Labour has three stages: the first opens your cervix, the second pushes your baby out, and the third delivers the placenta. The first stage is the long one, and guidelines split it in two: a latent phase, when contractions start and the cervix begins to change, and established labour, when it opens steadily to 10 cm.
This guide walks through each stage with the timings that NICE, WHO and the NHS give for a first labour and for later ones, what you can do at each point, the pain relief available and its trade-offs, and the signs that mean calling your maternity unit straight away, whatever stage you think you are in.
The short answer. Labour has three stages. The first opens your cervix: a latent phase up to about 4 cm, then established labour to 10 cm, which NICE says averages 8 hours in a first labour and 5 hours in later ones. The second stage is pushing and birth. The third ends when the placenta comes out.
The Stages at a Glance
The timings below come from NICE and the NHS, and they are the figures British midwives give women. They describe most labours rather than every labour: NICE stresses that the length of labour varies between women.
| Stage | What happens | First baby | Later babies | What you do |
|---|---|---|---|---|
| Latent first stage (early labour) | Contractions start, may come and go; cervix softens, thins and opens to about 4 cm | No standard length: many hours, sometimes days | Stay at home, rest, eat, drink, time contractions | |
| Established first stage (active labour) | Regular, stronger contractions; cervix opens from 4 cm to 10 cm | About 8 hours on average; unlikely to last over 18 | About 5 hours on average; unlikely to last over 12 | Be at your birth unit or with your midwife; keep moving, choose pain relief |
| Second stage (passive, then active pushing) | Cervix fully open; baby moves down and is born | Birth usually within 3 hours of active pushing | Birth usually within 2 hours of active pushing | Push with the urge, in any position except flat on your back |
| Third stage | Placenta and membranes come away | Within 30 minutes with an injection (active management); up to 60 minutes without (physiological) | Hold your baby skin to skin; choose active or physiological | |
First Stage, Part One: the Latent Phase
The latent phase is the start of labour. NICE describes it as a period, not necessarily continuous, when you have contractions and your cervix changes: it moves forward, softens, thins and opens up to 4 cm. Contractions can be irregular, can stop for hours and can start again. The NHS lists backache and a show of blood-streaked mucus among the signs that labour has begun; our mucus plug guide covers what the show looks like.
How long it lasts
No one can give you a number. WHO says a standard duration for the latent phase has not been established and that it varies widely between women. The NHS says it can take many hours, or even days, before you are in established labour, and that it is usually the longest part of labour.
What helps at home
In the latent phase
- If it starts at night, sleep if you can; by day, stay upright and gently active (NHS)
- Eat and drink: you will need the energy later
- A warm bath or shower, massage and breathing exercises may reduce pain at this stage, according to NICE
- A TENS machine is probably most useful now, while pain is mainly in your lower back (NHS)
- Time your contractions from the start of one to the start of the next
When to call
The NHS says to call your midwife or maternity unit once you have regular contractions every 5 minutes or more often, or whenever you think you are in labour and want advice. Many units use the 5-1-1 rule for a first baby: contractions about 5 minutes apart, lasting about a minute, for an hour. Our contraction timer tracks that pattern for you, and the full checklist for leaving home is in our guide to signs of labour. If your waters break, call whatever your contractions are doing.
If you go in early, you may be sent home. NICE tells midwives to recognise that contractions can be painful without changing the cervix, to offer support and pain relief, and to encourage you to stay at or return home unless that risks the baby arriving without a midwife or you are distressed.
First Stage, Part Two: Established Labour
Established labour, also called the active phase, is when contractions become regular and your cervix keeps opening until it reaches 10 cm. Midwives check progress by examining you, which NICE suggests offering about every 4 hours, and by watching how your contractions and your baby's heart rate change.
4, 5 or 6 cm: where the active phase begins
The major guidelines disagree on the starting line. NICE (UK) counts established labour from 4 cm. WHO set it at 5 cm in its 2018 recommendations. ACOG (US) uses 6 cm. The definition decides when staff start measuring your progress against the expected timings. If you are told you are "not in active labour yet" at 4 or 5 cm, ask which definition your unit uses.
How long it lasts
NICE tells women that established labour varies, but that first labours last on average 8 hours and are unlikely to last over 18 hours, and second and later labours last on average 5 hours and are unlikely to last over 12. WHO, counting from 5 cm, says the active phase usually does not go beyond 12 hours in a first labour and 10 hours in later ones.
