Vaginal Birth: Stages of Labor & Delivery

What Is Vaginal Birth?

Vaginal birth is the natural process of delivering a baby through the vaginal canal. It involves three stages: cervical dilation during labor, active pushing to deliver the baby, and expulsion of the placenta. Approximately 70% of all births worldwide are vaginal deliveries.

Vaginal birth, also called vaginal delivery or spontaneous vaginal delivery, is the most common method of childbirth. During this process, the baby travels from the uterus through the cervix and vaginal canal to be born. The body prepares for this event throughout pregnancy, with hormonal changes that soften the cervix and prepare the pelvic muscles for the stretching required during delivery.

The experience of vaginal birth varies greatly from person to person. Some labors progress quickly over a few hours, while others may take a day or more. Factors that influence the duration and intensity of labor include whether this is your first pregnancy, the baby's size and position, your pelvic anatomy, and your overall health. Understanding the stages of labor and what to expect can help you feel more prepared and reduce anxiety about the birthing process.

While vaginal birth is the most physiologically straightforward method of delivery, it's important to remember that the ultimate goal is a healthy mother and baby. Your healthcare team will monitor both you and your baby throughout labor and will recommend interventions if necessary to ensure the best possible outcome.

Benefits of Vaginal Birth

Vaginal birth offers several advantages for both mother and baby when it proceeds without complications. For mothers, recovery is typically faster compared to cesarean delivery, with most women able to walk and care for their baby within hours of giving birth. The hospital stay is usually shorter, averaging 1-2 days compared to 3-4 days after cesarean section.

For babies, passing through the birth canal helps squeeze fluid from the lungs, preparing them for breathing outside the womb. The baby is also exposed to beneficial bacteria in the birth canal, which may help establish a healthy microbiome. Additionally, the hormonal changes triggered by labor help prepare both mother and baby for breastfeeding.

What Happens During the First Stage of Labor?

The first stage of labor involves the cervix dilating from 0 to 10 centimeters. It consists of early labor (0-6 cm) with irregular contractions, and active labor (6-10 cm) with strong, regular contractions every 2-3 minutes. This is the longest stage, typically lasting 8-12 hours for first-time mothers.

The first stage of labor is when your body prepares for the actual delivery of the baby. This preparation centers on the cervix, which must thin out (efface) and open (dilate) to allow the baby to pass through. The cervix needs to dilate from completely closed to approximately 10 centimeters in diameter – wide enough for the baby's head to pass through.

This stage is driven by contractions of the uterine muscle, which gradually become stronger, longer, and more frequent as labor progresses. These contractions serve two purposes: they push the baby's head against the cervix to promote dilation, and they begin to move the baby down into the pelvis.

Early Labor Phase

Early labor, sometimes called the latent phase, is when contractions begin but are usually mild and irregular. During this phase, the cervix dilates from 0 to approximately 6 centimeters. Contractions typically occur every 5 to 30 minutes and last 30 to 45 seconds. Many women describe early labor contractions as similar to menstrual cramps or lower back pain.

This phase can last anywhere from a few hours to several days, especially for first-time mothers. The variability is entirely normal. During early labor, you can usually remain at home, continuing normal activities, eating light meals, and resting when possible. It's a good time to practice relaxation techniques and conserve energy for the more demanding phases ahead.

Your water may break during early labor, though this doesn't always happen. If your membranes rupture, you'll notice a gush or steady trickle of clear or slightly pink fluid. You should contact your healthcare provider when this occurs, as they'll want to know the time, amount, and color of the fluid. If the fluid is green or brown, this could indicate the baby has passed meconium (first stool) and requires immediate evaluation.

Active Labor Phase

Active labor begins when the cervix reaches about 6 centimeters and continues until full dilation at 10 centimeters. This phase is characterized by stronger, more intense contractions that come every 2 to 3 minutes and last about 60 to 90 seconds each. The cervix dilates more rapidly during this phase, typically at about 1 centimeter per hour for first-time mothers.

