The Second Stage of Labour - Suffolk and North East Essex Maternity and Neonatal Services

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What is happening during the Second Stage of Labour?

The second stage of labour is from when your cervix is fully open until the birth of your baby.

As you move from the first to the second stage of labour, your hormones will change and your contractions will prepare you to birth your baby. This is powerful and can feel overwhelming. Everyone feels different about this stage. Some feel like they can’t do it; some enjoy this part more; and for others it can be a sleepy, restful time. You may want constant reassurance or to be left alone. Everyone is different!

The pushing bit!

As your baby moves lower, you may feel a building in pressure building that leads to involuntary pushing from you. This is the time to listen to your body. You will feel an increasing pressure in your bottom, and most people feel an urge to bear down. It may feel overwhelmingly like you need a poo. This is completely normal, and is the pressure of baby’s head on your rectum.
Although we call it ‘pushing’, this can be misleading, and might make you feel like you would just need a few pushes to birth your baby.

In reality, if this is your first baby, you will nudge the baby down with each contraction – moving them just millimetres. This can take an hour or more. Many people are surprised at this, but it’s not like birth on TV! Your pelvis is gently curved, and contractions are moving your baby around the ‘bend’ in the pelvis. Give your body the time it needs.

If you have an epidural, the signs and feelings of second stage may be masked and a vaginal examination will help to know you are in second stage. You may need some guidance from the midwife as the overwhelming urge to bear down is often missing with an epidural. Once the second stage of labour has started, the midwife will offer to listen to your baby more frequently, as the second stage can be tiring for your baby.

What can I do to help myself in the 2nd stage?

Upright birth positions

It helps to be in upright positions during this stage. Being upright and mobile uses gravity, which makes birth quicker. You may find yourself using different positions as your body tells you what you need to do. Your pelvis is curved, and laying on your back will make the journey slower. Even with an epidural, you can be supported to be in a more upright position, maybe leaning over the back of the bed if you cannot stand.

Breathing techniques

As the baby moves lower with each contraction, the perineum, which is the skin between your vagina and anus , will begin to stretch slowly. Massaging your perineum in pregnancy helps it to stretch. A slow birth will also allow time for this, and your midwife will talk and guide you through this bit.

Something that can feel amazing at this point is a warm compress on your perineum. This can be a flannel or a pad. Birthing in water also helps with softening and stretching the muscle.

The crowning bit!

At some point in second stage, your baby’s head will be visible during a contraction, but it then slips back into the birth canal when you are resting. Once the baby is really low, it usually remains visible between contractions as you move towards what is called the ‘crowning’ stage. This is where breathing techniques can help a slow birth, giving time for everything to stretch. As your baby’s head births you might feel a stinging, burning sensation. This can feel different for everyone as we are all individuals. The midwife will guide you through this part.

Once your baby’s head is born, there will be a pause until the next contraction, before the rest of your baby is born. This can sometimes be 2-3 minutes. Your baby needs time to turn their shoulders and make the most of the space available. The rest of your baby is usually born with the next contraction, and given straight to you for skin- to- skin contact.

Please let your midwife know if you or your partner would prefer to be the ones to lift the baby up and how you would like to discover the sex of your baby.

Tears

As your baby’s head is born, the skin between the vagina and the anus (called the perineum) is stretched. For many women it will stretch and remain intact. For others it may stretch and tear.

Perineal tears are described in degrees, which tell us their size and effect:
First-degree tears are small, skin-deep tears. These usually heal naturally.
Second-degree tears are deeper and affect the muscle of the perineum. These usually require stitches.
Third-degree tears involve the muscle that controls the anus (the anal sphincter). Stitches will be needed.
Fourth-degree tears are the same as third-degree but extend into the lining of the anus. Stitches will be required.

Find out more about third- and fourth-degree tears here

Third- and fourth- degree tears

What can I do to help prevent tearing?

Sometimes there is nothing you can do to control whether your perineum tears. However, we know that there are some things that might help.

Birth position – being upright and free to move, kneeling being on all fours or lying on your side may reduce tearing.

Warm compress – a warm flannel or pad placed on the perineum in second stage can help the skin to warm up and stretch.

A ‘hands on’ birth means that your midwife or doctor can help support the perineum in second stage.

Perineal massage while pregnant has been shown to help. Ask your midwife for information and instructions on how to massage your perineum to help prevent tearing during birth.

Perineal massage a step by step guide

Explanation Point

Term	Description
Cervix	the cervix is the bottom end of the uterus, it expands to create a wide opening into the vagina.
Hormones	Hormones are chemicals that tell cells and body parts to do certain things.
Epidural	An epidural is an injection in your back to stop you from feeling pain in part of your body.
Contraction	Contractions are the tightening of muscles at the top part of the uterus. Contractions push the baby down into the birth canal during labour.
Pelvis	The pelvis is a bowl-shaped bony structure made up of two pelvic bones (hip bones) and the sacrum., iIt connects the trunk and the legs.