You may have heard that the cervix should open 1 cm an hour. WHO no longer recommends that benchmark: it found the 1 cm-per-hour line unrealistically fast for some women and inaccurate at picking out those at risk. NICE suspects a delay when the cervix opens less than 2 cm in 4 hours, and then rechecks before acting.
Moving, eating and drinking
NICE says midwives should help you move and take whatever positions you find most comfortable throughout labour, except lying flat on your back. If labour brings a lot of backache, the NHS says kneeling on all fours may help. You can drink when you are thirsty, and NICE says you can eat a light diet in established labour unless you have had an opioid or develop risk factors that make a caesarean more likely.
Second Stage: Pushing and Birth
The second stage begins when your cervix is fully open and ends with your baby's birth. NICE splits it in two:
- Passive second stage: you are fully dilated but not yet pushing. With an epidural, you may be advised to wait before pushing, for up to 2 hours with a first baby or 1 hour with later babies.
- Active second stage: your baby's head is visible, or you are pushing, on your own urge or with guidance, at full dilatation.
Once active pushing starts, NICE expects most first babies to be born within 3 hours and most later babies within 2 hours. WHO gives the same 3 and 2 hours. Your midwife reassesses progress after 1 hour of pushing with a first baby, or 30 minutes with later babies, and asks for a senior review if birth is not imminent after 2 hours or 1 hour respectively.
Positions matter here too. NICE says lying flat on your back can lower your blood pressure and reduce blood flow to the placenta. Without an epidural, upright positions and keeping mobile may help; with one, lying on your side may increase the chance of a spontaneous vaginal birth.
If you feel a strong urge to push at home and think your baby is coming now, the NHS says to call 999 for an ambulance in the UK (911 in the US) rather than setting off by car.
Third Stage: the Placenta
The third stage lasts from your baby's birth until the placenta and membranes come out. You choose how it is managed, and it is worth deciding before labour and writing it into your birth plan:
- Active management: an injection of a medicine that makes the uterus contract, with the cord clamped and cut between 1 and 5 minutes after birth. The placenta usually comes within 30 minutes. NICE says active management lowers the risk of heavy bleeding after birth (postpartum haemorrhage) and of needing a blood transfusion.
- Physiological management: no injection; the cord is left until it stops pulsing, usually 2 to 4 minutes, and you push the placenta out yourself. It can take up to an hour, though it often takes a few minutes.
NICE calls the third stage prolonged if it is not complete within 30 minutes with active management or 60 minutes with physiological management. If you start with physiological management and want to shorten it, you can switch to active management.
Pain Relief, Stage by Stage
Each option has a trade-off, and several are only available in an obstetric unit. The pairs below are what NICE and the NHS tell women.
| Option | What it offers | Limits |
|---|---|---|
| Breathing, bath or shower, massage | May reduce pain in the latent phase; usable from the first contraction | NICE's advice covers the latent phase; check what your unit offers later on |
| TENS | Probably most useful early on, for lower back pain; no known side effects | Not shown to work in established labour |
| Water (birth pool) | Helps you relax and makes contractions feel less painful | Water kept no warmer than 37.5 °C; not within 2 hours of an opioid or if you feel drowsy |
| Gas and air (Entonox) | Takes the edge off within 15 to 20 seconds; you control it | Does not remove all the pain; can make you feel sick or light-headed |
| Pethidine or diamorphine injection | Works in about 20 minutes and lasts 2 to 4 hours | Limited relief; drowsiness and nausea; not advised close to pushing because it can affect your baby's breathing and first feed |
| Remifentanil (button you press) | Works within minutes and wears off fast; can be used until the birth | Obstetric units only, with one-to-one midwife care; can make you breathless |
| Epidural | The most effective option: complete pain relief in most cases. NICE says it does not lengthen the first stage or raise the chance of a caesarean | Obstetric units only; about 20 to 25 minutes to set up and work; longer second stage and a higher chance of forceps or ventouse; continuous monitoring; heavy legs |
| Sterile water injections | For back pain in labour: relief from about 10 minutes, for up to 3 hours | A stinging feeling at first |
ACOG's guidance is that an epidural should be offered for pain relief at any stage of labour. Slow, rhythmic breathing helps whatever else you choose; our breathing exercises include timers you can practise with now.
