The second stage of labor
For a first baby, the second stage of labor generally doesn’t last longer than two hours and it may be as little as five minutes. Bearing down is a reflex, an instinctive urge to push down, which is caused by the baby’s head pressing on the pelvic floor and the rectum. You will know automatically to take a deep breath, so lowering your diaphragm, which exerts pressure on the uterus and helps the pushing. You then hold your breath, slightly bend your knees and strain downwards. Pushing is much harder if you are lying on your back. It is easier if you are upright, squatting, sitting up supported, on all fours, or on your knees leaning against a chair or your partner. This way you have the force of gravity to help you. Your pushing should be smooth and continuous. All of the muscular efforts should be down and out. It should be justly slow and gradual so that the vaginal tissues and muscles are given time to stretch and accommodate your baby’s head without tearing or making an episiotomy necessary. Even so, you can still tear.
The push during a contraction. Your pushing only helps the uterus to expel the baby. The involuntary muscles of the uterus can expel the baby on their own. So you help most by beginning your pushing effort with the peak intensity of each contraction. While pushing, the pelvic floor and the anal area should be as relaxed as possible, so try to relax this part of your body (see Things to know about pregnancy; The pelvic floor muscles). When you’ve finished a push, you’ll find two slow, deep breaths helpful, but don’t relax too quickly at the end of a contraction as the baby will maintain its forward progress if you relax slowly.
The second stage of labor nursing interventions
- Remind her to relax her pelvic floor during pushing. She should take two or three deep breaths and then push her hardest at the peak of contractions. Remind her that she should start in a strong, uniform way.
- Tell her to look in the mirror so that she can see the baby emerging.
- If you are in the hospital and are asked to leave the delivery room suddenly, do so without question. There may be a medical emergency and staff will have to move very fast. You cannot guarantee that you will not be in the way. Leave the delivery room but stay close by outside.
- Remind her to lie back and relax fully between contortions so that she conserves her strength for pushing.
- You are now more of an observer once your baby’s head has crowned. The midwife will be the one who needs to coach your partner through the pushing stage.
- Don’t expect your partner to communicate with you during the birth. She will be preoccupied and may not notice you for some time.
- When the baby is placed on your partner’s stomach, if possible put your arms around them both to keep them warm and show her that you’re still there.
- Be ready for your own and your partner’s reactions. There may be tears, silence, whoops of joy, perhaps even squeamishness. It’s all perfectly natural and understandable so don’t feel you have to hold back your emotions.
POSITIONS FOR THE DELIVERY
You will know by now from your experience of the second stage of labor so far what position is going to be most comfortable to give birth in. Take advice from your Medical attendants; they will lead you through the pushing stage. Enjoy yourself and feel your time. Your baby will soon be born.
Supported squat (see BEST SQUATS DURING PREGNANCY )
Your partner can help you by taking your weight in his arms. He should keep his back straight, and his knees slightly bent.
This opens up the pelvis, relaxes the pelvic floor and vaginal opening and uses the force of gravity to deliver the baby, To squat on a bed, you will need two helpers to support you so that you feel safe.
A typical delivery position
Sit propped up with cushions, hold onto your knees and drop your chin to your chest. You can lie back and relax between each contraction and conserve your energy. You will be able to see the newborn emerge.
If you feel happier being close to your partner during the delivery, you can lean back against him. His closeness will give you confidence and he can encourage you to push during the contraction.