Stage 2 of Labour
The second stage of labour starts when your cervix is 10 cm dilated. This will be confirmed by an internal (vaginal) examination. Up to an hour may pass before you will be asked to start active pushing. During this time, the baby’s head will come down through the birth canal. The urge to push is caused by the pressure of your baby’s head on your back passage. Sometimes, this feeling of pressure can make the bowels open.
Getting familiar with pushing may take some time, especially if it is your first baby. If you don’t have an epidural, find a position that is comfortable and effective for you. You may wish to stay on the bed supported with pillows or to kneel, squat, stand or sit. These positions can be adopted on the bed or on the floor.
As the baby’s head descends further through the birth canal, the contractions get stronger and so does the urge to push. If you have an epidural, you won’t really be aware of these sensations. During each contraction, the midwife will tell you how and when to push. This stage is hard work and it is important to rest and relax between the contractions. After each contraction the midwife will listen to your baby’s heart rate and will keep you informed of your progress. Your birth partner will also encourage you and may offer you sips of water and help support you in your chosen position.
As your baby’s head moves down to the vaginal opening, the baby’s head will become visible. At a certain stage, the midwife will tell you to either stop pushing, to push very gently or to pant (blow in an out quickly through your mouth). This is important so that your baby’s head can be born slowly, giving the skin and muscles of the perineum time to stretch without tearing. (The perineum is the area between the vagina and the back passage.) Sometimes the skin won’t stretch enough and may tear or it may be necessary to perform an episiotomy, which is a cut in the skin to widen the opening. The perineum is numbed with a local anaesthetic before an episiotomy is done (unless you have an epidural).
After your baby’s head is born, the hard work is over. With one more contraction, your baby’s body will be born and your baby will be placed onto your tummy, so that you can feel and be close to each other immediately and you can start getting to know your son or daughter.
Soon afterwards, the umbilical cord is clamped and cut and the baby is dried. Sometimes, some mucous needs to be cleared from the baby’s mouth and nose. If your baby needs oxygen or any other care immediately after birth, they will be placed on a radiant warmer, which is like an open cot with a heater overhead, in the birth room. Your baby won’t be kept away from you any longer than is necessary. As soon as possible, your baby will be returned to your arms for another cuddle.