Once the cervix is fully dilated (10cm. diameter)
The baby can now pass out of the uterus, through the
vagina and be delivered. This part of labour from
full dilation of the cervix to delivery of the baby
is called the 2nd stage of labour.
During this stage, the contractions are extremely
strong and come every 2 – 3 minutes. You may feel
that the second contraction starts before the cessation
of the first one.
do you feel / experience?
the cervix is fully dilated, you have entered the
2nd stage of labour.As the baby’s head
descends down into the vagina, it presses on the rectum
and bladder. Due to the pressure on the rectum and
stretching of the vagina, you may feel an urge to
push. Your contractions are strongest, coming every 2 –3 minutes
and lasting for 1 1/2 minutes. You may even feel that
they are endless and that the next one is coming on
before the 1st disappears. As the head is delivered,
you may feel a stretching/ tingling sensation, due
to stretching of the vulva.
During this stage you may involuntarily pass stools
or urine. This is absolutely normal and nothing to
feel embarrassed about. You
may feel exhausted or sometimes get a “second wind”.
This stage may last for a
maximum 2 hours If this stage is prolonged instrumental
delivery may be necessary .This is done by using either
a vacuum or a forceps application.
What Does Your
you have been in your room till now, you may be shifted
to the labour ward. During this stage, the nurse or
doctor makes record of your baby’s heartbeats more
frequently than what they have been doing till now.
An internal examination is
done to find out the level of descent of your baby’s
head and also to know its position (whether it is
occipito posterior or “back labour”)
Depending upon the hospital protocol / policy, you may be given
a specific position for delivery. The various positions
– lying on your back.
birth in a tub (usually practiced in west, not in
with the legs strapped to 2 rods placed at the end
of the bed (lithotomy position).
Commonly, the dorsal or lithotomy position is used.
The doctor / nurse will wash
up and wear gowns / gloves for conducting the delivery.
They will guide you and help you with your delivery.
They will tell you “how to ” and
“when to” push or bear down and may tell you
how you are doing. Follow their instructions carefully.
Once the head is seen bulging at the Vulva, an Episiotomy
may be given if necessary after giving adequate pain
relief. This is usually given by injecting local anaesthesia
The doctor / nurse will give support to your perineum
while you are bearing down so that the head doesn’t
come out suddenly and tear the perineum. Once
the head is delivered, they will suction out the mucus
/ amniotic fluid from the baby’s mouth / nostrils.
At the same time, you will be asked to continue bearing
down and perineal support will also be continued till
the rest of the baby is delivered.The
time of birth is noted by the doctor/nurse.
Once the shoulder of the
baby is delivered, you may be given an IV drug or
an injection on your buttocks (methergin). This is
to help your uterus to contract and thus help in reducing
the bleeding and expelling the placenta.Some doctors
may wait till the placenta is delivered to give the
injection. Instead, if you have an IV line, then a drug called “oxytocin”
may be added to your drip to the same purpose.
cord is tied and cut after its stops pulsating.
The baby may then be taken away for cleaning and drying
or may be given to
you immediately for nursing. The baby is examined
carefully and his/her foot prints may be taken for
identification and tags may be tied to his/her wrist
as also yours for proper identification.
The baby is dried, weighed, given Vit K injection
and then wrapped. The baby will then be shown
to those accompanying you and then kept in nursery
or with you.
Role – Do's & Dont's
During the 1st
stage your have not been an active performer. Now
in the 2nd stage of labour active pushing
effects are needed from you so that the baby can be
Get into a comfortable pushing position as allowed by
Push only when you have contractions or when your doctor
tells you to.
and take deep breaths in between contractions.
Relax not just your buttocks, thighs
and perineum but your entire body. This
will help to reduce fatigue or exhaustion.
While you are pushing, some amount of stools and urine
is bound to be expelled. Don’t be embarrassed
and let this inhibit you. This HAPPENS
TO EVERYONE and is NORMAL. The doctor
and nurse are used to this and it will
be quite nonchalantly cleaned.
While pushing try to maintain the push for as long as
possible. Pushing is done in a manner
similar (but more strongly) to when
you are constipated and trying to pass
stools. If you can not hold your breath
and maintain the push for the entire
duration of contration, don’t despair.
Just try your level best and follow
your own urges to push, give it all
that you’ve got. Think about your baby
and like “NIKE” says “JUST DO IT!”
If it is allowed by your hospital and doctor’s
policy, ask your husband or labour partner
(mother, sister, close friend, etc.)
to be present with you in the delivery
room .In all the hospitals, they can
be with you in the first stage of labour
- Give you moral support.
you reassurance in the form of physical contact,
by holding your hand, supporting your back while
you to relax in between contractions.
be take care of your thirst by giving you few ice
chips, if allowed.
you feel comfortable by wiping your face with warm
/ wet towel and reassure you about your progress.
your husband is allowed during labour, he can hold
the baby when it is coming out and cut the umbilical
cord. This may / may not be permitted by your doctor.
But is quite commonly followed in the west (provided
he does not feel faint by the sight of fluid, blood,
labour partner / spouse should be aware that you
may say things that you don’t mean when you are
having painful contractions. You may have strong
words, which you normally would not use or which
your partner have thought you would use. This is
absolutely normal, nothing to feel bad about.
You will have lot of time
to apologize later, but it is always best and warn
every one before hand.
is a small incision / cut given on the vagina and
vulva so as to facilitate the delivery of the baby.
This is done in women who are delivering for the 1st
time or in women who have a very tight perineum, inspite
of previous deliveries. But in women who have had
previous deliveries the vagina are usually lax. Another
indication for an episiotomy is in cases of an instrumental
(Forceps or vacuum) delivery. Episiotomy is done so that
the baby can deliver without irregular and multiple
tears of the mother’s birth canal. An episiotomy is easier to stitch and heals faster than
ragged tears caused during birth of the baby when
episiotomy is not given.
In short episiotomy is given
to any woman during delivery where the doctor / nurse
anticipates that the birth canal may tear during delivery
of the baby. i.e. the baby size is bigger than the
completely stretched birth canal.
important points you ought to know about the episiotomy
are as follows:
is done during the 2nd stage of labour.
doctor will give and stitch the episiotomy after
injecting a local anaesthetic agent. Hence it is
is done immediately after the delivery of the placenta
stitching, you may not appreciate the pain at the
episiotomy site for few minutes due to the action
of the local anaesthetic agent. But once the effect
wears off there will be certain amount of pain perceived.
Pain can be reduced by:
- Medication (painkillers) given by the doctor.
- Hot water bath.
- Ice packs
- Moving around will help you bear the pain and
reduce the swelling. If you do not get up and move
around, the pain perception will not be reduced.
- Infra red light.
need to clean the episiotomy wound and apply antiseptic
cream 2 – 3 times daily and every time after passing
stools / urine. While cleaning or removing pads
go from front to behind so as not to soil the area
of wound with stools and germs.
stitches will usually fall off on their own within
8 – 10 days (some in 2 weeks) and need not be removed
you notice excessive swelling or if the pain has
increased considerably or if you have difficulty
in passing stools or urine, report to your doctor
immediately so that he/she can have a look at the
episiotomy wound. And find out what’s wrong.
weights, straining, etc. will not put any pressures
on the stitches and will not cause the stitches
to give way. So don’t worry.