The pregnancy test was positive, and your bump has been growing ever since. You can’t wait until the big day arrives and you finally get to meet your baby — but you’re also wondering what it’ll be like to go into labor.
Every birth experience is remarkable and life-changing, but what exactly is going on as you bring your new bundle of joy into the world?
Welcome to the miracle of your body in labor.
How your body prepares for birth
Before the first whisper of a contraction, your body is already preparing for the big event.
About two to four weeks before you deliver, you may notice your bump looks a little bit lower than it used to. That’s because, near the end of pregnancy, your baby “drops,” moving into a head-down (vertex) position deeper into the pelvis to prepare for the grand exit.
Around this time, your body may also release a blob of clear or pink discharge, sometimes referred to by the charming name “bloody show.” This is your mucous plug, a jellylike barrier that seals off your uterus during pregnancy to protect your baby from pesky bacteria that are trying to get in.
As your body prepares for birth, your cervix — the muscular ring between your uterus and vagina — begins to soften, dislodging the mucous plug.
The exact chain of events that trigger your body to prepare for and begin labor, however, is still a mystery.
“For all that we know about the human body, we still don’t know what starts labor,” explains Margaret Bolton, a certified nurse midwife at Meridian Women’s Health at UW Medicine. “We suspect that it has something to do with the baby and the placenta.”
The early signs of labor
Although experts don’t quite understand how labor starts, there are some telltale signs that labor is imminent.
One is your water breaking. This isn’t actually water but is rather amniotic fluid, which is released when the amniotic sac around your baby ruptures. It may feel like a trickle or small gush. Either way, you can tell the difference between this and urine — no judgement, leaking is common — because amniotic fluid is pale and odorless. If your water breaks, contractions are usually only a few hours away.
Not all women have their waters break, though. Only about 1 in 10 moms-to-be experience this before they go into labor. For the other 90%, your water may not break until you’re already laboring or when your OB-GYN or midwife does it manually.
“Rarely, the baby is born ‘in the caul,’ which means that the baby is born with the bag of water intact,” Bolton says.
Amniotic sac rupture or not, once labor does start, your brain releases a hormone called oxytocin to trigger contractions. This hormone travels through your uterine artery and lands on receptors in the uterus, signaling to your uterine cells that it’s time to wake up and start contracting.
“You’ll feel a cramping, tightening sensation in the lower abdomen and sometimes in the back as well,” Bolton notes. “The sensation builds and then releases as the contraction passes.”
The first stage of labor
Labor is typically divided into three stages. The first stage — marked by contractions and cervical dilation — is further divided into three distinct phases: early, active and transitional labor.
During early labor, your cervix will open to around 3 centimeters. Your uterine cells start out sporadically, with short contractions and long stretches between each one. This can go on for a few hours or a few days, with contractions becoming more regular and intense as time goes on.
Right around the end of early labor, when contractions start lasting longer and occurring with more frequency, is when many pregnant women leave for the hospital. Usually your OB-GYN or midwife will tell you to wait until you’re experiencing at least an hour of contractions that last one minute, with five minutes between each one.
Contractions pick up even more during active labor, dilating your cervix to about 7 centimeters. At this point, contractions feel like a tightening or cramping in your midsection and are coming every four or five minutes. The pain can radiate to your back and other areas of your body as your adrenaline wears off from the initial excitement of going into labor.
Active labor is when you may begin asking for pain relief options, including epidurals, nitrous oxide (laughing gas) and short-acting pain medications. Your uterus will still be contracting, but the pain you feel will be reduced or minimized depending on what pain relief you may choose.
The final phase is transitional labor. Although it’s the shortest part, it’s also the most intense. This is when your cervix reaches its full 10-centimeter dilation. Contractions are still about one minute long but pick up in pace, coming every two or three minutes.
It can feel exhausting to have such little rest between each contraction, Bolton notes, and many women are more inwardly focused during this phase to help themselves cope. It’s normal to experience a range of emotions as you work through the sensations in your body, including questioning your ability to get through this.
As those uterine contractions open up your cervix, your baby will move even further down. This added pressure touches on stretch receptors in your pelvis, triggering your urge to push.
