Between the excitement of knowing you're about to finally meet your child and the scary reputation of labour, the birth of your baby is an incredibly emotional time.
There's so much to think about when you're having a baby. Whether it's thinking about getting through a stomach bug during pregnancy to if you'll get the dreaded post-partum night sweats or whether to use active management when delivering your placenta, there's a lot on a mum-to-be's plate.
Knowing what to expect can help you feel more confident about the birthing process, so we've put together this helpful guide to everything you need to know about the second stage of labour.
What Happens In The Second Stage Of Labour
There are three stages of labour, with some maternal health specialists also adding a transitional phase between the first and second.
The first stage is when contractions start and the cervix begins to dilate. The second stage of labour begins when the cervix opens to its full 10 cm dilation, and ends at the delivery itself. When the baby is born, that's the signal that the second stage is over, and you're moving on to the third stage, the delivery of the placenta.
The second stage of labour has two phases: active and passive. The passive phase begins when the cervix is fully dilated, but you are not yet feeling the urge to push. If your body gives you a break by going into the passive phase, take advantage of the chance to have a breather. Not all women get a passive phase though, for some women, active labour begins as soon as the cervix is fully dilated.
Once the active phase starts, you'll feel an urge to push with each contraction. It's often described as 'overwhelming' or 'irresistible', and it means your instincts are doing their job. During this phase, pushing moves the baby down the birth canal and through the pelvis. With a first baby, most healthy women give birth within three hours of feeling the urge to push. If you've already had a baby, it's usually two hours or less.
Many women feel as if they need to use the toilet as the baby moves into the birth canal. This is normal and happens because the baby is pressing on the bowel. It's also common to feel as if the baby is going backward and forwards in place for a short while as they pass through the pelvis. This happens because the pelvis is on a tilt compared to the rest of the birth canal, a bit like the bend at the end of a drainpipe. It takes some backward and forwards movement to get the baby through at the right angle.
Just before delivery, you'll probably feel a burning or stinging as the baby's head stretches the skin around the perineum. It's a normal phase of birth called crowning and means the baby's head is getting ready to be born. Perineal massages during pregnancy and using plenty of moisturiser can help with this.
Once the baby's head has been born, the shoulders and rest of the body should arrive with the next couple of contractions. This is when the third stage begins.
How Is The Second Stage Different From The First Stage Of Labour?
Most women will notice a big difference in the way they experience the first and second stages of labour.
The first stage begins when your contractions start and the cervix opens (dilates). Once your cervix is dilated to 4 cm, you're said to be in established labour. At this stage, most women experience contractions that are 40-60 seconds long, roughly every five minutes, getting longer and stronger with time. For a first baby, this can last anything up to 18 hours. Many women describe it as feeling like a dull ache in their back, or their belly fluctuating between hard and soft.
During the first stage, your birthing partner can support you in practical ways by bringing drinks and snacks to keep your energy up, offering massages, helping you try various positions to decrease discomfort, and phoning the hospital or your midwife or doctor if you don't feel up to it.
Towards the end of the first stage, you'll go to the hospital or to your birth centre if you've chosen to go to one. This is when active management of your birth process by your midwife will begin. They'll carry out some checks, and may conduct an internal exam.
The end of the first stage is also when maternal distress is often highest. Some midwives give this stage its own name, calling it the transitional phase. Many women feel intensely emotional or out-of-control and have an almost constant need to change positions. This is also prime time for snapping at your birth partner, so ask them beforehand to give you some space if you need it.
In the second stage, the out-of-control feeling usually passes. Your contractions will be shorter and further apart. The second stage passes much more quickly as well. For most mums delivering a first baby, it's normally less than three hours, while for mums who've been here before, it's usually less than two.
In the second stage, your birth partner's role will change. The most effective way they can help you now is by offering reassurance and supporting your choices around things like pain relief and active management of when you deliver the placenta. You might also want them to narrate what's happening.
Management Of The Second Stage Of Labour
During the active second stage, your midwife and/or birth partner will stay present to give encouragement or reassurance. Upright positions are recommended while giving birth as being upright means gravity gives you a boost. Your birth partner will be able to help you try out different positions and keep your balance as you find one that works for you.
If there are any concerns about your health or your baby's health, your intrapartum care team may use an electronic monitor to keep tabs on baby's heartbeat and your contractions. Some hospitals also use them if you've had an epidural.
As your contractions continue, your midwife will encourage you to keep breathing. You need oxygen to support all that effort that's going into pushing. If you forget to breathe because of the pain, your blood oxygen levels may drop, which can upset your baby. Timing your breathing in rhythm with your contractions and exhaling as you push can help you to self-regulate. Pregnancy yoga is a great way to practice breath control in advance (if your doctor approves).
As the baby gets close to crowning, your midwife may ask you to stop pushing and take some short breaths, although your contractions will still continue. This is to help your baby make a slow and calm entrance into the world. It's common for women to experience a small amount of tearing around the perineum as the baby comes out, and if you tear a lot, your doctor may give you a few stitches. If the baby is struggling to crown, the doctor may also perform an episiotomy, meaning that they will make a small cut to increase the size of the vaginal opening.
Once the baby has been born, the second stage is over. Unless there are medical complications, your midwife will give you your new baby to hold.
Causes Of Prolonged Second Stage Of Labour
If you've been in the second stage of labour for a couple of hours but your baby has not yet made an entrance, your midwife may decide you're in a prolonged second stage. Causes of a delayed second stage of labour can include the following.
Epidural Injections: Epidurals can increase the length of labour. While epidurals are great for managing the pain of labour and birth, they also interfere with some natural hormonal processes like the release of oxytocin that makes contractions more expulsive.
Breeching: If your baby is in a breech position (coming out backward), labour may take longer than usual.
High Birth Weight: Large babies sometimes simply have difficulty fitting through the cervix or pelvis, causing a prolonged second stage of labour.
High Maternal Weight: If you've gained a lot of weight during the pregnancy, it can sometimes slow down the baby's journey to birth.
It will be up to your midwife or doctor to recommend whether you continue with a vaginal birth or need a Cesarean section. They'll make this decision based on risks to your health and your baby's, like blood loss or a drop in the baby's heartbeat. If you do choose to continue with vaginal birth, it's possible that your midwife may use forceps or other medical instruments to help the baby come out.
However your child ends up making their entrance, once you're holding your precious newborn, it will be time for the third and final stage of labour, and the first stage of parenting your child out in the world.
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