The five phases of childbirth: moment explained step by step

If you are in the last trimester of pregnancy and delivery is approaching , you will be interested in knowing how the birth of your baby will unfold and what will happen at each moment to arrive as prepared as possible.

Its usually called childbirth at the time the baby is born, but the truth is that labor begins much earlier. It consists of five phases , four plus the last one -when you finally have your baby in your arms- which must be considered as part of the process. We tell you what happens in childbirth step by step .

Phase One: Early or Latent Dilation

The first phase of labor is that of dilation, in which we can differentiate a first moment of early, latent or passive dilation , which is when the opening of the cervix begins .

This stage is usually the longest and luckily the least intense; In fact, most women won’t even notice their early dilation until they’re examined by their gynecologist at their pre-delivery visits .

The effacement , softening, and dilation of the cervix up to 3 centimeters that characterize this stage can be achieved over a period of days or weeks without bothersome contractions.

The oxytocin passes smoothly into the blood and the woman begins to have faint contractions . These contractions are common from the 35th week of gestation, but they do not become regular, progressive or intense enough to think that the time has come to give birth and go to the clinic. However, they are a sign that the day is coming .

The symptoms that can be perceived are back pain (either with each contraction or constantly), pelvic pain similar to menstruation , indigestion, diarrhoea, feeling of heat in the abdomen…

To a large extent, the quality of our delivery may depend on this stage, since it is not the same to reach the true contractions with a three centimeters “advantage” and with the cervix effaced, that is, already thinned and shortened.

Phase Two: Active Dilation

Early or latent dilatation gives way to the phase of active dilatation. Here the cervix will go from 3 to 10 centimeters dilated to open the birth canal and allow the baby to come out.

In this phase, the contractions are already rhythmic, strong and more followed , although in each woman their intensity and rhythm will vary, resulting in dilations of very different duration. You can dilate a centimeter per hour , but you can also progress more quickly, especially if you have already given birth before.

It will dilate until it reaches approximately 10 centimeters, which will be when the baby will be able to stick its head out and come out in the next phase, the expulsive phase. At this time it is convenient to put into practice all the techniques to relieve pain , such as breathing and other non-pharmacological techniques, or to decide if we want the epidural .

The mental attitude and relaxation are also important, since I could help overcome an agonizing dilation and make it more bearable. The father has a fundamental role in this sense and also the hospital staff who accompany us if that is the case.

The pain that accompanies this phase is due to the fact that the efforts of the uterus are very concentrated and when the uterus contracts strongly, it tends to expel all the blood that is in its muscle fibers, which are squeezed. The absence of blood produces a lack of oxygen in the muscle and that is what determines the pain.

When the contraction ends, the muscle expands, relaxes and receives blood supply again, oxygenating itself again, which is when the pain ceases momentarily.

In this period of effacement and dilation , the amniotic sac usually breaks and 2 stages can be differentiated: accelerated dilation up to 5-6 centimeters and advanced dilation up to 10 centimeters. Let’s look at each of these stages.

Dilation up to 5-6 cm.

We are in a period of acceleration is in which the contractions begin to become more painful . We go from the initial centimeters achieved in the latent dilation phase to the real labor. During contractions the pain is considerable, and the mother may not be able to speak while she is having them or needs to squeeze something with her hands. Many women find it helpful to concentrate on the breathwork. Each mother will cope with these moments in a different way, and the perception of pain will also not be the same or localized in the same places (it can be more intense in the abdomen, in the kidneys, spread through the legs…).

Between contraction and contraction, the pain usually disappears and the mother can take the opportunity to continue with her pain relief techniques and relax, because it is convenient to gather strength for the next stage in which we will not have rest.

It is at these moments when the epidural is usually administered if the mother wishes, since after 5 centimeters the process will go much faster.

Dilation of 5-6 to 10 cm

It is also called advanced active dilation or transitional dilation, as it leads us to the next phase, expulsion. This is the stage of maximum speed, when it dilates in a short time at high speed and the sensation of pain increases due to the increase in the intensity of the contractions. It is likely that the mother already finds few moments of absence of pain, since the contractions practically arise chained to each other, although you should always try to remain calm.

At these times, hospital staff often consider that epidural administration is no longer convenient. Let us think that it is usual for the last 3 centimeters of dilation to occur in 15 or 20 minutes. And the baby is about to be born.

The mother usually feels a great pressure on the lower back and/or on the perineum, which causes an intense desire to push , and although it is not yet the time to do so, we will only have to wait a little longer. If we push when the cervix is ​​not yet fully dilated, we could cause it to swell, which could lengthen labor.