Red Flags in Any Stage
Call your maternity unit straight away, day or night, if: you are bleeding more than a streaked show; your waters are green or brown; your baby is moving less than usual; you have constant or severe pain that feels different from contractions; you have a fever of 38 °C or more; a contraction lasts longer than 2 minutes, or you have 6 or more in 10 minutes; or you are under 37 weeks and think labour has started.
Call 999 in the UK or 911 in the US if you are bleeding heavily, if you have a strong urge to push and think your baby is coming, or if you feel or see the umbilical cord in your vagina after your waters break. For the cord, the RCOG says to get onto your knees with your elbows and hands on the floor and bend forward until help arrives.
At a Glance
Labour has three stages. The first opens the cervix: a latent phase of no fixed length, then established labour from 4 cm (NICE), 5 cm (WHO) or 6 cm (ACOG) to 10 cm, averaging 8 hours in a first labour and 5 in later ones. The second stage is pushing, with most babies born within 3 hours of active pushing for a first birth and 2 hours after that. The third stage delivers the placenta within 30 minutes with an injection or up to an hour without. Bleeding, stained waters, fewer movements or constant pain mean calling now, at any stage.
Inside Baby Novum. The contraction timer logs every contraction with a tap, works out the average length and gap, and alerts you when the 5-1-1 pattern has held for an hour. The birth plan builder records your pain-relief and birth-position choices and exports them as a PDF for your midwife. The app records; your maternity team decides.
Next: Signs of Labor: When to Go to the Hospital → · Hospital Bag Checklist → · Birth Plan Template →
Frequently Asked Questions
How many stages of labor are there?
Three. The first stage opens the cervix to 10 cm and has two parts: the latent phase and established (active) labour. The second stage runs from full dilatation to the birth of your baby, and the third ends when the placenta and membranes come out.
Which stage of labor is the longest?
The first stage, and within it usually the latent phase. The NHS says it can take many hours, or even days, to reach established labour. Established labour then averages about 8 hours in a first labour and 5 hours in later ones, according to NICE. Pushing and the placenta are measured in minutes to a few hours.
How long does early labor last?
There is no standard length. WHO says the latent first stage varies widely from one woman to another, and the NHS says it can take many hours or even days before established labour begins. Contractions may stop and start. Time them, rest, eat and drink, and call your maternity unit once they come regularly every 5 minutes or sooner.
What is the difference between the latent and active phase of labor?
In the latent phase contractions can be irregular and the cervix softens, thins and opens slowly. Active, or established, labour brings regular, stronger contractions and steady dilatation. Guidelines draw the line in different places: NICE at 4 cm, WHO at 5 cm and ACOG at 6 cm. Your unit follows one of them, so ask which.
How long does labor last with a first baby?
NICE says established labour in a first birth averages 8 hours and is unlikely to last over 18. Before that comes a latent phase with no standard length. Pushing then usually ends in a birth within 3 hours, and the placenta follows within 30 minutes with an injection or within an hour without one.
Can I sleep through early labor?
Try to. The NHS advises sleeping if labour starts at night, and staying upright and gently active if it starts during the day. Early labour can go on for many hours, so rest you get now is energy you keep for later. A warm bath or shower and slow breathing can help you settle between contractions.
Can I eat and drink during labor?
Usually, yes. The NHS suggests eating and drinking during the latent stage. NICE says you can eat a light diet in established labour unless you have had an opioid such as pethidine or develop risk factors that make a caesarean more likely. Drink when you are thirsty; isotonic drinks may help more than water, and drinking extra brings no benefit.
How long after the birth does the placenta come out?
It depends on how the third stage is managed. With active management, an injection after the birth, the NHS says the placenta usually comes within 30 minutes. With physiological management it can take up to an hour. NICE calls the third stage prolonged after 30 minutes with active management or 60 minutes without it.
Sources
- NICE — Intrapartum care (NG235), recommendations
- WHO — Recommendations: intrapartum care for a positive childbirth experience (2018)
- Oladapo OT et al. — WHO model of intrapartum care for a positive childbirth experience (BJOG, 2018)
- American Family Physician — Labor Management: Guidelines From ACOG (2025)
- NHS — The stages of labour and birth
- NHS — Signs that labour has begun
- NHS — Pain relief in labour
- NHS — Vaginal bleeding in pregnancy
- RCOG — Umbilical cord prolapse in late pregnancy