Second Stage of Labour
The second stage of labour starts when your cervix is fully dilated. That means there is no more cervix left to prevent your baby from progressing down the birth canal. It is during this stage that your baby will be born.
For some women, the second stage is short. If there are signs that your baby is moving down quickly, then your midwife may not need to do a vaginal examination (VE) to confirm full dilation. For other women, the second stage can be long and tiring, with vaginal examinations to determine the baby’s progress.
There are a few factors that can affect how long your second stage is, including:
- first babies take longer to move down than subsequent ones;
- if baby’s head is asynclitic it will take longer (see the ‘Which way’s up’ section for information about baby’s position);
- a baby in OP position usually takes longer;
- epidurals may make for a longer second stage, particularly in first-time mums
Ideally, your body will do its own thing, and when your baby is in the right spot, your urge to push will be overwhelming and uncontrollable. This urge is called the foetal ejection reflex. When women can birth their babies according to their body’s urges, babies usually have little need of help from us.
However, if there has been an intervention, your midwife may need to coach your pushing. If you have had an epidural, you may not feel the pushing urge. In this case, your midwife will tell you when you should push. If your pushing isn’t moving your baby, we may suggest you hold your breath while you are bearing down. While this is not ideal, it can be very effective – just don’t hold your breath too long.
Birthing your baby
Sometimes it seems that while you are pushing, you are getting nowhere – especially if you are a first-time mum. Every time you push effectively, you move your baby down the birth canal a little more; then in between contractions, he may slip back a little. It is two steps forward, one step back. This progress is normal, and nature’s way of stretching the tissue down there slowly. It gives baby’s head time to change shape to fit your pelvic structures (a process called moulding).
This stretching will continue until your baby makes his way around the ‘curve of Carus’. This is the corner created by your sacrum (tailbone) that your baby needs to navigate to stay in one spot and not slip back.
You must listen to your midwife at this point.
If everything is going according to plan your midwife probably won’t have much to say other than encouragement and reassurance; If your pushing starts to back off for any reason you will find they encourage you to keep going, and if the baby is arriving fast you may be asked to back off a bit.
The critical thing about birthing your baby is to maintain enough control to be able to breathe your baby out nice and gently. This gives women the best chance of minimizing damage to their perineum and other genital structures.
As your baby’s head approaches your perineum, it will stretch, causing an intense burning sensation. When the widest part of the baby’s head can be seen, it is called ‘crowning’. Your midwife is in an ideal position to see how the skin on your perineum is coping with the stretch. If they feel there’s a risk of tearing, they may ask you to slow down and just give little pushes, pant or just breathe.
If your perineum is not coping with the stretch and they believe you might get a bad tear they may consider or suggest an episiotomy. However, this should not be done without your consent. If a small tear in your perineum occurs, they may ask your consent to repair it after your birth.
With the next contraction, your baby’s head should be born; followed by his shoulders (not comfortable, but not quite as bad as the head) and then the rest of his body.
Your baby is born!
Of course, if you are birthing a breech baby, it’s a little different. Please click here to see photos of vaginal breech birth. These will give you an idea of what order baby’s arms and legs arrive in……
Dr Janelle McAlpine (PhD), Clinical Midwife
Photo by emin kuliyev used under license from Shutterstock.com