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Labor and birth : 2nd and 3rd Stages (part 1) - Delivering your Baby - Which positions to adopt

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The second stage begins when your cervix is fully dilated and your baby has moved deep into the pelvis. These signs may be accompanied by an overwhelming urge to bear down and, once your doctor is satisfied that you are ready to do it, you will be able to push your baby out. The third stage, the delivery of the placenta, marks the end of labor.

NOTE

The moment of delivery is within sight and you will soon meet your long-awaited baby

Delivering your Baby

In the second stage, your labor starts to accelerate as you actively push your baby out into the world.

As you enter the second stage of labor, you will probably experience an overwhelming desire to bear down. Once your doctor has established that you are fully dilated and are ready to start pushing, you may start to feel more in control of your labor since your pushing helps move your baby farther down into the pelvis.

The second stage

The second stage of labor starts when your cervix is completely open, at about 10 cm, and ends with the birth of your baby. This stage usually lasts for around 45 minutes to two hours during a first labor and from 15 to 45 minutes in subsequent deliveries. The second stage is intense and during this time your contractions will become stronger, but may occur less frequently, occurring around every two to five minutes. At this point you may feel a sensation of fullness in your vagina or bowel and have a strong urge to push. Many women find labor pains more bearable in the second stage since they can now actively work with the contractions and push their baby out. Other women find this a particularly hard part of labor because they start to feel exhausted from the effort of prolonged pushing.

Second stage positions

Although you may be tired and want to lie down, it’s recommended that you resist this urge in the second stage. Your partner and nurse can give you plenty of support to help you adopt the most comfortable position.

Staying upright

Adopting an upright position during the second stage of labor has several advantages. The main one is that you are using gravity to assist your baby’s descent, which will also help you bear down and push. Being upright can also improve the alignment of your baby in the birth canal; can increase the efficiency of your contractions; and widens the passageway through the pelvis.

There is also evidence that adopting upright positions in the second stage of labor can reduce the length of time you take to bear down and give birth, and make it less likely that you will have an instrument delivery or episiotomy .

Which positions to adopt

Upright positions during the second stage of labor include upright sitting and squatting positions.

If you prefer a sitting position, try to sit in an upright or semi-recumbent position. If you adopt a sitting position on a bed, sitting at a 45-degree angle can help your breathing and reduce the risk of a condition known as aortocaval compression, which can affect how well your blood is circulated around your body and to your baby. This is caused by the weight of your uterus and the baby pressing on major blood vessels (the aorta and vena cava), reducing the amount of oxygen that circulates around your body, which makes you feel light headed and dizzy. If this happens, you will be advised to lie on your left side to relieve pressure and increase the amount of oxygen circulating.

Because kneeling or squatting increases the pelvic outlet, many women will naturally adopt a squatting or all-fours position to give birth since they find that this is the most comfortable and easy position in which to deliver their baby. Upright squatting and kneeling positions help increase your pelvic outlet by around 28 percent compared to when you’re in a lying-down position. This means that there is more room for your baby to descend through your pelvis and into the birth canal. Some women find it hard to squat down comfortably because they are not used to being in this position and tire easily. If this is the case, ask your partner to support you as you squat.

Alternatively, you may find that lying on your side is your preferred position; your partner can help you by supporting one of your legs to keep your pelvis as open as possible. There is also some evidence that lying on your side can protect your perineum from tearing.

In a kneeling position, both your partner and the nurse can support you as you bear down (image).

Being on all fours with the hospital bed for support can be a comfortable position .

An upright squatting position is good for pushing and can be adopted if you have firm support from your partner. He can support you under the arms while you put your hands around the back of his neck.

Using props

Some women find using props such as a beanbag, birthing ball, pillows, or a large cushion while kneeling and leaning forward helpful.

When to push

Your baby will start to rotate his or her head and shoulders to enable these to descend through your pelvis to be born, and you will feel the urge to bear down and push as this is happening. Your doctor will help you focus and encourage you to push when you feel the urge, which will come naturally with a contraction. With each contraction, you will need to concentrate on pushing down deep into the pelvic area and bottom. It can help to put your chin on your chest and to bear down for as long as possible during a contraction, during which time you may need to take several steady breaths. You may feel like grunting and making noises when bearing down, or you may prefer to breathe deeply and quietly; you should do whatever you find helpful and works best. You will need to work with your body’s instincts and adopt the position you find most comfortable and easy to give birth in (see Which positions to adopt). Pushing your baby out into the world takes a huge amount of effort and energy, but you have the ability and are very capable of doing this.

Your doctor and birth partner will encourage and support you throughout this stage and help you to believe in your ability to give birth.

Your baby’s descent

The time it takes to push your baby out once he or she is deep within the pelvis can take around 30 minutes to one hour for a first labor, although this time may be considerably reduced in subsequent labors, sometimes taking just a few minutes. The combined force of the contractions (which are now around every two to five minutes) and your pushing moves your baby farther down into the pelvic outlet. As this occurs, the pressure on your back and rectum will intensify and you may experience a stinging sensation as your vagina becomes fully stretched. Your doctor may tell you to stop pushing at this point so that your perineum can thin further and so that the baby’s head isn’t delivered too suddenly, which could cause serious tears. She may tell you to pant or blow instead to help you resist the urge to bear down.

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