Complete Childbirth Stages Cheatsheet: A Comprehensive Guide to Labor and Delivery

Introduction: Understanding Childbirth

Childbirth is the process through which a baby is born, typically occurring around 40 weeks after conception. This natural process unfolds in distinct stages, each with specific characteristics and challenges. Understanding these stages helps expectant parents prepare mentally and physically for labor and delivery, reducing anxiety and promoting informed decision-making during this transformative experience.

Core Concepts: The Three Stages of Labor

Labor and delivery progress through three main stages, plus a preliminary phase called “early labor” or “prodromal labor.” These stages are:

Detailed Breakdown of Each Stage

Preliminary: Early/Prodromal Labor

• Physical signs:
  • Irregular contractions (5-30 mins apart)
  • Mild to moderate intensity
  • May stop and start
  • Possible lower back pain
  • Bloody show (pink or brown mucus discharge)
  • Possible rupture of membranes (“water breaking”)
• Cervical changes:
  • Effacement (thinning) begins
  • Early dilation (0-3 cm)
• Duration: Hours to days
• What to do:
  • Rest when possible
  • Stay hydrated
  • Time contractions
  • Continue normal activities if comfortable
  • Contact healthcare provider for guidance on when to go to birth location

First Stage: Active Labor & Transition

Early Active Phase (4-6 cm dilation)

• Contractions:
  • Regular pattern (3-5 minutes apart)
  • Lasting 45-60 seconds
  • Moderate to strong intensity
• Physical signs:
  • Increased discomfort
  • Progressive cervical dilation
  • Possible nausea
• Duration: Typically 3-6 hours
• What to do:
  • Move to birth location
  • Use comfort measures and breathing techniques
  • Stay upright and mobile if possible
  • Consider pain management options if desired

Active Phase (6-8 cm dilation)

• Contractions:
  • Strong and regular (2-4 minutes apart)
  • Lasting 60-90 seconds
• Physical signs:
  • Continued cervical dilation
  • Increased pressure
  • Possible shaking or trembling
• Duration: Typically 2-3 hours
• What to do:
  • Focus on breathing and relaxation between contractions
  • Use support person for physical and emotional assistance
  • Change positions regularly
  • Stay hydrated (small sips of water/ice chips)

Transition Phase (8-10 cm dilation)

• Contractions:
  • Very intense
  • 1.5-2 minutes apart
  • Lasting 60-90 seconds
  • Possible “double-peak” contractions
• Physical signs:
  • Complete cervical dilation (10 cm)
  • Intense pressure
  • Urge to push
  • Nausea/vomiting
  • Hot/cold flashes
  • Irritability or feeling overwhelmed
• Duration: 15-60 minutes (typically the shortest but most intense phase)
• What to do:
  • Use focused breathing techniques
  • Avoid pushing until fully dilated
  • Verbalize needs clearly to support team
  • Rest between contractions

Second Stage: Pushing & Birth

• Contractions:
  • Strong expulsive contractions
  • May space out slightly (3-5 minutes apart)
• Physical signs:
  • Strong urge to push
  • Pressure on rectum
  • Crowning (baby’s head becoming visible)
  • Stretching sensation
• Duration: 20 minutes to 2+ hours (shorter for subsequent births)
• What to do:
  • Push with contractions
  • Rest between contractions
  • Try different positions (squatting, side-lying, hands-and-knees)
  • Follow healthcare provider’s guidance on pushing technique
• Birth sequence:
  1. Crowning
  2. Delivery of head
  3. Delivery of shoulders
  4. Complete delivery of baby
  5. Immediate newborn care (skin-to-skin, delayed cord clamping if chosen)

Third Stage: Delivery of Placenta

• Contractions: Mild contractions continue
• Physical signs:
  • Gush of blood
  • Umbilical cord lengthening
  • Uterus rising in abdomen
• Duration: 5-30 minutes
• What to do:
  • Hold baby skin-to-skin if possible
  • Gentle pushing when instructed
  • Begin breastfeeding if desired (helps stimulate contractions)
• Healthcare provider actions:
  • Check placenta for completeness
  • Assess for tears/lacerations
  • Monitor bleeding
  • Administer medications if needed to prevent hemorrhage

Pain Management Techniques by Stage

Non-Pharmacological Methods

Pharmacological Methods

Comparison: Signs of Labor Progress vs. Stalled Labor

Common Challenges and Solutions

Prolonged Labor

• Causes:
  • Large baby
  • Posterior position (baby facing mother’s abdomen)
  • Ineffective contractions
  • Anxiety/stress
• Solutions:
  • Position changes (hands and knees position helps rotate posterior babies)
  • Walking and movement
  • Rest and hydration
  • Oxytocin augmentation if medically indicated
  • Consider pain relief if exhaustion is a factor

