The Second Stage of Labour
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There are three stages of labour, and the first can take what seems like a very long time. To think that you still have two more stages to go might seem overwhelming at the time, but the time left will usually be much shorter than what you have already been through. Also, by the end of the second stage of labour you will finally meet your baby!
What happens during the second stage of labour?
This stage is all about pushing your baby out into the world. This stage cannot begin until your cervix is fully dilated (about 10cm) to allow your baby to pass from the uterus down the birth canal. You can expect this stage to take between 30-60 minutes, but as with every other aspect of labour and childbirth, there are wide variations on the average. For some women, this stage lasts for less than ten minutes (this is more likely in second or subsequent babies), whereas for others it can take up to two or three hours.
Learn about the second stage of labour in our articles below:
How will I know that the second stage of labour has begun?
The key difference between the first and second stages of labour is usually thought to be the urge to push. Remember that some women feel this urge to push before they are fully dilated, in which case the midwife will tell you to try to resist until they are happy that the cervix is fully dilated.
The contractions usually remain about 60-90 seconds in duration but they may be more regular, possibly with a longer rest period between each one. The urge to push should coincide with each contraction, although you could feel up to two or three separate such urges during one contraction. The pain associated with each contraction is often less during this stage of labour, which is something to celebrate! However, the amount of effort that is needed for each contraction now increases. In fact, while the level of pain and discomfort during the first stage of labour may have been high, there is (by comparison) no work for you to do. It is during the second stage of labour that you need to put all your energy into helping that baby move down through your vagina and out into the big wide world.
How will I know when to push?
To push or not to push? If this is your first child then it can be very difficult to know when to start pushing. You must remember that your body will tell you when you need to start pushing. In fact, once you need to start pushing you probably won't be able to help yourself. You will feel an uncontrollable urge to push down, in a similar movement to when you are emptying your bowels - only much stronger. Some women describe this impulse to push as being similar to what you feel when you vomit, only in the opposite direction! Let your midwife know when you get the urge to push, and follow their advice.
What does the second stage of labour feel like?
You can expect to feel some pain from the contractions, but probably not as much as during the first stage of labour. The urge to push should be regular and you will probably feel it as a downward pressure against your rectum. The level of this sensation, and the pain of contractions, will be significantly less if you have had an epidural. With an epidural, you may even need to be told when to push if you are able to feel very little.
Remember that the baby tends to move down the birth canal in a "two steps forward, one step back" movement. So don't be frustrated if you can actually feel the baby slipping back a little. The key thing is that the baby moves forwards more than it moves backwards with each push. If your midwife feels that you need to push harder then he or she will let you know.
Assuming you can feel what is going on, the area of pain will change as your baby's head emerges from the vagina. This is often described as a burning, or stinging type of pain. This pain is the head stretching the skin at the opening to the vagina. Once the baby fully emerges you will probably feel a great deal of relief and excitement at finally meeting your new baby.
What is the best way to get through the second stage of labour?
First of all, find a good position. You may have already considered this ahead of the birth, or you may want to ask you midwife's advice. While many women deliver in a semi-inclined position leaning backwards, it is considered fine and sometimes more comfortable to deliver on all-fours or in a squatting position. Remember that gravity can play its part to help the baby down the birth canal, so being in an upright position might have more than just comfort to tempt you.
Try to use your energy efficiently; don't waste it. When the need to push comes along then give it all you can, but focus the pushing down into your rectum area like you are passing a bowel movement. Pushing in your chest or face will waste energy and can leave you with bruising or pain post-labour. Many women worry about actually passing a bowel movement during the pushing stage of labour. Whilst it is an embarrassing thought, it really is quite normal. Your midwife or delivery team will have seen it lots of times before and if you do pass a movement, it will be cleaned away so quickly that you probably won't even realise what's happened. Passing some stool is actually a good indication that you are pushing in the right place and pushing efficiently. Trying to avoid doing so will probably be ineffective, and could well make this stage of labour last longer than necessary.
Some women hold their breath while they are pushing, others exhale. See what comes naturally to you. If your partner or midwife is doing something that distracts you while you are pushing, such as rubbing your back or counting out loud, then ask them politely to refrain. Being able to focus will help you to put all your efforts into each and every push. Try to remember that a half-hearted push might achieve nothing, other than a wasted expenditure of your energy. If you think of this during the second stage of labour it is likely to spur you on - the thought of wasting even a tiny amount of energy at this point will be too terrible to contemplate!
Your midwife will tell you when the baby's head is crowning. This term means that the baby is becoming visible at the opening to the vagina. You may want to reach down to touch it. Actually feeling that your baby is nearly with you can act as a great incentive to keep up your efforts through the final pushes.
As your baby crowns, your midwife may ask you to slow down or not to push. This is because the perineum and the opening to the vagina will stretch better if given a bit of time. This can be very hard to do but try to follow their instructions. Remember that panting or blowing repeatedly with an urge to push can help you to stop pushing. Your midwife will tell you when to start again and you won't be left trying to resist the pushes for too long.
Once the head is out then the hardest work is done. The midwife may use a small vacuum to clear mucus from the baby's nostrils and mouth; they will also remove the cord from the baby's neck if necessary. They will then help to ease out the shoulders, and you may need to give one last push to assist with this. After the shoulders, the rest of the body should slip out easily. Finally, your baby will be with you. Provided the midwife is happy that the baby doesn't need any medical attention, they will be handed to you or your partner for your first cuddle.
Now is the time to congratulate yourself for the nine months of incubation that you have provided and the hard work you have put in to deliver your baby.
Clamping or cutting the cord.
Most hospitals will allow the birthing partner to cut the umbilical cord once the baby is born. You can encourage your partner to do this but don't pressure them if they aren't comfortable doing so. There are no nerves in the umbilical cord so do not worry about causing any pain to the baby. The cord is quite tough though, and some people find it uncomfortable cutting through it, despite the fact that they know it does not hurt the baby in any way.
Be aware that the baby will be left with a small amount of the umbilical cord still attached to their belly button, which will fall off in time.
How will I feel once the baby is born?
While your body will have gone through an awful lot, you will probably not be aware of any pain or discomfort as the adrenalin kicks in and the emotion of meeting your baby overwhelms you. Emotionally, every woman is different. Sometimes women are taken aback by a feeling of detachment, disappointment or simply a lack of enthusiasm to hold their newborn baby. If this happens to you, try not to worry as it is quite normal. You have been through a huge physical experience and your body will be suffering from hormone overload at this point. Be proud of your accomplishment, but don't overanalyse how you feel. There is so much anticipation surrounding meeting your baby that it really isn't surprising that some women feel a sense of deflation after their body has been put through such an ordeal. There is plenty of time for that attachment to arrive. The nine months of waiting is finally over and you have a whole lifetime ahead of you being a mum.