When Does the Second Stage of Labor Begin?
When your cervix is fully dilated and your baby is ready to begin their descent through the birth canal. This is the second stage of labor, also called the pushing stage. It can last up to 2-3 hours or as short as a few minutes.
Once the second stage of labor is over you will meet your baby! Laboring parents often feel a surge of energy at this stage as they are working with each contraction towards bringing their baby forth into the world.
Dilation of The Cervix
In the first stage of labor your contractions work to dilate the cervix. By the second stage you should be fully, or almost fully dilated so that your baby’s head can slip past the cervix into the vaginal canal. You will dilate to a full 10 centimeters.
How Contractions Progress
In the pushing stage contractions are more spaced apart, about every 3-5 minutes, allowing the laboring person some rest in between. Contractions can last 40-90 seconds in this stage, and will be accompanied by a very strong urge to push, or bear down. Your contractions are working to help you push your baby down and out through the birth canal.
What Positions Are Good for Pushing
Most people delivering babies in film and television are lying on their backs the entire time which is perfectly fine if that is what you want. But in reality you can choose to labor and deliver your baby in many different positions as long as your care provider deems it safe for you and baby. If you choose to have an epidural your choices are more limited but you are still usually able to move around on your birthing bed. Some delivery positions besides laying on your back are:
- Side Lying – Laying on your side with pillows or better yet a peanut between your legs opens the pelvis to make space for baby’s head. This position is good for those with epidurals
- Sitting – You can sit on a toilet or special birthing chair which has a space cut out for baby to emerge. This position uses gravity to help open the pelvis and urge baby down and out
- Squatting – Squatting also uses gravity to help baby down through the birth canal. You can squat with a birth bar (often provided in birth centers or hospitals), or with the help of your partner or doula.
- Standing – You can stand to deliver your baby. A wide stance makes space for baby’s head by opening the pelvis and gravity helps too.
What Does The Urge to Push Mean?
Laboring people experience an irresistible urge to push in the second stage of labor. This might feel like you need to have a bowel movement (which may also be the case, as many people defecate during this stage of labor). There may be a time when your care provider instructs you to resist the urge to push. This could be if your cervix is not yet fully dilated and pushing would swell the cervix and slow the progress of labor.
How to Push During Labor
There are two ways to go about pushing during labor. Each might be appropriate under different circumstances. You might think that one way of pushing will work best for you but when the time comes another option sounds best.
- Spontaneous pushing follows the natural flow of your body when the urge to push overcomes you.
- Coached pushing is when the laboring person follows the instructions of their care provider for how and when to push.
Defecation and Urination
When you are pushing your baby out you are using some of the same muscles used to push out fecal matter. If your bowels have anything in them it is possible and even likely that this will come out when you are pushing in labor. This is entirely natural and nothing to be worried or ashamed of. Many birth workers see this every day, and they are used to it. Same goes for urine. This is a natural part of the process.
What is Crowning
When baby’s head pushes against your vaginal opening this is called crowning. You are moments away from meeting your baby.
What is The Ring of Fire
When hearing about labor and delivery you might have heard the term ”ring of fire”. This does not refer to the Johnny Cash song unfortunately. This term describes the feeling when your baby’s head is pushing against your vaginal opening. The pushing and stretching creates a burning fiery sensation, thus it was deemed “the ring of fire”. This can last 30 seconds or a few minutes.
If you have done any perineal massage you might be familiar with this sensation in a minor way. Perineal massage, while it might help the delicate skin and muscles of the vulva get used to stretching, also can familiarize the mind with this burning sensation. Preparing your mind and body in this way is helpful so that when the ring of fire occurs during delivery you are not so afraid that labor slows.
What is External Rotation in Delivery?
In the birth canal your baby will rotate to fit the head past the pubic bone. Typically your baby’s head will rotate to face the spine as they descend through the birth canal. Once the head is delivered the shoulders will rotate to emerge one at a time.
How to do Skin to Skin
Once your baby is born they will usually be placed on your abdomen. This is called skin to skin. It is helpful for your baby to transition into the world by being near something familiar. The beat of your heart, the rise and fall of your chest, the smell of your nipples (which smell like amniotic fluid). With baby on your abdomen you can bond, and give them a chance to acclimate to the new world around them. They may even make their way up to your chest and try to nurse.
Episiotomy vs. Tearing
An episiotomy is when an incision made at the vaginal opening to create space for the baby’s head as it emerges from the birth canal. Your obstetrician or midwife can make the surgical cut midline, straight down (toward the anus), or mediolaterally, back and angled to the side. You will have local anesthetic for the procedure if you have not already had an epidural. This cut will need stitches and takes about three weeks to heal.
Tearing is a rupture of the skin during childbirth when the head does not fit easily through the vaginal opening. Tearing of the perineum when you give birth is quite typical. Tears can be stitched together if necessary or can heal naturally on its own in a few weeks.
What is Assisted Vaginal Delivery?
Assisted vaginal delivery is when your care provide decided that you need help bringing baby forth from the birth canal. This can happen for a number of reasons. Usually it is because baby should not be spending too much time hanging out in the birth canal. It is very squished in there and it is not an optimal position for birth parent or baby.
Forceps
Forceps are an obstetric tool to help delivery the baby’s head through the vaginal opening. They look a bit like salad tossers with spoon-like ends. These spoons gently hold the baby’s head and guide it out into the world with the help of your pushing. Forceps might be used along with an episiotomy to make space for the tool.
Vacuum Assisted
Ventouse delivery is another term for vacuum assisted delivery. A cup made of plastic or metal is attached to your baby’s head as they are crowning. This cup is attached to a suction mechanism which helps bring your baby’s head forth through the vaginal opening.
Risks
Your obstetrician and/or midwife need consent to perform an assisted delivery. They should inform you of your choices and explain why they believe this is the best course of action. It might be time sensitive so it is a good idea to educate yourself on the risks associated with assisted delivery. Though choosing to forgo assisted delivery obviously poses risks as well, or your care provider would not suggest it.
Risks for your baby include but are not limited to:
- Forceps delivery – bruising on baby’s head or damage to their brain.
- Vacuum delivery – damage to the head or scalp, higher risk of your baby’s shoulder getting stuck during delivery.
The risks for the birth parent with both forceps and vacuum deliveries are:
- tearing of the genital tissue.
- urinary incontinence.
- weakening of the muscles that support the pelvis which could lead to prolapse.
In Conclusion
The second stage of labor is an exciting moment right before you meet your baby for the first time. You can deliver your baby in an array of different positions, and with the help of gravity. Your contractions are powerful guides to help push your baby out. To poop or pee during this stage of labor is totally normal, please don’t be embarrassed by it. When your baby’s head pushes against the vaginal opening you might feel that ring of fire. It is possible that you will tear during delivery, or your provider may choose to do an episiotomy. Your care provider could decide to help with the assistance of forceps or a vacuum if this stage of labor is prolonged. Your baby will be with you once you have made it through this stage of labor. This is a time to celebrate. You did it!