as strongly. But she adds, “Don't worry, your healthcare provider will be there to help you push effectively.”

Reid says, “The best way to know when to push is to wait until you feel pressure in your bottom, which means the baby's head is coming down the birth canal.”

Breathing techniques during labor

Breathing techniques can help you relax and manage labor pain. Try to practice these controlled breathing techniques before your due date.

• Lamaze. One popular breathing technique is the Lamaze method, which involves breathing in slowly through your nose and breathing out slowly through your mouth. According to Dr. Phillips, Lamaze “can help you stay focused and relaxed during contractions.”
• J-breath. This technique involves breathing in through your nose and exhaling in short, rhythmic breaths like a pant.

Every labor and delivery experience is different. Dr. Phillips says, “It's important to communicate with your healthcare provider and let them know what works best for you.” Reid adds, “Don't forget to stay hydrated and rest when you can. Labor can be tiring, but with the right support, you can do it!

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