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Chances are, if you get pregnant today, you’re going to have a vaginal birth. Though women are redefining the birthing experience in so many ways, most births—about 70%—still happen vaginally.
We asked top doctors to break down the process from start to finish. Here, the ins and outs of vaginal delivery from the moment you feel that first contraction to the weeks of recovery following delivery.
What are the stages of vaginal birth?
A vaginal delivery is divided into three stages, according to the Mayo Clinic: early labor, active labor, and delivery of the placenta. The entire process can be a slow one, lasting up to two to three days, says Torre Halscott, M.D., an assistant professor of maternal-fetal medicine and critical-care medicine at the Johns Hopkins University School of Medicine.
When you first notice contractions (which, fun fact, could be at night, since the sleep hormone melatonin may enhance the effect of the hormone oxytocin creating stronger contractions), it’s not time to go to the hospital just yet, experts say. “We generally like the 5-1-1 rule, which is where every five minutes, there is a contraction that lasts for one minute, and that has been happening for one hour,” says Costa Sousou, M.D., chair of the department of obstetrics and gynecology at Mayo Clinic Health System located in La Crosse, WI. “A real contraction is painful cramping that stops you in your tracks and does not get better or resolve with rest.”
During early labor, your cervix begins to dilate and efface—both things a doctor or midwife will measure to track the progress of your labor. Dilation refers to how many centimeters open your cervix is (it needs to open to 10 centimeters to allow for delivery) and effacement describes how thin your cervix is, expressed as a percentage. (The cervix starts as a long thick tube—0 percent effaced—and as it opens, it thins and shortens until it is 100 percent effaced.)
Typically doctors advise that you wait until you have 5-1-1 contractions to head to the hospital. But if your water breaks, if you have any vaginal bleeding, or you feel that your baby is moving less or has stopped moving, head to the doctor ASAP, says Ashely Brant, D.O., an ob-gyn at the Cleveland Clinic. Not quite sure where you’re at in the process? “You can always call your health care provider if you’re unsure whether you need to be seen for an evaluation,” she says.
Once your cervix has dilated past six centimeters, that means you’re officially in what doctors call active labor, the second stage of labor. This is when the pain of contractions intensifies as they get stronger and closer together. While every woman and every pregnancy is different, on average you can expect to dilate 0.5 to 0.7 centimeters an hour, according to the American College of Obstetricians and Gynecologists (ACOG).
If you choose to, you can have an epidural block to desensitize the lower half of your body and block pain. With an epidural, an injection is made into your lower back. Since it’s a sterile procedure, anyone who you want in the room for delivery will be asked to leave while the epidural is put in.
Even if you initially decide not to have an epidural, you can change your mind as labor progresses. “It’s only ‘too late’ for an epidural if you’re expected to give birth in less time than it takes to receive the epidural and for it to take effect—about 30 minutes,” says Brant.“I’ve had patients get the epidural at 10 centimeters and be very happy with that decision.”
Once you are completely dilated, it’s time to push. “We used to recommend a rest period between reaching full cervical dilation and pushing, but newer evidence suggests it’s better to start pushing right away,” Brant says. Your medical team will explain what to do, or you can rely on what you learned in any birthing classes you may have taken—more or less, you push as if you’re having a bowel movement during a contraction. “Pushing can last for as little as a few minutes to as long as four hours or more, with the average time being about one and a half hours,” says Brant. “Women who have had a prior baby generally push for less time.”
Technically, there’s no firm cutoff of how long you can push before doctors may recommend a C-section, but ACOG recommends that women who have not previously had a baby be allowed to push for at least three hours and women who have had a baby be allowed to push for at least two hours. After that, doctors should evaluate whether a C-section is needed.
Once you deliver, the umbilical cord is cut and your baby is handed to a pediatric nurse for evaluation.
After your baby is born, labor technically isn’t over. You’ll still be experiencing contractions (though they’re much milder), and within five minutes to an hour, you’ll deliver the placenta (the organ that develops in pregnancy to deliver baby nutrients), the Mayo Clinic explains. After the placenta is delivered, your doctor or a member of your health care team will make sure no fragments have been left behind, since they could cause bleeding or infection.
If your cervix tore, which happens to most women, doctors will stitch any significant tears. But don’t let this worry you too much: “As many as three out of four women giving birth have tears that are considered normal and minor,” says Brant.
Recovery After Vaginal Birth
Generally, recovery from a vaginal birth is much easier than from a cesarean section, both in the activities you are able to perform as well as in when you can go home, says Sousou.
After a vaginal delivery, you can expect to stay in the hospital one to two nights, says Brant. “Most of this time in the hospital is spent bonding with and learning to care for the baby. It’s also an opportunity to receive breastfeeding support.”
Most women don’t need prescription pain medications to recover from a vaginal birth—the pain is generally mild to moderate, related to uterine cramping and tears, says Brant. It’s usually well controlled with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Postpartum bleeding, or lochia, is also a common side effect of childbirth (for both vaginal births and C-section deliveries)—a result of the placenta detaching from the uterus and other blood and mucus from the cervix exiting your body. It’s normal, but bleeding can last (ugh) up to six weeks. You just want to keep an eye on how much you’re bleeding, docs say. If you’re soaking through more than a pad an hour, tell your doctor.
What Are the Benefits and Risks of a Vaginal Birth?
“A vaginal birth is generally the ideal way to deliver because of speedier healing,” says Sousou.
Brant adds, “In addition to avoiding the risks of surgery, vaginal delivery is associated with higher breastfeeding rates and lower rates of respiratory problems for infants.”
There is some research to suggest that babies born vaginally have more gut bacteria from their mothers, which could potentially play a role in immunity, Brant says. But research on the relationship between method of birth (vaginal versus C-section), infant gut microbiota, and childhood illness is still evolving. “There is not enough information available at this time to make recommendations about method of delivery,” she says.
As for risks of a vaginal delivery? “There are very few risks that are involved with having a vaginal birth,” says Sousou. While tearing is a common concern, tears usually heal well by six weeks postpartum, says Brant. Rarely (less than 5% of the time), women experience more serious tears that affect the muscles of the rectum (which can result in bowel and bladder dysfunction), she says. “Pelvic-floor physical therapy can be a very helpful first step for women who are experiencing urinary or bowel problems.”
What If I Have to Be Induced?
In some cases, your doctor might jumpstart your vaginal birth—it’s called induction of labor. Some reasons your ob-gyn might suggest inducing you:
- You’re post-term, meaning you’re past your due date by two weeks, which is when amniotic fluid surrounding the baby can decrease.
- You have an infection in your uterus.
- You have problems with your placenta.
- Your baby has stopped growing at the expected pace.
- You have other medical problems such as kidney disease or high blood pressure.
- You’re past 39 weeks and want to deliver at a specific time—you live far away from your hospital, for example, or have a history of superfast deliveries and want to make sure you’re in the hospital when your baby comes.
If you’re being induced, there are various methods, including a procedure called an amniotomy—a doctor ruptures the amniotic sac (“breaks your water”) with a small plastic hook—or using a synthetic version of oxytocin called Pitocin to cause your uterus to contract and speed up labor.
Of course, whether or not you need to be induced is something that’s best discussed with your ob-gyn, who knows you and your pregnancy best. After all, most of the time your body will prepare itself to bring your baby into the world on its own.
Cassie Shortsleeve is a writer in Boston covering health, lifestyle, travel, and parenting. Follow her at @cshortsleeve.
