Contractions and pushing
The second stage is the expulsive stage - you push your baby out. It lasts from the time your cervix is fully dilated until your baby is born and, for a first baby, generally takes less than two hours.
The average second stage lasts about one hour and it may be as little as 15-20 minutes for subsequent babies. At this time contractions are 60-90 seconds long and come at two- to four-minute intervals.
You'll almost certainly feel the urge to push, known as bearing down. The urge is caused by your baby's head pressing down on your pelvic floor and rectum, and is quite involuntary. Keep your pushing as smooth and continuous as you can; make the muscular effort smooth and slow so that your vaginal and perineal tissues and muscles have enough time to stretch and will be able to accommodate your baby's head. The most efficient position to be in when you're pushing is upright, whether you sit on a birthing stool, stand with your arms around your partner's neck, or squat. This means that the downwards muscular force of your body and the downward force of gravity are working together to push your baby out.
As you push, it helps if your pelvic floor and anal area are fully relaxed, so make a conscious effort to let go of this part of your body. Don't be embarrassed if you urinate or lose a little stool - lots of women do. When you've finished a push, take two slow, deep breaths, but don't relax too quickly at the end of a contraction. Your baby will continue to maintain her forwards progress if you relax slowly.
Normal delivery with contractions and pushing
The first sign that your baby is coming is the bulging of your anus and perineum. With each contraction, more and more of your baby's head appears at your vaginal opening, until it doesn't slip back at all between contractions. This is known as crowning. Midwives can use hand manoeuvres to protect your perineum as your baby's head is born, but more often than not these days, they'll let nature take its course (the HOOP study - HOOP stands for hands on, or poised).
You'll probably feel a stinging sensation as your baby stretches your vaginal opening. As soon as you feel this, try to stop bearing down, pant, and allow the contractions of your uterus to push your baby. This may be difficult as you'll probably still feel like pushing, but if you continue to push you run a greater risk of tearing or needing an episiotomy.
As you stop pushing, lean back and try to go limp. Make a conscious effort to relax the muscles of your perineal floor. The stinging sensation only lasts for a short time and is followed by a numb feeling as your baby's head stretches your vaginal tissues so thinly that the nerves are blocked, having a naturally anaesthetic effect.
When her head has been delivered, your baby will be face down, but almost immediately she will twist her head so that she's facing your left or right thigh. Your midwife will wipe your baby's eyes, nose, and mouth, and clear any fluid from her nose and upper air passages. The midwife will also check that the umbilical cord is not round your baby's neck - if it is, she will gently lift it over the head or make a loop through which the baby can be delivered. If the cord is very tight, she may clamp and cut it.
After delivery of your baby's head, your contractions will stop for a minute or so. When they start again, the first will usually deliver one shoulder and the next the other. Once both shoulders are delivered, the rest of your baby will slide out quickly and easily. Your attendants will hold her firmly as she'll be slippery with blood, amniotic fluid, and vernix.
Breathing in the second stage
You'll be shown breathing exercises in antenatal classes. I can't stress enough how important good breathing techniques are during the second stage of labour. They help you feel in control of your own body and this is very empowering.
As you begin the second stage of labour, you may want to accelerate your breathing. This is the most shallow form of breathing you use in labour. Instead of using your chest and throat, focus on breathing only through your mouth. Breathe lightly in and out through your lips, starting slowly and gradually speeding up. Be careful not to breathe out too deeply or you'll start to hyperventilate. If you start to feel at all dizzy, place your hands lightly over your nose and mouth while you're breathing.
What your baby does when you contract and push?
- She'll bring her chin down on to her chest as she descends through your pelvis.
- She'll turn her head.
- She'll extend her head backwards so that the back of her head almost touches her back as she emerges from the birth canal and vagina.
- She'll make a little sideways wriggle so that her head turns to one side or the other; the shoulder of that side can then be delivered through your vagina.
- She'll make another little wriggle to swing her head all the way round so that the other shoulder is delivered. (If you imagine this in quick succession, it's like a shrug of one shoulder after the other - so fast that you hardly notice it.)
- Her trunk, buttocks, and legs follow her head out through your birth canal.
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