Babies Tale

The second stage ranges in length from fifteen minutes to three or more hours. The baby is born during the second stage.

When your cervix is fully dilated, the intense out-of-control feelings may subside. The contractions seem to 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 that your cervix is fully dilated and you can begin pushing whenever you feel like it.

During the second stage, you may behave differently than in the first 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 is actually fighting against the birth of your baby-and it hurts much more than letting go.

You will probably notice a real change in your contractions in the second stage. Most contractions will contain a reflex need to strain or grunt, called an “urge to push”, which comes and goes three to five times per contraction. With each urge to push, 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.

1. Get the contraction with a long breath, and curl your body forward whether you are reclining, lying on your side, squatting, or even sitting on a toilet or birthing chair.
2. Breathe as you did in second stage contractions.
3. When you feel the reflux urge to push [it is unmistakable], follow it by grunting or holding your breath and bearing down. You will need reminders to relax your pelvic floor. The urge to push will go away after a few seconds. Then breathe again until the urge returns. Repeat until the contraction ends.
4. Relax or change positions between contractions.

Positions for the Second Stage

Unless the baby is coming fast, you will 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 are giving the baby more room to come down through your pelvis than in other positions. Sitting on the toilet 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 is having a slowing of the heartbeat during contractions. Semi-sitting is a good position because you can see your doctor and the baby as he comes out. It is also a convenient position for your doctor.

Lying on the back with the legs up in stirrups [the lithotomy position] used to be the way all women gave birth. Most women disliked the position. Their objections to it, plus the fact that it sometimes caused slowing of the baby’s heartbeat and other problems for the mother, finally led to its being discontinued as a routine position by most midwives and many physicians. It is still used however, particularly in anesthetized births and deliveries assisted with forceps or vacuum extraction.

You may 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 doctor in advance.

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