A Guide to the Second and Third stages of labour
The Second stage of labour
The second stage of labour is also known as the 'pushing stage'.
When a woman reaches the second stage of labour she may feel that her body wants to bear down. Some women say they feel like they want to open their bowels/go to the toilet.
This is normal and the sensations of this is caused by the baby's head when it has descended and the presenting part of the head has come into contact with the pelvic floor.The head is in such close proximity to the back passage and so the feeling of wanting to open your bowels is normal but not all women actually do this.
This change from the first stage to the second stages of labour is also known as transitional stage as a woman can also feel that her legs are trembling and sometimes there maybe a lull in contractions before a woman can start pushing.
It is also important to keep your bladder empty during this stage as a full one can actually stop the head descending and can cause trauma and further problems postnatally. A midwife or doctor that is looking after you will be able to advise you further especially if you have an epidural in place.
Once the midwife has confirmed that you are fully dilated and there is no cervix left then she would be able to advise you to start pushing with each contraction. Your contractions may already give you urges to push involuntarily, or it may take a while to get those urges even if your fully dilated, listen to what you midwife is telling you to do, eventually your body will take over and you will push your baby out!
Once you start to push with your contractions it is hard work, but in a strange kind of way it is less painful then trying to 'fight off' the pain you get in the first stage as you are pushing with the contractions.
The Mechanism of the Second stage of Labour
How long is the Second stage of Labour?
The length of the second stage can vary, depending on whether this is your first pregnancy or if you have had a baby before. Also pain relief, hydration and energy and position of baby is a factor on the effectiveness of the second stage.
- Pain relief - sometimes this can cause the second stage to be slower ie: epidurals - as you have no sensations to push and will need to be directed by your caregiver. Also opiates such as pethidine or remifentanil for pain relief can cause the mother to get tired and sometimes too tired to push your baby out, if given near the second stage of labour these can also make baby a little sleepy when they are born.
- Position of baby - There are only two ways a baby can be delivered vaginally, when baby's back is around to the front of you, which is the ideal position for delivery and the most common. However if your baby is back to you back what we call 'OP' position then your baby can be delivered that way but may take longer to arrive and can cause you to have a lot of backache in labour.
- Feeding and Hydration - energy is very important for this stage as its hard work!! You need some sort of long lasting energy to get through it such as biscuits, or a sandwich, energy drinks give you minimal amounts of energy and are very short lasting.
When you are about to deliver your baby, the head will crown, this is when the widest points of the baby's head are passing through the vaginal opening. At this point the midwife may direct you to 'pant' or just not to push and breathe baby out gently to minimise you tearing.
Episiotomies (where you have a midwife or doctor that cuts the opening) are rarely used these days and are not routine in normal childbirth, however they may need an episiotomy for instrumental deliveries such as a forceps or ventouse, or if the delivery needs to be expedited quickly.
After crowning the rest of the babys head will be delivered, either face down or even face up and then the head then rotates to the side to allow for the next contraction to deliver the body.
Aids to help with pushing in second stage
There are various ways to help with pushing and more common lately are the use of aids to help expedite a delivery
- Birthing Stools - Some look like an oversized potty with a hole, these are brilliant to use as they help open up the pelvis and also gravity allows the head to push down too, they should be available on your chosen birthing unit.
- Handles - The delivery beds sometimes will have handles to hold onto so that you can apply some traction in order to push down when delivering your baby, some women grab hold of a door handle if they are stood up pushing which applies the same principles.
- Chairs - especially high backed chairs (Like a dining chair) are very good for pushing. again if you sit on it back to front this opens up the pelvis whilst you can hold onto the back and push down onto the chair
- Leg Rests or Foot rests - some delivery beds have this facility and is particularly useful if you are slightly restricted ie: with an epidural.
- Birthing Partner! - not the best idea but it does happen! Depends if your partner is strong enough to withstand you grabbing them! A partner is good for support purposes but for nails embedded in their arm, I dont think they will appreciate that!
- Toilet - Sitting on the toilet is great for pushing, same principles apply as a birthing stool but not for delivering down there!
- Holding onto a tie or rope - Some birthing units provide this where there is a rope or tie coming down from the ceiling and is great to hold onto during second stage
Third Stage of Labour
The third stage of labour is when the placenta is delivered. It can be managed in two different ways:
Physiological 3rd Stage of Labour.
- Physiological management is where no drugs are used in the delivery of the placenta. Its more of a wait and see. The cord is left intact and attached to both the baby and the placenta. The placenta can take up to over an hour to deliver this way but breastfeeding your baby or even skin to skin contact with your baby can help this process happen quicker. The midwife will assess any excessive bleeding and manage it accordingly. Once the placenta is delivered then the cord is cut.
- If there are any signs of haemorrhage then the midwife will use drugs to help expedite delivery quicker to stop the bleeding.
- Drugs are used to help expedite the delivery of the placenta usually an injection in your leg immediately when baby is born, either syntometrine or syntocinon is used.
- The Cord is clamped and cut once it had stopped pulsating.
- The midwife delivers the placenta by pulling on the cord (traction)
- This process usually takes 5-10 minutes with the drug used.
- Most hospitals use this method however more and more of them are using the physiological method on normal deliveries, with no complications.
Once the Delivery of the placenta has occurred then the midwife will assess any bleeding and check for stitches.