This is usually when you'll want to be at your chosen birth location – whether a hospital, birthing center, or at home with a midwife. Active labor demands your full attention, and most women find they need to focus on coping with contractions. Movement, position changes, breathing techniques, and support from your birth partner become increasingly important.

The end of active labor includes what's often called the "transition" phase – the final dilation from 8 to 10 centimeters. Transition is typically the most intense part of labor, with very strong contractions coming close together. Many women experience shaking, nausea, or an overwhelming sensation during this phase. However, transition is usually the shortest phase, lasting only 15 minutes to an hour.

What Happens During the Second Stage of Labor?

The second stage of labor is the pushing phase, beginning when the cervix is fully dilated at 10 cm and ending with the birth of the baby. You'll feel the urge to push with each contraction. This stage typically lasts 20 minutes to 2 hours for first-time mothers, and may be shorter for subsequent births.

Once your cervix is completely dilated, you enter the second stage of labor – the pushing stage. This is when you actively work with your contractions to push your baby down through the birth canal and into the world. Many women describe this stage as more manageable than transition because they can actively participate rather than simply enduring contractions.

The second stage begins with the baby's head positioned deep in the pelvis. With each contraction, you'll feel an overwhelming urge to bear down and push. This urge is caused by pressure on the rectum and pelvic floor as the baby descends. Your healthcare provider will guide you on when and how to push effectively.

The Pushing Process

Effective pushing involves working with your contractions rather than against them. When a contraction begins, you'll take a deep breath, curl forward slightly, and push down through your pelvis while holding your breath or exhaling slowly. The goal is to direct your effort toward pushing the baby out, similar to having a bowel movement.

Between contractions, you'll have brief rest periods to catch your breath and prepare for the next push. Your healthcare team will monitor the baby's heart rate throughout this stage to ensure the baby is tolerating labor well. Position changes during pushing can help the baby navigate the pelvis – many women find squatting, kneeling, or being on hands and knees more comfortable than lying on their back.

There are different approaches to pushing. "Directed pushing" involves pushing for specific counts as instructed by your healthcare provider. "Spontaneous pushing" or "mother-led pushing" allows you to follow your body's natural urges without specific instruction. Research suggests that spontaneous pushing may be less exhausting and equally effective, though directed pushing may be necessary in certain situations.

Crowning and Delivery

As pushing continues, the baby's head begins to appear at the vaginal opening – this is called crowning. You may feel a stretching or burning sensation, sometimes called the "ring of fire," as the tissues stretch around the baby's head. This intense sensation is temporary and signals that delivery is imminent.

Your healthcare provider may ask you to stop pushing briefly as the head crowns, using gentle panting breaths instead. This allows the tissues to stretch gradually, reducing the risk of tearing. Once the head is delivered, the provider will check for the umbilical cord around the baby's neck and clear the baby's airway if needed.

With the next contraction, usually just one or two more pushes, the shoulders and body are delivered. The baby is typically placed immediately on your chest for skin-to-skin contact, which helps regulate the baby's temperature, promotes bonding, and encourages the initiation of breastfeeding.

What Happens During the Third Stage of Labor?

The third stage of labor is the delivery of the placenta, occurring within 5-30 minutes after the baby is born. Mild contractions continue to help separate the placenta from the uterine wall. Your provider may gently massage your abdomen to encourage the uterus to contract and reduce bleeding.

After your baby is born, labor isn't quite over – the placenta still needs to be delivered. This third stage is usually the shortest and least demanding part of labor. The uterus continues to contract, causing the placenta to separate from the uterine wall and be expelled through the vagina.

You may feel mild cramping as the uterus contracts, but these contractions are generally much less intense than labor contractions. Your provider may ask you to give a gentle push to help deliver the placenta. Some women are so focused on their newborn that they barely notice this stage.

Active vs. Physiological Management

There are two main approaches to managing the third stage. Active management involves giving an injection of a medication (usually oxytocin) immediately after the baby is born to help the uterus contract strongly, followed by gentle traction on the umbilical cord to deliver the placenta. This approach reduces the risk of postpartum hemorrhage and is recommended by the World Health Organization, especially in settings where blood loss may be difficult to manage.