The second stage of labor
Once you begin pushing, you’ve entered the second stage of labor.
When your uterus contracts, your baby is pushed down. When the contraction ends, your baby naturally slides back up. That’s why your OB-GYN or midwife will encourage you to push during a contraction to encourage your baby’s downward trajectory. Expect to feel a lot of pressure in your pelvis and rectum as your baby moves downward.
Pushing can physically take a lot out of you, especially because it’s combined with those still-intense contractions you felt in the first stage of labor.
There are times, too, when all your pushing can result in an unintended bowel movement. While that might seem embarrassing, at this intense point during labor, you probably won’t even notice, Bolton says.
“Either way, your nurses and providers are used to all the things that happen during labor and will take care of the details,” she adds.
Eventually, the top of your baby’s head will reach your pubic bone and become visible through your vaginal opening — something called crowning. As your vagina stretches to accommodate your baby, you may feel a burning sensation and even experience tears in your vaginal tissue.
This is common during birth and, like the bowel movements, you probably won’t even notice until after you deliver your baby.
With baby’s head crowning, it usually only takes a few more pushes for the entire head to come out followed by the rest of the body. Seeing your baby for the first time can trigger a range of emotions, all of which are normal.
“Once the baby comes out, women usually feel a sense of relief,” Bolton says. “Many other emotions can accompany the birth of a baby. Some women feel emotion toward the baby immediately and others take time to feel emotions toward their baby.”
The third stage of labor
Although your baby has finally arrived, labor isn’t over just yet.
Your uterus will keep contracting, although less intensely than it did before. This separates the placenta from the uterine wall and helps stop the bleeding where it detached. Within 30 minutes — and sometimes with one more requested push — your placenta easily slips out. This is called the afterbirth.
In the following hours after giving birth, you may also feel your body shaking from the adrenaline and various birth hormones circulating within your body. This is completely normal and will settle down as your emotions and body do.
How a C-section works
Sometimes your baby needs to be delivered using a surgical procedure called a caesarean section, known most commonly as a C-section.
This can be because your baby’s heart rate drops during labor or your labor isn’t progressing as your OB-GYN or midwife anticipates. Sometimes a C-section is planned in advance, like if your baby never makes it into that heads-down position and ends up feet down instead, something called a breech position.
Whatever the reason, a C-section is done to ensure your baby’s health and safety.
You’ll be given anesthesia so you don’t feel anything from your torso down, but you’ll be awake and aware for the entire procedure. Once everything is prepped, your OB-GYN will make a cut in your abdomen and torso and then pull the baby out, followed by the placenta.
It can take only about 10 minutes from when this process starts to when your baby is born. From there, the doctor will repair your muscles and stitch the incision closed.
Delivering multiples and more
If you’re pregnant with twins or more babies, your labor and delivery will be a little more unpredictable. That’s because most women who are carrying multiples go into labor earlier than they might with a single pregnancy, although experts still don’t know why that is.
According to 2018 data from the National Center for Health Statistics, 8.24% of singleton babies in the U.S. are preterm, or born before 37 weeks. By comparison, 60.32% of twins and 98.32% of triplets are delivered before the 37-week mark.
Sometimes one or both twins can be delivered vaginally because both are in the heads-down position, but there are times when one twin or both are breech and need to be delivered via C-section. Usually, triplets or more multiples must be born using a C-section for their safety.
Recovering from birth and delivery
In the hours following your baby’s birth, your body will begin the healing process.
Your breasts will also start producing colostrum, a yellowish, nutrient-rich substance that you use to feed your baby until your breast milk comes in about 48 to 72 hours later.
Through it all, expect to ride a wave of various emotions as your hormones change and you adapt to the needs of your little one.
The best thing you can do, Bolton says, is to try and stay in the moment as best as you can.
“Pregnancy is a time of transition and change,” Bolton says. “This transition can be so full of joy and excitement, and it can also be very challenging and scary. It helps to be gentle with one’s self during this time. Know that your experience will be what it is. It can help to loosen your attachment to things going one particular way.”