What to do when labor starts: A stage-by-stage guide

You spend months preparing for labor. You read the books, pack the hospital bag, save the contraction timer app, and rehearse the route to the hospital. And then one day, something feels different.

Maybe it’s a cramp that doesn’t go away. Maybe it’s a contraction that makes you pause mid-sentence. Maybe you wake up in the middle of the night wondering, “Is this actually labor?”

If you’re like most parents, your first question will be “What am I supposed to do right now?”

The answer depends on where you are in the labor process. Early labor, active labor, and pushing all require slightly different approaches, and knowing what to expect can help you feel calmer and better prepared for the hours ahead.

This guide walks through each stage, tells you when to stay home, when to call, and how to manage what’s happening in your body until you’re holding your baby.

We asked two birth experts what they wish parents knew when labor begins:

• Juliana Parker, Founder and Registered Nurse at Nurse Core Triage, Inc.
• Kathleen Dowd, CNM, NP, MSN, Founder and Women’s Health/Mental Health Clinician at Gentle Touch Wellness. Kathleen has more than 30 years of experience supporting physiologic birth and helping reduce C-section rates at a major Kaiser Permanente campus in the San Francisco Bay Area.

If you’re still watching for the signs that labor is approaching, start with the signs labor is near.

Understanding the stages of labor

Labor has three stages. The first stage which covers everything from early contractions to pushing is the longest and also involves most of the decision-making.

Early labor (latent phase)

Your cervix dilates to less than 6 cm. Contractions are mild and irregular: anywhere from 5 to 20 minutes apart, lasting 30 to 45 seconds.

How long does early labor last: According to the American Journal of Obstetrics & Gynecology (AJOG), the latent phase of labor can last 20 hours or more in first-time mothers, which is why staying home and conserving energy matters far more than arriving at the hospital quickly.

The evidence backs this up. A landmark study found that women admitted to hospital in the latent phase of labor had significantly higher cesarean rates than those who arrived in active labor. 

What to do when early labor starts: Early labor can last many hours. As Juliana Parker says, “Think of this phase as the ‘calm before the real workout.’”

You can support your labor progress by:

1. Walking slowly and consistently. Kathleen Dowd says, “When you keep moving in early labor, it helps the baby to engage and engage in the correct position. Women were not meant to go through labor, lying down.”
2. Taking a warm shower directed at your lower back. Warm water on the lower back and sacrum reduces the pain of back labor and muscle tension. Only do this if your water has not broken.
3. Eating a light, nutritious meal. Opt for easily digestible carbohydrates, like a toast, a banana, a smoothie, broth, rather than heavy proteins or fats that slow digestion.
4. Resting horizontally between contractions if it’s nighttime. If your early labor begins at night, try to sleep or at least rest lying down between contractions. 
5. Using a heat pack on your lower back and pelvis during contractions. Applying heat increases local blood flow and reduces muscle spasm. Alternate with an ice pack if heat alone isn’t providing relief.
6. Practicing slow, calm breathing with each contraction. Practice inhaling for 4 counts through the nose and exhaling for 6–8 counts through the mouth, while relaxing your jaw, shoulders, and hands with each exhale.
7. Distracting yourself. Juliana Parker suggests, “This is a great time to work on a puzzle, do an adult coloring book, try a Sudoku, play a card game, or binge a favorite show—anything that keeps your mind busy while your body does its thing.”
8. Checking your hospital bag one last time. Checking your hospital bag and confirming everything is ready reduces the mental load of active labor significantly.

Cradlewise note on your birth partner or doula: The person who is with you during early labor matters as much as any technique. Research says continuous support from a trained birth companion, be it a partner, doula, or nurse, reduces cesarean rates, shortened labor duration, and lowered epidural use. Your birth partner needs to stay present and calm, offer comfort, assist, and be patient.

Active labor

Your cervix dilates from 6 cm to 10 cm. Contractions come every 3 to 5 minutes, last 45 to 60 seconds, and are strong enough that you’ll need to stop and breathe through each one. It is time to head to the hospital or birth center.

