Rest of the body
After the delivery of the
head, your baby will turn slightly so that the first shoulder can be
delivered in the next contraction. Your doctor may help by applying
gentle traction to your baby’s head at the side to help the first
shoulder emerge. Once the first shoulder has been delivered, your baby
will turn again slightly so that the second shoulder can be delivered.
After this, the rest of the body will slip out and the delivery of your
baby will be complete.
Monitoring you and your baby
In the second stage,
the baby’s heartbeat and your contractions are monitored. If the second
stage is becoming prolonged, with the possibility of you becoming tired
from pushing, an assisted delivery may be suggested with forceps or vacuum.
Episiotomies
An episiotomy is a cut
made between your vagina and anus to aid the delivery. Around 30 years
ago, episiotomies were routine since it was assumed that a cut prevented
worse tears. This has been shown since not to be the case, and today,
an episiotomy is only done by a doctor to aid a forceps delivery or in
an emergency, for example if the baby is in distress; if the baby is
large; or if the perineum is tight. Before doing the procedure, the
doctor should explain why they think it is necessary and should obtain
your verbal consent.
Before you’re cut,
you’ll have a local anesthetic to numb the area. The cut is usually done
at an angle between the vagina and the rectum and will be stitched
after the birth. The doctor will insert a long absorbable stitch in the
posterior wall of the vagina, in your perineal muscle layer, and under
the skin layer. If you feel discomfort, the stitches can be snipped or
taken out.
You may be given oral
analgesics for pain relief after you’ve been stitched, and
anti-inflammatory medication may be recommended. Ice packs or a
maternity cooling gel pad can ease pain and swelling, and bathing can be
soothing.
Perineal tears
Some women tear
naturally during the delivery of their baby and this tends to be more
common in a first labor. Spontaneous tears are classified by their
severity and the tissue layers involved. A first degree tear involves
the skin layer only; a second degree tear involves the skin and
muscle-tissue layers; a third degree tear involves skin, muscle, and the
anal sphincter. Fourth degree tears are uncommon and involve a tear
through to the rectum. A first degree tear usually doesn’t need
stitches, but second, third, and fourth degree tears do. Second degree
tears are the most common. Only, a small number of women sustain third
or fourth degree tears, which are usually associated with assisted
deliveries.
The birth passage, far from being straight, involves a series of rotational maneuvers known as the “mechanisms of labor.”
This curve, known as the
“curve of Carus,” is thought to result from the evolution of humans from
being on all fours to being upright. This caused the spine to curve,
the pelvis to tilt, and gave a curve to the birth canal. Your pelvic
floor muscles help the head rotate through the birth canal.
… Your birth partner
Support in the second stage
In the second stage, your partner’s support is invaluable. His or her role is to make you feel supported and safe and to offer lots of encouragement.
Your birth partner can
provide verbal support to help you deal with the strenuous task of
pushing your baby out with each contraction. There may be times when
you’re not lucid and your partner will need to speak for you and liaise
with medical staff.
In addition to
emotional support, your birth partner can act as your physical support
in whatever position you adopt in the second stage, whether this is a
squatting position or another position that you find comfortable. Your
partner will be able to massage your back if this is helpful, and can
hold you and comfort you and help you focus on your breathing during and
between each contraction.
Your partner can also
watch as your baby’s head crowns and describe what he or she can see, or
hold a mirror for you to see the baby’s head, which can be deeply
reassuring as you realize that the end is in sight.
The emotional and physical support provided by your birth partner
can be crucial during the second stage of labor, the time when you are
having to exert yourself physically to push your baby down in your
pelvis and out through the birth canal.
… How you’re feeling
Coping in the second stage
The second stage of labor can be a time when instinct takes over
and you may find that you are oblivious to everything around you as you
follow the overwhelming urge to push. You may have been concerned
before labor about how you would behave during the delivery. Some women
are worried that they will defecate while they are pushing. This is
actually very common and it’s natural to pass a stool during the
delivery; you should rest assured that the nurses and doctors will be
completely used to this. You may not even notice yourself that this has
happened.
Rather than be
concerned about how you will act, try to take encouragement from the
fact that you now have more control over your labor and are actively
pushing your baby out. You may find that you want to grunt or moan while
pushing, or you may push quietly and intensely. Focusing on the
imminent arrival of your baby will help you to persevere.
Pushing with an epidural
If you have had an epidural, this can affect your awareness
of when to bear down and push. If this is the case, your doctor will
first check that your baby isn’t showing signs of distress, and may then
decide to wait a while for the epidural effect to wear off slightly so
you can feel when to bear down and push. Alternatively, the doctor will
feel the top of your uterus so that she is aware of when a contraction
is starting and will then guide you to bear down and push.
Shoulder dystocia
This is an emergency situation during a delivery
that occurs when the baby’s head has been successfully delivered, but
the shoulders appear to be stuck. Since the head may be delivered fairly
easily, the problem is often not discovered until this point in labor,
and immediate action is then needed to deliver the rest of the body
safely. The danger is that, if the baby is not delivered rapidly, he may
be starved of oxygen. The doctor will need to apply firm traction on
the baby’s head and neck to encourage first one and then the next
shoulder to be delivered. An episiotomy (see Episiotomies) may need to be performed to assist the rapid delivery of the baby.
Shoulder dystocia is
more likely to occur where the baby is particularly large, where the
mother has a small pelvis, or in women with diabetes or who are obese.
If this condition has occurred in a previous pregnancy, then an
obstetrician may be necessary at the birth.
Birth story: water birth
Becky is a 22-year old
woman in her first pregnancy. She’d had no problems and at her 36 week
appointment, she discussed her birth plan and told her doctor that she
wanted a water birth at the local birth center.
Becky’s birth story: By the time I was two days overdue I was having irregular contractions. I’d had a bloody show and had a backache. The next day I woke at 6:30 am with regular
contractions. I coped using breathing techniques, stayed active, and
used a birthing ball. When my contractions were every 5 minutes and
lasting a minute, I called the birth center since I felt I needed to use
the pool. They said they would get it ready.
At 11:35 am, my partner
and I reached the center and met the doctor. She felt my contractions,
listened to the baby’s heartbeat and did a vaginal examination. She said
I was in established labor since I was 5 cm dilated, my cervix was 50
percent effaced, and the head was descending. In the pool, I was able to
move around and change position. The warm water eased my backache and
contractions. I felt calmer and started to relax. I found kneeling in
the water and rocking my pelvis back and forth and from side to side
helpful. My partner supported me and periodically the doctor listened to
my baby’s heart rate.
At 3:20 pm, my
contractions were every 1 to 2 minutes and very strong. The doctor and
my partner reassured me and I managed to focus. I began to feel the urge
to bear down. At 3:50 pm, my baby’s head was born and a couple of
minutes later I pushed my baby out into the water. The doctor gently
lifted my baby up to me and we stayed in the water a few moments. I got
out to deliver the placenta, which I did without drugs. At 4:20 pm my
placenta was delivered and I didn’t need stitches.
The doctor’s comments:
Becky found the warm water helped her deal with contractions, and she
stayed calm. She tried different positions and the water kept her
buoyant. She and her partner were focused. Her labor progressed well and
was just under 10 hours. It was wonderful to observe.
