Second Stage of Labor: Pushing Your Baby Out


What is the second stage of labor?

The second stage of labor starts after your cervix has dilated (opened) to 10 centimeters (about 4 inches), and it continues until your baby finishes moving through your vagina and is born. During this time, you will push or bear down (like you do when you have a bowel movement) to help your baby come out. The second stage of labor can last from a few minutes to a few hours. It may last longer if this is your first baby and/or if you have an epidural.

How do I know when it is time to push?

Women's bodies are smart and know how to give birth. If you do not have an epidural, you will feel a very strong urge to push down as if you are having a bowel movement. If you have an epidural and cannot feel your lower body as well, your body will give you clues that it is time to push. You may feel pressure or pain in your vagina or rectum (bottom), or you may feel as if you need to have a bowel movement.

When should I start pushing?

Some women start to feel like pushing or bearing down before the cervix is dilated to 10 centimeters. Others feel like pushing right after the cervix is completely dilated. For other women, after the cervix has dilated to 10 centimeters, it takes time for the baby to move down into the vagina, then they feel like pushing. Until recently, women have been asked to start pushing as soon as the cervix has dilated to 10 centimeters, but as long as you do not have a fever and your baby's heart rate is normal, there are many benefits to waiting to push until you feel the need to push. Waiting until this feeling occurs is sometimes called “laboring down” or “rest and descend.” If you wait until you have the feeling that you want to push or bear down:

  • • you are more likely to push for less time,
  • • you are less likely to need help with a vacuum tool or forceps to get your baby out,
  • • you are less likely to get so tired you can't push anymore, and
  • • your baby is less likely to have heart rate problems while you are pushing.

What are the best positions for pushing?

The most common position for pushing and giving birth is lying on your back, but this position raises the chance your baby will have heart rate problems before birth. It also raises the chance that the tissue at the opening of your vagina will tear when your baby comes out. Several other positions are better for pushing. Changing positions frequently while you are pushing may be the best of all.

Side lying. Lying on your side helps you rest between contractions when you are pushing. This position can also lower your pain levels, lower your need for pain medication, and lower the chance that your bottom will tear when your baby comes out. Lying on your side can also help your baby's head turn to a position that is better for birth.

Sitting or squatting. Upright positions like sitting or squatting can reduce the time it takes to push your baby out by making the contractions stronger and by making the space between your pelvic bones a little bit bigger. Upright positions can also lower your pain levels, lower your need for pain medication, and lower the chance that your bottom will tear when your baby comes out.

What is the best way to push?

You may be told to push by holding your breath and pushing for as long as it takes to count to 10. This method is called “closed glottis pushing” and has been the way women have been told to push for many years. Today, we know that the best and safest way to push your baby out is by pushing when you feel the urge to bear down or have a bowel movement and by not holding your breath. This method is called “open glottis pushing.” When you push this way, your work will add to the work of the contraction. The table describes the 2 ways to push and lists the pros and cons of each:

For More Information

  • • Lamaze: Describes the 3 different stages of labor, what to expect, and what may help you cope in each stage
  • • http://magazine.lamaze.org/Birth/LaborDay/tabid/71/Default.aspx
  • • Giving Birth Naturally: Discusses the most effective way to push, good positions for pushing, and what to expect and do while you are pushing

http://www.givingbirthnaturally.com/pushing-stage.html

 Open Glottis PushingClosed Glottis Pushing
How to do it• A health care provider and/or support person is there to encourage you to trust your body and support you as you push. 
• You push when you feel the urge to bear down or when you feel like having a bowel movement. 
• Most women take several breaths between pushes. 
• You probably will push for about 5 seconds 3-5 times during each contraction. 
• You may grunt or make a deep noise when you are pushing. This is a sign that you are pushing well.
• A health care provider and/or support person tells you how and when to push. 
• You take a big breath and hold it before you start pushing, then you bear down as if you are having a bowel movement. 
• You push for a count of 10, starting at the beginning of a contraction, then take a breath and push again. 
• You push about 3 times with each contraction. 
• You may be asked not to make any noise when you push.
Benefits• Blood flow to your uterus and baby is not affected, so there is less chance that your baby will have heart rate changes. 
• There is less chance that you will get so tired you can't push anymore. 
• There is less chance that your bottom will tear when your baby comes out.
• This type of pushing might shorten the time it takes you to push your baby out.
Risks• The second stage of labor may be slightly longer.• The blood flow to your uterus and baby is lowered, which can raise the chance that your baby will have heart rate problems. 
• There is a higher chance that you will feel so tired you can't push anymore. 
• There is a higher chance that your bottom will tear when your baby comes out. 
• There is a higher chance that you will have problems urinating after your baby is born.

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