Active labor comfort measures: The focus is on coping with your contractions. Support your contractions by:

1. Changing positions frequently every 20-30 minutes encourages the baby to rotate and descend. 
2. Using hands-and-knees position or a supporter forward lean over a birth ball during back labor often provides relief from back pain. 
3. Asking for counter pressure on the sacrum during contractions to reduce back labor pain. 
4. Using the birth ball for hip-opening movements between contractions opens up your pelvis and encourages your baby’s descent. 
5. Getting into the birth tub or shower if available helps with pain relief. 
6. Vocalizing freely (a slow “ohhh” or “mmmm”) relaxes the jaw and throat rather than high-pitched crying that has the opposite effect. 
7. Letting your nurse know what’s not working so they can suggest alternatives and help you feel comfortable as possible.

Transition and pushing (second stage)

Transition is the bridge between active labor and pushing. It is intense, but typically the shortest part (minutes to about an hour for most). Once fully dilated, you begin active pushing with each contraction until delivery.

Delivery of the placenta (third stage)

Once your baby is born, you enter the third stage of labor where you deliver the placenta. 

You continue to have mild and less painful contractions after the delivery of your baby, that help move the placenta into the birth canal. With a gentle push, you deliver the placenta. It takes about 20-30 minutes.

How to time contractions and when to go to the hospital in labor

The 5-1-1 rule

At this point, you’re likely in active labor and it’s time to go to the hospital.

To time contractions correctly: Count from the start of one contraction to the start of the next. This is the frequency. Duration is how long each contraction lasts from start to finish.

Some providers use a 4-1-1 rule for first-time mothers, so check with your care team about their specific guidance for your situation.

When to call your doctor during labor

If you see the following labor signs, call your provider immediately:

• Your water breaks 
• You’re bleeding heavily 
• Your baby’s movements have significantly reduced or stopped 
• You have a severe headache, visual disturbances, or sudden swelling of the face and hands

How to manage pain during labor

Labor pain management options include both non-medical pain management options and medical options. Many women combine both methods for a comfortable delivery experience.

How to manage pain during labor without epidural

Before reaching for an epidural, there’s a meaningful range of non-medical pain management approaches: 

• Warm water (shower or bath)
• Counterpressure massage
• TENS (Transcutaneous Electrical Nerve Stimulation)
• Nitrous oxide (laughing gas)
• IV opioids

Epidural during labor: When to get one

If non-medical options are no longer managing your pain, or if you simply want an epidural, that is a completely valid choice.

A few things parents often don’t know going in:

• Peanut ball: Ask for a peanut ball. This peanut-shaped exercise ball is placed between the knees while you’re lying in bed post-epidural. It holds the pelvis in an open position facilitating your baby’s descent even when you can’t move freely. 
• Position changes still matter post-epidural: Ask your nurses to rotate you side to side every 30 minutes to influence your baby’s position even when you can’t feel contractions.
• Modern low-dose epidurals often allow some mobility: Ask, don’t assume, if with the epidural, you will be able to retain enough sensation and muscle control to shift your weight, change position in bed, or even stand with support. 
• Epidurals and pushing: Most women, contrary to popular belief, can push effectively with an epidural. If sensation is very low, your nurse will guide you with each contraction based on the monitor.

Conclusion

No labor goes exactly to plan. The process, the timeline, the pain, and the progression, all of it has a way of surprising even the most prepared people. In such times, knowing what’s happening and why, having a framework for each phase, and trusting the people around you help tremendously.

Do not rely on every decision made in advance; it rarely works that way. You just need to know when to stay home, when to go to the hospital, what to try first, and when to ask for help. 

Once your baby arrives, the Cradlewise blog has everything you need for what comes next:  from the first night home to navigating newborn sleep.

You may also like:

• Perineal massage during pregnancy: what it is, when to start, and does it really help?
• Is vaginal seeding safe and should you consider it?
• C-section recovery: Week-by-week timeline, tips, and what to expect.

Sources:

1. The latent phase of labor can last 20 hours or more in first-time mothers. AJOG. 2023. The latent phase of labor.
2. Women admitted to hospital in the latent phase of labor had significantly higher cesarean rates. PubMed Central. 2022. Hospital Admission in the Latent versus the Active Phase of Labor: Comparison of Perinatal Outcomes.
3. Continuous support from a trained birth companion. PubMed Central. 2017. Continuous support for women during childbirth.
4. Peanut ball. PubMed Central. 2026. The Effect of Peanut Ball Use on the Labour Process and Maternal—Neonatal Outcomes in Parturient Women With High Maternal Body Mass Index: A Randomized Controlled Trial.