Back Labor

• Causes: Usually baby in posterior position
• Solutions:
  • Counter-pressure on lower back
  • Hands and knees position
  • Hip squeezes
  • Double-hip squeeze
  • Warm shower or bath directed at back
  • Cold or heat applied to lower back

Slow Progression

• Solutions:
  • Change positions frequently
  • Empty bladder regularly
  • Stay upright when possible
  • Stay hydrated and maintain energy
  • Consider medical interventions if prolonged

Premature Urge to Push

• Causes: Baby’s position pressing on nerves, incomplete dilation
• Solutions:
  • Panting or “blow” breathing
  • Side-lying position
  • Position changes
  • Wait for complete dilation before pushing

Exhaustion

• Solutions:
  • Rest between contractions
  • Light nutrition if permitted (clear fluids, honey sticks)
  • Consider pain relief options to allow rest
  • Change to less taxing positions

Best Practices for Labor Support

For the Laboring Person

• Stay hydrated throughout labor
• Empty bladder regularly
• Change positions at least every 30 minutes in early labor
• Use gravity-favorable positions when possible
• Vocalize needs clearly to support team
• Rest between contractions
• Focus on one contraction at a time
• Use rhythm to cope with contractions (swaying, rocking, etc.)

For Support Persons

• Offer verbal encouragement and reassurance
• Provide physical comfort (massage, counterpressure)
• Help with timing contractions
• Advocate for the laboring person’s needs and preferences
• Assist with position changes
• Provide hydration and comfort measures
• Take photos if desired (with permission)
• Help maintain a calm environment
• Remember BRAIN for decision-making:
  • Benefits – What are the benefits?
  • Risks – What are the risks?
  • Alternatives – What are the alternatives?
  • Intuition – What does your intuition tell you?
  • Nothing – What if we do nothing/wait?

Signs That Labor Is Beginning Soon (Prelabor)

• Lightening: Baby drops lower into pelvis (can occur 2-4 weeks before labor)
• Bloody show: Pink or brown-tinged mucus discharge
• Rupture of membranes: Water breaking (clear fluid leaking or gushing)
• Consistent contractions: Beginning to form a pattern
• Nesting urge: Sudden energy and desire to prepare
• Loose stools or diarrhea: Body’s natural clearing process
• Backache: Persistent lower back discomfort
• Loss of mucus plug: Thick mucus discharge

When to Go to the Hospital/Birth Center (5-1-1 Rule)

Contact your healthcare provider and consider going to your birth location when contractions are:

• 5 minutes apart
• Lasting 1 minute each
• For at least 1 hour

Note: This is a general guideline. Follow specific instructions from your healthcare provider, especially for:

• First-time mothers: May be advised to wait longer (4-1-1)
• Experienced mothers: May need to go sooner (5-1-1 or even 7-1-1)
• High-risk pregnancies: May have special instructions
• Distance from hospital: Further distance may require earlier departure

Immediate Reasons to Seek Medical Attention

• Water breaking with green or brown tint (meconium)
• Bright red bleeding (more than light spotting)
• Decreased fetal movement
• Severe, constant abdominal pain
• Severe headache or visual changes
• High fever
• Sudden, severe swelling

Positions for Labor and Birth

First Stage Positions

• Walking/standing/swaying
• Sitting on birth ball
• Hands and knees
• Leaning forward with support
• Side-lying
• Supported squat
• Lunging

Second Stage (Pushing) Positions

• Semi-reclined with support
• Side-lying
• Supported squat
• Hands and knees
• Birth stool or toilet
• Standing/supported standing

Resources for Further Learning

Books

• “Ina May’s Guide to Childbirth” by Ina May Gaskin
• “The Birth Partner” by Penny Simkin
• “Pregnancy, Childbirth, and the Newborn” by Penny Simkin et al.
• “Birthing from Within” by Pam England and Rob Horowitz

Online Resources

• American College of Obstetricians and Gynecologists (ACOG): www.acog.org
• Evidence Based Birth: www.evidencebasedbirth.com
• Childbirth Connection: www.childbirthconnection.org
• Lamaze International: www.lamaze.org

Classes and Support

• Childbirth education classes (hospital-based or independent)
• Doula services (professional labor support)
• Lactation consultants
• Postpartum support groups
• Virtual birth communities and forums

Remember: Every birth is unique. This cheatsheet provides general information, but always follow the guidance of your healthcare provider for personalized care based on your specific situation.