Physiological (or expectant) management allows the placenta to deliver naturally without medication or intervention. This may take longer but is preferred by some women who want a completely natural birth experience. Your healthcare provider can discuss the benefits and risks of each approach with you before delivery.

After the Placenta Delivers

Once the placenta is delivered, your healthcare provider will examine it to ensure it's complete, as retained placental tissue can cause bleeding and infection. They'll also assess any perineal tears and repair them with stitches if necessary. These stitches are dissolvable and don't need to be removed.

Your uterus will continue to contract to close off the blood vessels where the placenta was attached. This is why breastfeeding is encouraged soon after birth – the hormone oxytocin released during breastfeeding helps the uterus contract. You may feel cramping during breastfeeding, especially in subsequent pregnancies, which is a sign that your uterus is returning to its normal size.

What Pain Relief Options Are Available During Vaginal Birth?

Pain relief during labor ranges from non-pharmacological methods (breathing, movement, water, massage, TENS) to medications (nitrous oxide, epidural, pudendal block). Epidural anesthesia is the most effective option, blocking pain in the lower body while you remain fully conscious. Discuss options with your provider beforehand.

Managing pain during labor is a personal choice, and there's no right or wrong approach. Some women prefer to use only natural coping techniques, while others want the strongest pain relief available. Many find they use a combination of methods as labor progresses. Understanding your options allows you to make informed decisions about your care.

Non-Pharmacological Pain Relief

Many women find significant relief from techniques that don't involve medication. These methods work by redirecting attention, promoting relaxation, and reducing tension that can intensify pain. They can be used alone or in combination with medical pain relief.

Breathing and relaxation techniques are foundational skills for coping with labor. Slow, focused breathing during contractions helps you stay calm and prevents the tension that can make pain worse. Progressive relaxation, visualization, and meditation can also be helpful.

Movement and position changes are powerful tools during labor. Walking, swaying, rocking, and changing positions not only help you cope with contractions but can also help the baby descend through the pelvis. Upright positions and movement take advantage of gravity to progress labor.

Water immersion – using a shower or bath during labor – can provide significant pain relief. Many hospitals and birthing centers have tubs available for laboring. The warmth and buoyancy of water help relax muscles and can make contractions feel more manageable.

Massage and counter-pressure applied by a birth partner can help relieve back pain during contractions. Applying firm pressure to the lower back or hips can counteract the pressure from the baby's head against the spine.

TENS (Transcutaneous Electrical Nerve Stimulation) uses mild electrical pulses to stimulate nerves and reduce pain perception. Electrodes placed on the back deliver gentle impulses that you control. TENS is most effective in early labor and is completely safe for you and your baby.

Pharmacological Pain Relief

Nitrous oxide (laughing gas) is a mixture of nitrous oxide and oxygen that you breathe through a mask during contractions. It takes effect quickly, wears off within minutes, and has no lasting effects on you or your baby. While it doesn't eliminate pain, many women find it helps them relax and cope with contractions.

Epidural anesthesia is the most effective form of pain relief during labor. A thin catheter is placed in the epidural space of your lower back, through which medication continuously flows. This blocks pain signals from the lower body while you remain fully awake and alert. You can still feel pressure and the urge to push, but without the pain.

Epidurals are very safe and don't increase the risk of cesarean delivery. However, they can cause temporary numbness or weakness in your legs, may slow the pushing stage, and require continuous monitoring. You'll need an IV and won't be able to walk around, though "walking epidurals" that provide less complete numbness are available at some facilities.

Other regional blocks include pudendal blocks (which numb the area around the vagina and perineum) and paracervical blocks (which numb the cervix). These are typically used for specific situations rather than continuous pain relief throughout labor.

When Should You Go to the Hospital During Labor?

Go to the hospital when contractions are regular (every 3-5 minutes), strong, and lasting about 1 minute each – typically when you're around 4-6 cm dilated. Go immediately if your water breaks, you have heavy bleeding, decreased fetal movement, or severe continuous pain.

