The second stage of labor begins when the cervix is completely dilated and effaced, and ends with the birth of the baby. The contractions are more like those experienced during active labor, lasting approximately 60 to 75 seconds. They slow in frequency and are usually 3 to 5 minutes apart. The pushing stage may last from 10 minutes to 2 hours. For a woman who has given birth before, this stage is generally short.
During the peaks of the contractions, you will feel a strong urge to push. If you do not feel the urge to push, ask to wait to begin pushing and continue to use your breathing patterns. Get into a more upright position to allow gravity to aid the descent of the baby in the pelvis. Avoid pushing until you feel the urge develop. Pushing without your body’s direction is difficult and unsatisfying. If you were given an epidural, ask to have the medication reduced or turned off so that you can feel the contractions. If you are unable to move your legs or feel the contractions, it may take a while for the epidural’s effects to diminish. Your pushing will be more effective if you wait until you can feel the urge to push and are able to move your legs.
You might find yourself enjoying a rest period between the first and second stages of labor. The contractions may stop for 10 to 15 minutes. Use this opportunity to rest and to prepare for the hard work of pushing.
During the pushing stage, your mood will greatly improve. You will become sociable, even talkative, and will feel more positive about your progress in labor. If you have been blowing to combat a premature urge to push, you will feel tremendous relief at being able to work actively with the contractions. Many women feel great satisfaction while pushing the baby down the birth canal, even though they are working very hard. Some women even equate the baby’s emerging from the vagina with an orgasmic experience.
As the baby descends the birth canal, you may experience an increased bloody show, a burning or splitting sensation, or leg cramps. Your face may turn red or begin perspiring, and you may have a look of intense concentration. You may grunt or groan involuntarily as you actively work with the contractions. Your partner may misinterpret these normal responses as expressions of pain. Some women express discomfort or pain with pushing, which is usually associated with an unusual presentation or position of the baby, poor position of the woman, a large baby, or an unrelaxed pelvic floor. You may have a strong feeling of needing to have a bowel movement, to which you may respond by tightening the pelvic floor so that you will not soil the bed. This feeling is a normal sensation as the baby’s head presses against the bowel. Do not react to this sensation by tensing. Instead, concentrate on relaxing your bottom for maximum comfort and progress. (If you relax your jaw. your pelvic floor will also relax. When you practice your Kegel exercises, you should notice that if you tense your jaw, you feel a tightening in the pelvic floor. Conversely, if you relax your jaw, your pelvic floor also relaxes.)
You will feel a large amount of pressure or a burning sensation as the baby nears the perineum. Your caregiver may perform perineal massage to stretch the tissues. During contractions, you may notice the baby’s head at the vaginal outlet, along with some bulging of the perineum and separation of the vaginal lips. The head may appear wrinkled and covered with wet hair. It will recede between contractions until, finally, the top part remains visible between contractions. This is known as crowning. (See Figure 6.7.)
With the next few contractions, the head will be born. It will then rotate, the face turning toward your thigh. The shoulders will be delivered, and the body will slide out with ease, often accompanied by a gush of amniotic fluid. Many couples help with the delivery of the baby. Once the shoulders are free, the woman and/or labor partner can reach down and pull the baby onto the woman’s abdomen. The labor partner can then cut the umbilical cord after it has stopped pulsating.
At this point, you and your labor partner will probably be so overwhelmed by the sight, sound, and feel of your new infant that you will not notice any of the other activity going on around you.
For a discussion of the differences between laboring and delivering in a birth center and in a hospital, see “Delivery Procedures in Out-of-Hospital Birth Centers and Hospital Birthing Rooms.”
For the Labor Partner: The Labor Partner’s Role During the Second Stage of Labor
- Assist your partner in finding a comfortable position.
- Tell your partner to "look for the baby" as she bears down.
- Apply warm washclothes to your partner's perineum.
- If your partner is breath holding while pushing, make sure she first lets a little air out, then pace her efforts by counting to 6.
- Provide a mirror so she can see her progress.
- Continue telling her that she is doing great.
Help your partner into a comfortable pushing position. If she holds her breath while pushing, count for her. In addition, make sure that she releases a small amount of air before holding her breath. Check her jaw to make sure that it is relaxed. Place warm wet compresses or washcloths on her perineum. They will be very comforting and can help ease the burning sensation. They may also help her relax and may reduce her chance of needing an episiotomy. As the baby’s head is delivered and the caregiver instructs your partner how to push and when not to push, you may need to repeat the instructions to her.
Have your camera or recording equipment ready. Make sure that the mirror is adjusted correctly and that your partner is wearing her contacts or eyeglasses if needed. Encourage her to keep her eyes open while pushing so that she can see her progress in the mirror and not miss the actual birth.
Cutting the Cord
Once the baby is born and breathing on his own, he no longer needs foe umbilical cord. The caregiver will clamp the cord and then may ask foe partner if he wants to cut it. Some caregivers do this immediately after birth. Others wait until the cord has stopped pulsating, which may take up to 5 minutes. Dr. Prederick Leboyer, a noted French obstetrician, advocated delay in cutting the cord. Delay benefits the infant, as he receives oxygen from two sources—his lungs and the placenta—until his lungs can adjust and take over on their own. This decreases the incidence of anoxia (lack of oxygen).
If you made arrangements to have the cord blood collected, it will be done at this time. (For a full discussion of this, see “Make Arrangements for Cord Blood Ranking”)