Second Stage of Labor - Birth
This stage begins when the cervix is fully dilated, and ends when the baby is finally birthed. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has successfully passed through the pelvic brim. Ideally it has successfully also passed below the interspinous diameter. This is the narrowest part of the pelvis. If these have been accomplished, all that will remain is for the fetal head to pass below the pubic arch and out through the introitus. This is assisted by the additional maternal efforts of "bearing down" or pushing. The fetal head is seen to 'crown' as the labia part. At this point the woman may feel a burning or stinging sensation.
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Once your cervix is fully dilated, you can begin to push. This stage of labor usually lasts one to two hours, but can range from two minutes to three hours. Most women have a strong urge to push, although some women may not feel this urge right away.
Usually, your contractions will be less painful and spaced further apart, allowing you more time to rest between them. Follow your body's urges as to when to push; however, your health care provider can help you if the sensation is not very strong. Sometimes it’s important to push the baby out slowly, which helps prevent the perineum (the tissue between the vagina and anus) from tearing.
The perineum stretches as the baby presses against it and moves through. When the perineum stretches you will probably feel a burning sensation, which quickly passes. This occurs to protect the tissues from tearing if you push too hard.
When the baby’s head “crowns” that means it appears at the opening of the birth canal. Crowning is a gradual process, with the head moving downward a little with each contraction, then slipping back slightly between contractions.
If your health care provider determines that there is not enough room for the baby to pass through, she may try different techniques to enlarge the opening. These include hot compresses, perineal massage, and if really necessary, your health care provider may perform an episiotomy, a small cut made at the bottom of the vagina.
Once the head fully crowns, it comes out of the vagina completely. The shoulders then turn and pass through, and the rest of the baby's body slips out easily.
Pushing and what to expect:
- The entire process of the second stage lasts anywhere from 20 minutes to 2 hours
- Contractions will last about 45-90 seconds with a 3-5 minute rest in between
- You will have a strong natural urge to push
- You will feel strong pressure at your rectum
- You will likely have a slight bowel or urination accident
- Your baby's head will eventually crown (become visible)
- You will feel a burning, stinging sensation during crowning
- During crowning you will be instructed by your health care provider not push
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Pushing and what to do:
- Get into a pushing position (one that uses gravity to your advantage)
- Push when you feel the urge
- Relax your pelvic floor and anal area (Kegel exercises can help)
- Rest between contractions so you can regain your strength
- Use a mirror so you can see your progress (this can be very encouraging!)
- Use all your energy to push
- Do not feel discouraged if your baby's head emerges and then slips back into the vagina (this process can take two steps forward and one step back)
Tips for the support person:
- Help her to be relaxed and comfortable (give her ice chips if you can and support her in her position)
- Encourage, encourage, encourage
- Be her guide through her contractions
- Affirm what a great job she has done and is doing
- Don't feel bad if she becomes angry or emotional with you
What your baby is doing:
While you are in labor your baby is taking steps to enter this world.
- Your baby's head will turn to one side and the chin will automatically rest on the chest so the back of the head can lead the way.
- Once you are fully dilated, your baby's head leads the way and the head and torso begin to turn to face your back as they enter your vagina.
- Next your baby's head will begin to emerge or "crown" through the vaginal opening.
- Once your baby's head is out, the head and shoulders again turn to face your side. This position allows your baby to easily slip out.
Delivery and what to expect:
Keep in mind your baby has been soaking in a sac full of amniotic fluid for nine months. He/she has been through contractions, and your very narrow birth canal.
The results of this journey include:
- Cone-shaped head
- Vernix coating (cheesy substance that coats the fetus in the uterus)
- Puffy eyes
- Lanugo (fine downy hair that cover the shoulders, back, forehead, and temple)
- Enlarged genitals