Knowing when to go to the hospital or birthing center can be challenging, especially for first-time parents. Going too early may result in being sent home or having a longer hospital stay, while waiting too long could mean arriving in advanced labor with little time to get settled or receive pain relief if desired.

The general guideline is the 5-1-1 rule: contractions every 5 minutes, lasting 1 minute each, for at least 1 hour. However, this rule may need adjustment based on your individual circumstances. If you live far from your birth location, have a history of fast labor, or are having your second or subsequent baby, you may want to leave earlier.

Signs to Go Immediately

Some situations require immediate evaluation, regardless of contraction patterns. Contact your healthcare provider or go to the hospital right away if you experience:

• Your water breaks – especially if the fluid is green, brown, or has a foul odor
• Heavy vaginal bleeding – more than spotting or bloody show
• Decreased fetal movement – fewer than 10 movements in 2 hours
• Severe, constant abdominal pain – pain that doesn't ease between contractions
• Signs of preeclampsia – severe headache, vision changes, upper abdominal pain
• Preterm labor – regular contractions before 37 weeks

Why Is Continuous Support Important During Labor?

Continuous support during labor from a partner, doula, or other companion significantly improves outcomes. Research shows it reduces the need for pain medication, shortens labor, decreases cesarean rates, and leads to more positive birth experiences. WHO recommends all women have continuous support during labor.

Having someone by your side throughout labor is one of the most effective ways to improve your birth experience and outcomes. The World Health Organization recommends that all women have continuous support during labor and birth. This support can come from a partner, family member, friend, doula, or healthcare provider – the key is that they remain present throughout the process.

A landmark Cochrane review analyzing data from over 15,000 women found that those with continuous support were more likely to have spontaneous vaginal births, less likely to use pain medications or have cesarean deliveries, had shorter labors, and reported more positive feelings about their birth experience.

What Does Effective Labor Support Look Like?

Effective labor support includes emotional encouragement, physical comfort measures (massage, helping with position changes, applying cold or warm compresses), information and explanation of what's happening, and advocacy – helping communicate your wishes to the medical team.

A doula is a trained professional who provides continuous labor support. Unlike medical staff who may have multiple patients, a doula's sole focus is supporting you. Doulas don't perform medical tasks but complement medical care with focused physical and emotional support. Studies show that doula support is particularly beneficial for first-time mothers and those birthing without a partner.

What Happens Immediately After Vaginal Birth?

Immediately after birth, your baby is placed on your chest for skin-to-skin contact. The umbilical cord is clamped and cut after 1-3 minutes. The placenta delivers within 5-30 minutes. Your provider checks for tears needing stitches and monitors your recovery. Breastfeeding is often initiated within the first hour.

The moments after birth are filled with important processes for both you and your baby. While your focus will naturally be on meeting your newborn, your healthcare team will be busy monitoring both of you and completing essential post-delivery care.

Immediate Skin-to-Skin Contact

If you and your baby are both doing well, your baby will be placed immediately on your bare chest for skin-to-skin contact. This seemingly simple act has profound benefits. The baby's temperature is regulated by your body heat, stress hormones decrease, heart and breathing rates stabilize, and the baby is exposed to your beneficial bacteria.

Skin-to-skin contact also promotes bonding and stimulates the release of hormones that support breastfeeding. Many babies will naturally seek the breast and may even begin nursing within the first hour – this is called the "breast crawl." Even if you're not planning to breastfeed, skin-to-skin contact is beneficial for your baby's transition to life outside the womb.

Cord Clamping and Newborn Assessment

Current recommendations support delayed cord clamping – waiting at least 1-3 minutes before cutting the umbilical cord. This allows additional blood to transfer from the placenta to the baby, providing important iron stores that support development in the first months of life. The cord can be cut by your partner or healthcare provider.

Your baby will receive an Apgar assessment at 1 minute and 5 minutes after birth, evaluating heart rate, breathing, muscle tone, reflexes, and color. This assessment can be done while the baby is on your chest. Routine procedures like vitamin K injection and eye prophylaxis are usually delayed until after the initial bonding period, often after the first feeding.

