The Second Stage of Labor

The second stage is when the momentous occasion occurs. The feelings of love for your newborn baby -- and of relief -- will be incredible. The second stage ranges in length from 15 minutes to 3 or more hours.

When your cervix is fully dilated, the intense, out-of-control feelings may subside. The contractions often space out somewhat, and you may even get a short break from contractions (this is more likely with first-time mothers). It is always wonderful news when you are told your cervix is fully dilated and you can begin pushing whenever you feel like it.

During the second stage, you may find yourself holding your breath or slowly letting it out, while bearing down (something like, but much more than, what you do when having a bowel movement) and releasing your pelvic floor (relaxing the muscles in the area around your vagina). This last is most important because tensing the pelvic floor actually fights against the birth of your baby -- and it hurts much more than letting go.

A change in your contractions occurs in the second stage. Accompanying most contractions is a reflex need to strain or grunt, called an urge to push, which comes and goes three to five times per contraction. The combination of the uterine contraction and your bearing-down effort pushes the baby closer to the outside. It is hard work and it hurts, but it is also an exciting time, with lots of cheering and praise for your efforts. Most women find they have the strength to keep pushing.

The best way to push is to push only when your body makes it happen -- only when the urge to push comes. That way you won't hold your breath so long that you or the baby gets too little oxygen. The following is a routine many women use during second-stage contractions:

Greet the contraction with a long breath, and curl your body forward whether you are reclining, lying on your side, squatting, or sitting on a birthing chair.


Breathe as you did during first-stage contractions.


When you feel the reflex urge to push (it is unmistakable), follow it by grunting or holding your breath and bearing down. You may need reminders to relax your pelvic floor. The urge to push goes away after a few seconds. Then breathe again until the urge returns. Repeat this routine until the contraction ends.

Unless the baby is coming fast, you have time to change positions. Many childbirth educators encourage women to learn to squat comfortably before labor because this is such a helpful position for the second stage. When you squat, you give the baby more room to come down through your pelvis than in other positions. Sitting on a bedpan may help if you have trouble relaxing your pelvic floor.

Lying on your side is a good position if the baby is coming fast, if you have painful hemorrhoids, or if you must lie down for some reason. Resting on your hands and knees may help if the baby is large or experiencing a slowing of the heartbeat during contractions. Semi-sitting is a good position because you can see your caregiver and the baby as he comes out. This position is also a convenient one for your caregiver.

The lithotomy position, where the woman lies on her back with her legs in stirrups, used to be the way all women gave birth. Most women disliked the position. Their objections to it, plus the fact it sometimes caused slowing of the baby's heartbeat and other problems for the mother, finally led to discontinuation of its use as a routine position during most deliveries. Other caregivers continue to use the position, particularly with anesthetized births and deliveries assisted with forceps or vacuum extraction.

You might use several positions during the second stage, ending with semi-sitting or lying on your side for the actual birth. Discuss positions for the second stage with your caregiver in advance.

The Moment of Birth

You know when the baby's head emerges. You feel a stretching or burning sensation in your vagina. This is an exciting, intense time. You know the baby is almost here and may be tempted to push as hard as you can to help him fully emerge. That would be a mistake, however, because a sudden push could make the baby come out too quickly and damage your perineum (causing tearing). It is important for you not to push hard at this time. Let your uterus do the work alone. You should breathe rapidly and lightly (pant as animals do), so the baby can emerge gradually. Your caregiver gives instructions and helps the baby out slowly. You'll soon be holding your baby.

After the head emerges, the baby turns to one side, and a shoulder and then the whole body are born. And what a sense of relief you feel! Labor is over (or very nearly so). You have a baby. It may take a while for it all to sink in. In the meantime, you may be holding and caressing your baby or watching as a nurse or your doctor or midwife examines him and cares for him.