The stages of labor: what happens and how long each lasts

Labor has three stages: your cervix opens, your baby is born, and the placenta comes out. Every labor runs at its own pace, so the times below are typical ranges from ACOG, NICE and the NHS.

How many stages of labor are there?

ACOG defines the three stages like this:

1. The first stage opens your cervix from closed to fully dilated at 10 cm. It has an early, or latent, phase and an active phase.
2. The second stage runs from full dilation to your baby’s birth. This is the pushing stage.
3. The third stage is the delivery of the placenta.

Some sources add a fourth stage, the first hours after birth (Cleveland Clinic, HealthLinkBC). Cleveland Clinic puts it at 2 to 3 hours after the placenta is delivered. For a first baby, ACOG says labor typically lasts 12 to 18 hours in total. After an earlier birth, it’s typically 8 to 10 hours.

Stage	What happens	Typical length
First stage, latent phase	Cervix softens, thins and starts to open; contractions often irregular	Many hours, sometimes days (NHS)
First stage, active phase	Cervix opens from 6 cm (ACOG) or 4 cm (NICE) to 10 cm; contractions regular and strong	About 8 hours on average in a first labor, rarely over 18; about 5 hours in later labors, rarely over 12 (NICE)
Second stage	Pushing and birth	Up to 3 hours with a first baby, up to 2 hours after that (NHS)
Third stage	Delivery of the placenta	Usually within 30 minutes with an oxytocin shot, up to an hour without (NHS)

Early labor: the latent phase

In early labor, your cervix softens, thins and starts to open (NHS). NICE describes this latent first stage as a period that is not necessarily continuous. It brings contractions and some change in the cervix up to 4 cm. ACOG describes it as slower dilation that lasts until rapid change begins, which it places at 6 cm.

Contractions can range from slightly uncomfortable to painful, and there’s no set pattern to how often they come or how long they last (NHS). HealthLinkBC describes early contractions that feel like mild cramps. At first they last 15 to 30 seconds and come every 10 to 20 minutes. Later they last up to 45 seconds and come every 5 to 7 minutes. You may also notice backache, loose stools or a pinkish discharge called the show. ACOG lists the loss of the mucus plug and your water breaking among the changes that can signal labor is beginning.

Early labor can take many hours or even days, and it’s usually the longest part of labor (NHS). ACOG notes that a normal latent phase varies widely between people. Its guideline says a latent phase of more than 16 hours may be considered prolonged in a first labor. Even then, most people move into active labor with time.

What helps, according to the NHS:

• eat and drink something, because you’ll need energy later
• if labor starts at night, stay comfortable and sleep if you can
• during the day, stay upright and gently active to help your baby move down
• try breathing exercises, massage, or a warm bath or shower for pain

You’ll likely be told you can stay home during early labor (Cleveland Clinic). If you go in before labor is established, the hospital may suggest you go home again for a while (NHS).

Once contractions become regular, start timing them, on paper with a contraction chart or with our free online contraction timer. Cleveland Clinic suggests calling your provider once contractions come every 5 minutes for at least an hour. Our guide to the 5-1-1 rule explains this pattern, and when to go to the hospital covers the decision.

Active labor: does it start at 4 cm or 6 cm?

In active labor, your cervix opens faster and contractions become regular, longer and stronger. Where it begins depends on the guideline:

• In the US, ACOG’s 2024 guideline says 6 cm should be considered the start of the active phase.
• In the UK, NICE defines established labor as regular contractions with progressive dilation from 4 cm.

ACOG itself notes that the speed-up can happen anywhere between 4 and 6 cm. So the two cutoffs describe the same shift. The difference mostly affects how your care team judges whether labor is progressing normally.

HealthLinkBC describes active labor contractions as coming every 3 to 5 minutes and lasting 60 seconds or more. You might start to doubt whether you can cope and turn inward to focus. By now you should be at your hospital or birth center (Cleveland Clinic). For how a single contraction changes from stage to stage, see how long contractions last and what contractions feel like.

NICE says an established first stage lasts 8 hours on average in a first labor and rarely over 18. In second and later labors, it averages 5 hours and is unlikely to last over 12 hours. Cleveland Clinic gives 4 to 8 hours for active labor.

What helps, according to Cleveland Clinic:

• walking and changing positions
• gentle stretches and deep breathing
• a warm (not hot) bath or shower
• a birthing ball
• a support person

Your care team listens to your baby’s heartbeat regularly and can talk you through pain relief options.

Transition: the last few centimeters

Transition is the end of the first stage. Your cervix goes from about 7 or 8 cm to fully open (HealthLinkBC). ACOG and NICE don’t define it as a separate phase. HealthLinkBC treats it as the last of three phases of the first stage.

HealthLinkBC lists what you might feel in transition:

• strong contractions every 2 to 3 minutes that last 60 to 90 seconds
• pressure in your bottom
• moments of panic and confusion
• irritability, nausea or vomiting
• trembling legs, hot or cold flashes
• a strong urge to push

Focus on one contraction at a time. Tell your nurse or midwife if you feel the urge to push. If it comes before you’re fully dilated, HealthLinkBC suggests panting through the contraction.

Second stage: pushing and birth

The second stage starts when your cervix is fully dilated and ends with your baby’s birth (ACOG). NICE splits it into two parts. In the passive part you’re fully dilated but not pushing yet; in the active part you’re pushing or your baby is visible.

You may feel an urge to push that feels a bit like needing to poop. With an epidural, you may not feel it at all (NHS). You can push during contractions whenever you feel the urge. You can sit, kneel, lie on your side, stand or squat, whatever works for you (NHS).

The NHS says pushing should last no longer than 3 hours with a first baby. If you’ve given birth before, it should take no more than 2 hours. ACOG calls the second stage prolonged after more than 3 hours of pushing in a first birth. In later births the cutoff is 2 hours. Beyond that, ACOG recommends an individualized approach. HealthLinkBC gives 1 to 3 hours for a first baby, longer with an epidural.

When your baby’s head is almost out, your midwife or doctor may ask you to stop pushing and take short breaths instead. This lets the head be born slowly and gently (NHS). Once the head is born, the rest of the body usually follows in the next 1 or 2 contractions.

Third stage of labor: the placenta, and the hours after

After the birth, your uterus contracts again and the placenta comes out (NHS). There are two ways to manage this:

• With active management, you get an oxytocin injection, and the placenta usually comes out within 30 minutes. This lowers the risk of heavy bleeding, though it makes nausea and vomiting more likely and can make afterpains worse (NHS).
• With physiological management, there’s no injection, and the placenta can take up to an hour to come away (NHS).

NICE calls the third stage prolonged if it isn’t complete within 30 minutes with active management. With physiological management, the limit is 60 minutes. Your midwife will explain both options, ideally while you’re still pregnant.

The 2 to 3 hours after the placenta is delivered are sometimes called the fourth stage. Your care team watches for abnormal bleeding, and you get time to bond with your baby (Cleveland Clinic).