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First Stage of Labour – Phases, Duration & Care

The first stage of labour is the opening phase of childbirth during which regular contractions cause the cervix to dilate fully to 10 cm. It is the longest phase of labour.

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Things worth knowing about "First stage of labour"

The first stage of labour is the opening phase of childbirth during which regular contractions cause the cervix to dilate fully to 10 cm. It is the longest phase of labour.

What Is the First Stage of Labour?

The first stage of labour is the initial and longest phase of the birthing process. It begins with the onset of regular, progressively stronger contractions and ends when the cervix has fully dilated to approximately 10 centimetres. Only once this is complete can the baby descend through the birth canal.

Childbirth is classically divided into three stages: the first stage (opening phase), the second stage (expulsive phase), and the third stage (placental phase). The first stage accounts for the majority of the total labour duration.

Stages and Duration

The first stage of labour is divided into two distinct phases:

Latent phase (early first stage): The cervix slowly dilates from 0 to approximately 6 centimetres. Contractions may be irregular and less intense. This phase can last many hours, particularly in first-time mothers.
Active phase (active first stage): Cervical dilation progresses more rapidly from 6 to 10 centimetres. Contractions become stronger, longer, and more regular – typically every 2–3 minutes, lasting 45–60 seconds each.

Overall duration varies considerably:

In first-time mothers (nulliparous women), the first stage averages 8–12 hours.
In women who have given birth before (multiparous women), it is often significantly shorter, typically 4–8 hours.

Physical Changes During the First Stage

Several key physiological processes occur simultaneously during the first stage of labour:

Cervical ripening and dilation: The cervix softens, effaces (shortens), and progressively dilates.
Engagement of the baby: The baby's head descends deeper into the pelvis.
Rupture of membranes: The amniotic sac may rupture spontaneously during this phase, either early (premature rupture) or at a more advanced stage.
Increasing uterine activity: The release of oxytocin and prostaglandins coordinates and intensifies contractions.

Care and Pain Management

Throughout the first stage, the labouring person is closely monitored by midwives and medical staff. Several approaches are available for support and pain relief:

Non-pharmacological methods: Mobility, relaxation and breathing techniques, heat application, hydrotherapy, or water birth.
Pharmacological pain relief: Opioid analgesics (e.g., pethidine) or epidural analgesia, which is considered the most effective method of pain relief during labour.
Continuous support: The presence of a trusted birth companion or doula has been shown to positively influence the course of labour.

Complications and Medical Interventions

In some cases, the first stage of labour may be complicated by events requiring medical intervention:

Arrest of labour: If cervical dilation ceases to progress despite regular contractions, labour augmentation with oxytocin may be indicated.
Abnormal fetal heart rate: The CTG (cardiotocograph) continuously monitors the baby's heart rate and uterine contractions to detect signs of fetal distress.
Premature rupture of membranes: This increases the risk of infection (chorioamnionitis) and requires close monitoring.
Umbilical cord prolapse: A rare but serious obstetric emergency requiring immediate medical action.

References

World Health Organization (WHO): WHO recommendations: intrapartum care for a positive childbirth experience. WHO, Geneva 2018. Available at: https://www.who.int/publications/i/item/9789241550215
Zhang, J. et al.: Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes. Obstetrics & Gynecology, 116(6), 2010, pp. 1281–1287.
Cunningham, F.G. et al.: Williams Obstetrics. 25th edition. McGraw-Hill Education, New York 2018.

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