Your Physical Recovery Begins

While you're bonding with your baby, your healthcare provider will be monitoring your recovery. The placenta needs to be delivered, usually within 30 minutes. Your perineum will be examined for any tears that need repair. Ice packs may be applied to reduce swelling and provide comfort.

You'll be monitored for bleeding and helped to use the bathroom when ready – urinating within the first few hours after birth is important for bladder recovery. Your uterus will be checked periodically to ensure it's contracting properly, as this controls bleeding. These checks may be uncomfortable but are essential for your safety.

What Complications Can Occur During Vaginal Birth?

Most vaginal births proceed without complications. Potential issues include prolonged labor, fetal distress, perineal tears, postpartum hemorrhage, and umbilical cord problems. Your healthcare team continuously monitors for these and can intervene quickly if needed. Being informed helps you understand why interventions may be recommended.

While the majority of vaginal births are uncomplicated, understanding potential complications helps you make informed decisions if interventions become necessary. Your healthcare team is trained to recognize and respond to complications quickly, and continuous monitoring during labor helps detect problems early.

Prolonged or Stalled Labor

Sometimes labor doesn't progress as expected. This can occur due to inadequate contractions, the baby's position, or disproportion between the baby's size and the mother's pelvis. If labor stalls, your provider may suggest breaking your water (amniotomy) if it hasn't already broken, or administering oxytocin (Pitocin) to strengthen contractions.

Walking, position changes, and time may also help a stalled labor progress. If labor remains stalled despite interventions, cesarean delivery may become necessary for the safety of mother and baby.

Fetal Distress

Your baby's heart rate is monitored throughout labor. Concerning patterns can indicate that the baby isn't tolerating labor well. Interventions for fetal distress include changing your position, giving oxygen, administering IV fluids, or reducing oxytocin if it's being used. If these measures don't resolve the issue, emergency delivery (vaginal or cesarean) may be necessary.

Perineal Tears

Tearing of the perineum (the tissue between the vagina and rectum) is common during vaginal birth. First and second-degree tears are minor and heal well with stitches. Third and fourth-degree tears, which extend to the anal sphincter, are less common but require careful repair and longer recovery. Techniques like warm compresses, controlled delivery of the head, and avoiding directed pushing during crowning can help minimize tearing.

Postpartum Hemorrhage

Excessive bleeding after delivery (more than 500ml) is called postpartum hemorrhage. Risk factors include prolonged labor, large baby, multiples, previous hemorrhage, and conditions affecting the uterus's ability to contract. Treatment includes uterine massage, medications to contract the uterus, and rarely, surgical intervention. Active management of the third stage of labor significantly reduces this risk.

What Are Assisted Vaginal Deliveries?

Assisted vaginal delivery uses instruments (vacuum or forceps) to help deliver the baby when pushing is insufficient or the baby needs to be delivered quickly. These tools are used by trained providers when the benefits outweigh risks – such as prolonged pushing, maternal exhaustion, or fetal distress in the second stage.

Sometimes, even with effective pushing, help is needed to complete the delivery. Assisted vaginal delivery uses instruments to guide the baby out of the birth canal. The two main methods are vacuum extraction and forceps delivery.

Vacuum Extraction

A soft cup is attached to the baby's head using suction. With each contraction, gentle pulling coordinates with your pushes to help move the baby down. Vacuum extraction may cause temporary scalp swelling or bruising on the baby, but serious complications are rare when performed by experienced providers.

Forceps Delivery

Forceps are curved metal instruments that fit around the baby's head like salad tongs. The provider uses them to gently guide the baby out during contractions. Forceps require more skill and are less commonly used today, but remain an important option in experienced hands.

Assisted delivery is considered when the pushing stage is prolonged, the mother is exhausted or has medical conditions making prolonged pushing risky, or when the baby needs to be delivered quickly due to heart rate concerns. Your provider will explain why assisted delivery is recommended and discuss the specific technique to be used.