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| Home > Labour and Birth > Four Stages of Labor > The Second Stage of Labor
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| | The Second Stage of Labor
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The Second Stage of Labor - The Expulsion Stage
 Transition ends when the dilation is complete, beginning the second stage of labor. A new series of physiological events begins; your baby leaves the uterus, rotates within and descends through the vagina and is born.
Signs of Second Stage
The most noteworthy sign of the second stage is the urge to push, which coincides roughly with full dilatation. Some women experience this urge before full dilatation while others experience it sometime later. Powerful sensations combined with reflex actions caused by the pressure of the baby in the vagina during contractions bring about the urge to push. This urge is as difficult to describe as labor contractions. It is a strongly felt need to hold your breath and strain. It happens several times within a contraction and helps you press the baby downward. It is almost impossible to control this urge as is the case with sneeze or an orgasm, or vomiting. Women who combine with the urge to push find this as one of the most satisfying aspects of the entire birth experience. For others it is disturbing and painful.
Relief from the sensations of transition is another sign of the second stage of labor. The pain reduces considerably. Your composure returns and you cheer up, your attention now shift to others around you from your labor. Now you can strengthen yourself for the effort of pushing your baby down your canal. You stimulated your uterus to open by staying relaxed and taking help of positions to augment the process during the first stage. Now you will support your uterus to empty itself by voluntary bearing-down and using appropriate positions.
Key Concepts
Two key concepts should guide you during the second stage.
Do not hurry. Everyone in the room may be anxious to get the baby out but do not rush. Your body will signal you and you need to follow them either by bearing down or pushing spontaneously as the urge demands, while allowing time to your tissues to spread open. Avoiding hurry will enable your vagina to stretch open gently, thereby decreasing damage. Your energy usage will also be efficient. By joining in, holding your breath and bearing down only when you cannot resist the urge to push, you will be work-ing in conjunction with your uterus while using energy efficiently.
By bearing down for five to six seconds at one stretch and breathing in and out several times between bearing-down efforts, the oxygen availability to the fetus increases. The exchange of oxygen across the placenta decreases during contrac-tions. The relaxed uterus promotes this exchange and the fetus benefits.
Different positions like semi sitting, side lying, hands and knees, squatting etc may be adopted by you; depending on the comfort level each one provides and also alters progress either by hastening or slowing labor.
Positions for the Second Stage
You chose your position according to the comfort and progress of labor. Feel free during the second stage to use positions that are comfortable; that alter progress, either by enhancing or slowing the baby`s descent; or that provide other advantages.
The most common position in North America is semi sitting, with legs raised in stirrups or with feet in footrests or resting on the bed. This position is convenient for the birth attendant but it may not be the best for your comfort or progress. Positions that take advantage of gravity are an asset and may aid progress and descent.
Any comfortable position can be used when the second stage is progressing at a reasonable pace-not too fast or slow. In order to reduce the pace in the second stage try a gravity-neutral position. Sometimes, to aid descent you have to take position which hurts. Assume the posi-tion favored by your doctor when birth is imminent.
The duration of the second stage varies from fifteen minutes to over three hours. The multi-gravida`s second stage is usually faster than it was with primigravidas. The second stage can be divided into three phases: latent, active, and transition. These may be less marked than the phases of the first stage.
The Latent Phase
In the latent or resting phase of the second stage you are excited that you will deliver your baby soon, and would be relieved that transition has passed, providing a brief period of rest for your uterus. Contractions may be weak and intervals may last for ten or twenty minutes, descent may slow or stop for the time being, and the urge to push may be nonexistent or easily satisfied with slight bearing-down efforts. The uterus, which had been stretched tightly around the baby, becomes a bit flabby as the baby`s head slips through the cervix in the resting phase. The uterus needs time to tighten down around the rest of the baby`s body. Then strong contractions start and the urge to push overpowers. This temporary lull gives respite and is welcome as a chance to rest and recuperate after transition; it is no cause for alarm.
You may not experience the latent stage if your baby is at a very low station with the beginning of the second stage, but move right into the active phase as soon as your cervix is fully dilated.
The active Phase
During the active phase of the second stage, the baby descends and powerful contractions will fuel an irresistible urge to push. Bearing down with all your strength may be extremely rewarding for you. You can feel progress. The baby`s head stretches the vagina and presses on the rectal wall. The bulging feeling may alarm you. You may tense the pelvic floor by raising your hips, because of the fright to let you baby out. This will cause pain and slow progress. The most important thing for you to do during pushing efforts is relax your pelvic floor and bulge your perineum.
Your partner`s direction to "relax", "let the baby out", "open up" and "ease the baby out" are more important than at directions to "push, push, push". Pressing hot, moist towels against your perineum will help you relax and appropriately direct your bearing-down efforts. Do not clench your jaw and clamp your mouth shut as these signs indicate that you are probably tensing the muscles in your vagina. By relaxing your face, particularly your mouth, you may be more able to relax below.
With the progression of the active phase, the labia of the perineum begins to bulge, opening the vagina as the baby`s head descends with each bearing down effort. Between efforts, the vagina par-tially closes and the head recedes. Soon, the- baby moves fur-ther down and her head becomes clearly visible. You get renewed strength with the visibility of the baby`s head. You may reach down and touch your baby`s head at home, where sterile procedures are not required. You can see a mirror image of the baby in the hospital, if you want to. These con-crete reminders will boost the efficiency of your bearing -down efforts. During this phase, the baby descends and usually completes rotation to the occupied anterior position.
The Transition Phase
The third phase of the second stage is the transition phase, when the baby passes from inside the mother`s body to outside. It begins when the baby`s head moves forward only and does not recede as in the previous stage, between bear-ing-down efforts. The vaginal opening distends to a maximum amount at this phase, and is characterized by a stinging, burning sensation sometimes called the "rim of fire. Strong bearing down at this time is very painful, and may cause a serious tear of the vagina or perineum. "Rim of fire" is your body`s signal to decrease your bearing-down efforts. You should not hold your breath. Your breathing should be with a light panting or blowing pattern. Relax your vagina as the head crowns and emerges. Your nurse may prop up the perineum with hot compresses or their gloved hands. In order to promote slow stretching, massaging with a lubricant will help. Some people may apply pressure on the baby`s head to arrest its fast descent.
The top of the head up to the ears is the first to emerge, and then her bluish-gray, soaking wet face. Then his head rotates to the side, allowing his shoulders to slip more easily through the pelvis. The next to emerge is one shoulder (the one near your pubic bone) and then the rest of the baby comes quite rapidly. The baby appears bluish and may be streaked with blood at first. His body will also be partly covered with the white, lotion like vernix. His first breath makes his skin more normal flesh-tones which come within seconds. All babies, irrespective of skin color, go through these color changes in the first minute or two of life. Some are quite ruddy until their respiration and circulation adjust to normal. Suction of the baby`s nose and mouth may be required to assist respiration with the emergence of the baby`s head and again later. You may hold your baby or he may be placed on your abdomen while waiting for the delivery of the placenta.
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