The period of labor can be divided into three stages.

• The first stage is dilation.
• The second stage is expulsion, and
• The third stage is the placental stage.

a. First Stage: Dilation. During this stage, the cervix dilates at a rate of one to two centimeters per hour until dilation is complete at 10 centimeters (four inches). Effacement (shortening of the cervix) takes place in this stage. The uterus contracts regularly, and the amniotic sac ruptures. If the sac does not rupture by itself, it is ruptured artificially.

b. Second Stage: Expulsion.

(1) This stage is the period of time from complete dilation of the cervix through the delivery of the baby. During this stage, contractions take place every two to three minutes. The contractions last about 60 seconds and are more intense than in the first stage. The mother bears down involuntarily. She may bear down when she has the urge. There is increased pressure on the mother’s rectum which causes her to feel as though she has to have a bowel movement.

NOTE: Bearing down during the first stage of labor is of no help and will tire the mother.

(2) If you find a woman in the second stage of labor, observe her condition and ask her these questions:

(a) Is this her first baby?

(b) How long has she been in labor?

(c) What are her contractions like? (Frequency? Duration? Intensity?)

(d) Is the bearing down involuntary?

(e) Does she feel as if she has to have a bowel movement?

(f) Can you observe the baby’s head crowning?

CAUTION: If you observe the baby’s head crowning, DO NOT touch the vagina. Touching the vagina could cause infection.

(3) If the woman’s answers and your observations indicate that she is in the second stage of labor, prepare to assist in delivery. There is not enough time to get her to a hospital.

(4) The second stage of labor ends with the delivery of the baby.

c. Third Stage: Placental Stage. This stage of labor covers the time period after delivery of the baby when the placenta (the afterbirth) is expelled.

In this stage, the uterus contracts, causing the placenta to be expelled. This process can take from 1 to 30 minutes.

DO NOT pull the placenta out. It will deliver by itself. If you have assisted in a delivery outside a hospital, transport the placenta to the hospital with the mother and child. There the placenta should be examined along with the mother and child. The contractions of the uterus (in expelling the placenta) help constrict blood vessels torn in delivery, thus reducing the possibility of the mother hemorrhaging.