Instead of thinking about what we have left, we can look back and see all that we have already been through, the great road that we have already traveled. Draw strength from weakness and keep your spirits up. In a few minutes you will see your baby for the first time.

Phase Three: Expulsion

If in the early stages of childbirth the contractions had the function of opening and lengthening the cervix, during the expulsion period they are a kind of propulsion force that helps the baby to be born. They are associated with pushing and are accompanied by a sensation of pressure due to the baby’s head pressing on the rectum.

The contractions of this stage are more regular than the previous ones, they last between 60 and 90 seconds and they can be more distant. The perception of pain at this time is very different depending on the woman, sometimes they feel like more painful contractions than the previous ones, sometimes the fact of pushing makes the pain feel less.

The sensations of mothers at this time are very diverse, they can range from the recovery of energy knowing that they can now push and begin their more active participation in childbirth, to the feeling of despondency due to fatigue and pain. But what matters is not to lose heart and think that there are only a few minutes left to see our baby.

There are several positions to carry out this stage of expulsion , and it is becoming increasingly clear that the traditional hospital position, lying on the delivery table with legs apart and feet in stirrups placed at the end of the table, is one more option, not always the most suitable as we have seen. Vertical delivery, sitting or squatting, is another option.

To push, at each contraction the mother must take a deep breath, hold her breath and push two or three times, resting until the next contraction.

If necessary during this stage, an episiotomy would be performed, an incision in the perineum to facilitate the passage of the baby, and although this technique is applied routinely on many occasions , this application is not accepted by the World Health Organization ( WHO) .

Throughout this phase the baby progresses in stages. In head-on deliveries, the head begins to exit the uterus, passes through the pelvis, and once the muscles that separate the vagina from the rectum (perineum) stretch, the vagina dilates and the head appears. for the vulva. When the head is released, the shoulders come out and finally the rest of the body. The birth has taken place, we can now see our baby for the first time.

This expulsion phase can be of very variable duration, approximately between 30 and 60 minutes when it comes to the first birth and between 15 and 30 minutes when there have been other births. If the expulsive phase is prolonged, and if the mother is suffering intensely, she may feel frustration, or the need for the suffering to end, in a kind of “despair”, a normal and transitory reaction that professionals and companions can help to alleviate. mitigate with your understanding and advice.

Phase Four: Delivery

After the baby is delivered, and while the baby is being nursed and placed on the mother’s chest, uterine contractions return to expel the placenta, membranes, and the rest of the cord .

In this stage of delivery it is not necessary to resort specifically to an external help factor, we will only have to keep the body at rest, which will not be difficult after the effort and when we are finally with our baby.

The contractions, which at this stage are not just painful, will do the rest, and between 5 minutes and 1 hour after the baby is born, the placenta will be expelled. This passes into the lower segment of the uterus and into the vagina, whereupon it can be removed. Once the placenta is expelled, the doctor will take care of suturing any tears or the episiotomy if it has been performed.

If the mother has given birth with epidural anaesthesia, she will hardly notice any discomfort. Otherwise, she will perceive pain similar to that of the dilation period, but less intense and lasting.

At this stage, the mother’s feelings can be very varied, but in general, fatigue and pain give way to happiness at having the baby with us. Hunger, thirst, chills, tremors , impatience, relaxation, anxiety… each mother will describe these moments in a different way, but probably what they agree on is that all the previous suffering is forgotten.

After checking that the uterus has contracted well and that it is not bleeding excessively, the hospital staff cleans and disinfects the mother’s genital area. After her, she is taken to her room, or to an observation room if she has been given any anesthesia.

Phase Five: Immediate Postpartum

Ideally, the mother should be allowed to establish the first bonds with the baby thanks to direct contact and an environment that is as intimate and relaxed as possible.

After expulsion and while the placenta is delivered, the baby is placed on the mother’s chest to establish a first bond . It is a very emotional moment, the first time you have your baby in skin-to-skin contact with your body, feeling his warmth, his smell, seeing his face for the first time .

The power of instinct is so strong that if the baby is placed on the mother’s abdomen, it is capable of crawling to the breast unaided .

In some hospitals, after the first contact, the baby is taken to clean it, weigh it and do the first tests, including the Apgar Test , but it is recommended that this protocol be carried out close to the mother, to avoid separating them.

The first hour after childbirth, even the first two hours are said to be sacred for the mother and the baby . It is a particularly sensitive period in which early contact between mother and baby has both immediate and long-term positive effects. In those moments, what is known as affective imprinting is established, which favors the bond between the two and the establishment of breastfeeding.