Stage 2 of Labour
This stage lasts from full dilation until the birth. The contractions are described as expulsive and feel very different from those during stage 1, and many women find it easier to cope with them. The contractions cause an overwhelming urge to bear down and push out your baby, which is why women become more vocal at this stage, making involuntary noises with the effort of bearing down.
The onset of stage 2 can be confirmed by a vaginal examination, although many midwives find this unnecessary because there are often other signs that the cervix is fully dilated. These other signs include:
- Involuntary grunting with the effort of the contraction
- A heavy, blood-stained show (different to the show in early labour)
- Bulging of the back passage
- A slight dip of the baby's heartbeat with the contraction.
There are always exceptions to the rule, but most women in the second stage of labour will feel an overwhelming, involuntary urge to bear down and push. It builds up like a wave and is impossible to fight, and some women even describe the feeling as sexual. Some women initially find the feeling scary as it is so powerful, not painful, but it becomes far less scary if you stop fighting it and just go with the feeling. Most women find it a relief to do so and push as their body tells them to. The best thing for you and your baby is simply to listen to your body and push spontaneously. If you do this, you will naturally give three or four short pushes, lasting about 5 seconds each, with every contraction. Research suggests that if you push spontaneously, it is better for you and the baby.
If you have an epidural and, because of this, cannot feel the contractions for yourself, the midwife can feel them by placing her hand on your abdomen and will tell you when to push. An upright position is best during stage 2, so that gravity can help your baby come down the birth canal. However, you may need encouragement to keep changing positions to help the the progress of the birth.
With each contraction, your baby will start to move down the birth canal until a small part of his head is visible. With a first baby, the head will slip back between contractions but, eventually, the head stays in position and more of it can be seen. This is called crowning and some women experience a burning sensation at this point.
The midwife may ask you to pant rather than push at this point, in order to control the delivery of your baby's head and reduce the risk of tearing. Once a small part of your baby's head appears, reach down and touch it. Many women find this helps them to focus on where they are pushing, as well as giving them the encouragement of knowing that they are making progress and that the birth is not far off. Once his head is out, you will probably feel a sense of relief. Your baby will turn his head to come in line with his shoulders, which are turned to one side. The midwife will gently feel around his neck for the cord, which she can slip over his head.
The rest of your baby will be born with the next contraction. The first shoulder will emerge from under your pubic bone. Your midwife will gently lift this shoulder and your baby's head up to give the second shoulder (the one nearer the spine) more room. The rest of his body will then slip out easily accompanied by a further rush of amniotic fluid. Your baby can then be placed directly onto your abdomen, either naked or, if you prefer, wrapped up. The cord can then be clamped and cut, either by the midwife or by your birth partner.
breech birth If your baby is in a breech position, you will probably be advised to have a caesarean section, particularly for a first baby, if your baby is not in a 'frank breech' position, or is thought to be quite large. If your baby is found to be in a breech position when you are already in labour you may also be advised to have an emergency caesarean, unless it is too late and the birth is imminent. Ultimately the decision is yours so make sure that you are confident that you have had lots of information from your midwife or doctor.
twin and multiple births I he majority of twins are delivered in hospital and you will probably be advised to have an epidural in case you need an emergency caesarean or an assisted delivery for the second twin. Both babies are usually continuously monitored during labour.
In some hospitals, it is policy to deliver twins in an operating theatre (even for vaginal deliveries) or in a larger delivery room, for safety and to accommodate a midwife and a paediatrician for each baby, as well as the obstetrician.
Although around 60 per cent of twin deliveries are by caesarean section, it is possible to have a normal delivery if the presenting twin is in a head-down position. If the first twin is in the breech position, your obstetrician will usually advise a caesarean section. During labour, an emergency caesarean may be required, either because labour is not progressing well or because there is evidence of fetal distress.
After the birth of the first twin, the second twin may be lying across the uterus, in which case it may be possible to turn him into either a breech or a head-down position so that he can be oelivered vaginally.
You may be advised to have an epidural because of the higher risk of a caesarean section. After your first twin has been born, the obstetrician will confirm the position of the second twin and break the waters if necessary. Usually, you will be given a hormone drip to make sure that your contractions continue. The second twin is usually born within 20 minutes of the first.
Occasionally, he will show signs of distress, in which case you will be given an assisted delivery or a caesarean section. You will also be given a hormone drip after the birth. This encourages the uterus to contract to lessen the risk of bleeding because of the large area covered by the placenta.
Triplets or more are usually delivered by caesarean section. Much depends upon the position of your babies when you go into labour.
Your baby's first bowel movement is called meconium. It is a dark green-black tar-like substance, which can be passed during labour, particularly if your baby becomes distressed. Meconium is made up of different waste products, including bile pigment, mucus, amniotic fluid, lanugo and cells from the wall of the bowel.