Stages of labour and dilation: what happens at each stage, how long it lasts and when to go in

There are three stages of labour. In the first, your cervix opens from closed to 10cm; it has an early (latent) phase that can last many hours at home, and an active phase when contractions get strong and regular and you should be in the labour ward. The second stage runs from full dilation to the birth of your baby, and the third from the birth to the delivery of the placenta. HealthHub puts the pushing stage at up to 1 to 1.5 hours for a first-time mother, and KKH says active labour moves at about 1cm an hour once you pass 4cm. This guide explains dilation and effacement, then walks through each stage with what Singapore hospitals tell you, how long each one usually takes and when to head in.

The stages of labour at a glance

Timings come from HealthHub and KKH, and both say they're only a guide. Labour is generally longer with a first baby.

Dilation and effacement: what the numbers mean

Two things happen to your cervix in the first stage of labour. It thins out, which is called effacement, and it opens, which is dilation. Both are checked by a doctor or midwife during a vaginal examination.

• Effacement: the cervix is normally firm and a few centimetres long. In late pregnancy and early labour it softens, shortens and thins. Some doctors give it as a percentage, from 0% (not thinned) to 100% (fully thinned).
• Dilation: how wide the cervix has opened, in centimetres, from closed to 10cm. At 10cm you are "fully dilated" and the second stage starts.

The UK's NICE guideline on care in labour draws the line at 4cm, the same point at which KKH says things speed up. Before 4cm is the latent phase: contractions come and go while the cervix moves, softens, thins and starts to open. From 4cm, with regular contractions and steady opening, you are in established, or active, labour.

How long each stage takes, in numbers

These figures come from hospital and guideline sources, and your own labour may run faster or slower. A first labour is usually the longest.

• First stage: HealthXchange's KKH anaesthetists put it at 8 to 12 hours for first-time mothers. NICE gives an average of 8 hours for the active part of a first labour (rarely over 18 hours) and 5 hours for later labours (rarely over 12).
• From 4cm to 10cm: about 1cm an hour, KKH says, so roughly six hours, faster for many.
• When progress counts as slow: NICE suggests checking again after 2 hours and calling it a delay if the cervix has opened less than 1cm. Your team may then offer to break your waters or start a drip to strengthen contractions.
• Second stage: HealthHub says up to 1 to 1.5 hours for a first baby and a few minutes for some experienced mothers. NICE expects most first-time mothers to give birth within 3 hours of starting to push, and within 2 hours for later births.
• Third stage: the placenta usually comes 5 to 30 minutes after the birth, SGH says.

Our contraction timer helps you judge when early labour is turning into active labour.

First stage: early labour

Your cervix has been closed for about nine months. In early labour it softens, thins out and opens to about 3cm. You may feel a low backache and contractions that come and go, which HealthHub describes as waves that build, peak and fade, a bit like period cramps. This phase can take many hours, and the contractions usually aren't too painful yet.

Most women spend early labour at home. HealthHub's advice is to wait a while if you're not sure, and go in when the pain is persistent and getting steadily worse. Our contraction timer helps you track how far apart they are. If you've had tightenings for weeks, our 28 weeks pregnant guide explains how Braxton Hicks differ: they're irregular and usually painless, and they don't open the cervix.

First stage: active labour

Once contractions are stronger and more regular, you're in active labour, and HealthHub says this is when you need to be in the labour ward so you and your baby can be monitored. KKH says that after about 4cm you dilate at roughly 1cm an hour, so about six hours more to reach 10cm. It stresses that this is a guide and that some mothers move much faster.

In hospital, a machine tracks your baby's heartbeat and your contractions, and a doctor or midwife checks your cervix. KKH says to expect checks about every four hours at first, more often later. At NUH you can't eat during labour but can take sips of water, and your partner can stay with you throughout. If progress is too slow, your doctor may step in.

This is when most women ask for pain relief. HealthHub lists Entonox (laughing gas) as the most common, TENS, which takes 30 minutes to work and doesn't help much in the pushing stage, pethidine injections, and the epidural, the most popular. Our epidural guide compares them.

Second stage: pushing and birth

When your cervix is fully open at 10cm, you'll feel a strong urge to bear down, much like needing to pass a motion. Your doctor or nurse tells you when to push. HealthHub says this stage may last up to 1 to 1.5 hours for a new mother, or just a few minutes for an experienced one. KKH adds that long, steady pushes work better than short ones, and that screaming wastes the energy you need. Our guide on how to push during labour covers breathing, positions and pushing with an epidural.

The skin between your vagina and anus usually stretches but can tear, and your doctor may make a small cut (an episiotomy) to stop it tearing in several directions. You may need help with forceps or a vacuum cup if you've pushed for more than an hour, you're too tired to push well, or your baby shows signs of distress.

Third stage: the placenta

After your baby is born, your womb keeps contracting and the placenta separates from its wall within a few minutes. You'll get an injection in your thigh, which KKH says is oxytocin, to help your womb contract, push the placenta out and prevent heavy bleeding. Your doctor checks that the placenta is complete and stitches any tear or cut with dissolvable stitches.

Meanwhile your baby is weighed, measured and checked, given an identity tag and a vitamin K injection, and offered the hepatitis B vaccine if you agree. HealthHub's advice is to get back to skin-to-skin contact as soon as you can. If you want the cord cut later, see our delayed cord clamping guide.

When to go to the hospital

Not every labour goes to plan. SingHealth tells mothers there's about a 10% chance of an emergency caesarean during labour, usually because the baby's heart rate pattern is worrying or the cervix stops opening. Our signs of labour guide covers the early signs, and preparing for labour covers what to sort out beforehand. For the last weeks, see our 34 weeks pregnant and 37 weeks pregnant guides.

Frequently asked questions

What are the 3 stages of labour?

The first stage is your cervix opening to 10cm, in an early and an active phase. The second is pushing and the birth of your baby. The third is the delivery of the placenta.

How long does the first stage of labour last?

Early labour can last many hours. Once you reach about 4cm, KKH says you dilate at roughly 1cm an hour, so around six hours to 10cm, though it's only a guide and first labours tend to be longer.

How long can you push for?

HealthHub says up to 1 to 1.5 hours for a first-time mother. If you've pushed for more than an hour and you're too tired or your baby is distressed, your doctor may help with forceps or a vacuum cup.

How far apart should contractions be before going to hospital?

NUH lists regular contractions 5 to 15 minutes apart as a sign of labour. Go sooner if your waters break, you bleed, or your baby moves less.

How many centimetres dilated before you go to hospital?

There's no fixed number to wait for at home, because you can't check it yourself. Singapore hospitals go by your contractions and other signs instead: HealthHub says to go in when the pain is persistent and getting steadily worse, NUH lists regular contractions 5 to 15 minutes apart, and active labour, from about 4cm, is when you should be in the labour ward.

What is effacement in labour?

Effacement is your cervix softening and thinning before and during early labour, so that it can open. It's often given as a percentage, with 100% meaning fully thinned.

How long does it take to go from 4cm to 10cm?

KKH's rough guide is about 1cm an hour, so around six hours, but many women go faster, especially after a first baby.

What is the latent phase of labour?

It's the early part of the first stage, when the cervix thins and opens to about 3cm. It can last many hours, and most women stay at home for it.