A How2Mom guide

Signs and Phases of Labor your Doula Resource Guide

What happens, roughly how long it tends to last, and what helps. Read it now so it is already in you when the day comes.

Doula supporting a mother during early labor at home

A note on the numbers below. These ranges are wide, and plenty of labors do not follow them. A long early labor is not a stalled one, and a fast transition is not a rushed one. Your labor is doing its own thing, and we will meet it where it is.

The rhythm of labor

Four phases, each doing a different job. The first column of every card is what your body is doing. The second is what tends to help.

  • Early labor

    Hours to days

    The range of normal here is extremely wide, and it comes and goes. Your cervix softens, moves forward and thins out, reaching 0 to 3 cm. Endorphins begin flowing.

    What helps: eat, drink, and ignore it. Deep breaths, and let your body soften. Normal activities, sleep and rest. This phase is the body rehearsing, and it usually does better without an audience.

  • Active labor

    4 to 8 hours

    Your cervix finishes effacing and opens to 4 to 7 cm. Endorphins are building. Baby rotates and descends. Contractions get longer, stronger and harder to talk through, and your focus turns inward.

    What helps: light food, plenty to drink, deep belly breathing, full body relaxation, and movement. Soft, open, down. Stay in your groove.

  • Transition

    1 to 4 hours

    7 to 10 cm. Baby rotates and descends, the head molds, hormones shift to prepare for pushing, endorphins flood you, and the urge to push begins. This is the shortest phase and the most intense one. Doubt here is a sign of transition, not a problem.

    What helps: encouragement, focus, information, patterned breathing, movement, tub or shower, cool cloths. Follow your body's cues.

  • Pushing

    Up to 3 hours

    Baby descends, the head molds, your tissues stretch, and a hormone surge prepares baby for life outside. Contractions often space out a little after full dilation, and some people get a genuine rest here.

    What helps: follow your body's cues, stay upright and mobile, and ease off the pushes when crowning. If you get a rest at 10 cm, take it.

Pain management options

Not a recommendation either way. This is so you know what is on the table before anyone offers it to you, and so the conversation in the room is one you have already had.

  • Nitrous oxide

    How it is given
    A gas you breathe in through a mask, which you hold yourself.
    What it does
    Reduces anxiety and encourages brief relaxation.
    Side effects
    Feeling giddy, lightheaded or woozy, though it is short lived.
    How well it works
    Half of users still experience severe pain, but 92% in one study reported being less bothered by it.

  • Narcotics and opioids

    How it is given
    Through an IV.
    What it does
    An analgesic, so sensation remains but some people find they are not as bothered by labor pains.
    Side effects
    Grogginess, dizziness, feeling high, itchiness, lower blood pressure, nausea.
    How well it works
    Two thirds will still have moderate to severe pain, but 75% found it relieved some of the pain or took the edge off.

  • Epidural

    How it is given
    A needle is placed so a catheter can be threaded, then the needle is removed and a small catheter stays in to deliver the medication.
    What it does
    When properly placed, most people have all or most of their pain numbed.
    Side effects
    Low blood pressure, incomplete relief, discomfort at the placement site, slower labor, and continuous monitoring.
    How well it works
    Much less likely to feel severe pain. Most studies find over 90% report good pain relief.

  • Sleep aid

    How it is given
    Orally or through an IV.
    What it does
    It may not relieve pain, but it can help you sleep through contractions.
    Side effects
    Grogginess, itchiness and restlessness, and less energy for the pushing stage.
    How well it works
    Sleep aids do not typically eliminate pain, but they help some people rest through contractions.

Whatever you are weighing up, the five questions below are the ones we would ask alongside you.

BRAIN

For any moment you are offered a test, a medication or a procedure and have very little time to think. Five questions, in order. You can ask them out loud, and you are allowed to ask all five.

Benefits

What are the benefits to me, or to my baby, of this particular test, medication or procedure? Why is it being suggested right now, and is it necessary?

Risks

What are the risks to either of us? Are there side effects? How will this affect the rest of my birth, what other procedures might follow it, and will it limit my options later on?

Alternatives

Are there other alternatives or options available? What would we be choosing between?

Intuition

What does my intuition tell me? How does my partner feel? You know your body and your baby's patterns better than anyone in the room.

Next, not now, nothing

If I say yes to this, what happens next? If it is not successful, what is the step after that? What would happen if I did nothing? And what would happen if we waited an hour?

BURPEE

This one is written for your partner or support person, so it talks about you rather than to you. Six things to run through whenever they are not sure what to do next. There is almost always something on this list that helps.

Breathe

Slow, long, vocalized breath is an incredibly powerful tool. When she brings out a low, primal, mama-bear sound, she is telling her nervous system "I am okay, I am safe." It is nearly impossible to make those deep low moans and hold tension in the forehead, jaw, shoulders, arms and legs at the same time.

Urinate

If she is well hydrated through labor on clear fluids like water and coconut water, she will need to go every 45 minutes to an hour. Keep offering, because she will not think of it.

Rest and relax

In a 12 hour labor, only about 2 of those hours are actually spent doing the hard work. The rest is exactly that, rest. Think pillows, soft places to land, blankets, a quiet room, softness under knees and elbows and wrists, dim lighting and soft music.

Positions

It is incredibly beneficial for her to keep moving, whether that is a small roll of the head, a sweep of the pelvis from side to side, or something large like a lunge or a squat. It helps her relax and find her rhythm, and it creates the best opportunity for baby to descend through the bony structure of the pelvis.

Environment

Scan the room. How does it feel? If she needs to relax deeper, dim the lighting, keep the room quiet and use a relaxing essential oil like lavender or rose. If she and her support people need to wake up and shift the energy, open the windows, find music to match, and try lemon or peppermint.

Encouragement

Unless she has told you she wants silence, she can rarely hear too often how amazing she is, how beautiful and powerful and strong. Tell her you love her. Tell her you are proud of the work she is doing. Remind her she has everything she needs to be right here, right now.

When it is time, call us

What counts as early labor, when to reach out, and how we decide together when your doula joins you. Kept on its own page so it is quick to find.

When to call your doula

This page is general education and not medical advice. It does not replace care from your provider, and it is written for a typical unmedicated birth. There are plenty of situations where things go differently, and we will talk through yours at your prenatal visits.