A Second Look at the Second Stage of Labor

Authors

  • Joyce Roberts CNM, PhD FAAN, FACNM,

    Corresponding author
    1. Joyce Roberts is a professor and the head of the Department of Maternal-Child Nursing in the College of Nursing at the University of Illinois at Chicago.
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  • Deborah Woolley CNM, PhD FACCE

    1. Deborah Woolley is an assistantprofessor and coordinator of the Nurse-Mldwijery Program in the Department of Maternal-Child Nursing in the College of Nursing at the University of IllZnois at Chicago.
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Address for correspondence: Joyce Roberts, CNM, PhD, FAAN, FACNM, University of Illinois at Chicago, College of Nursing, (M/c 802), Department of Maternal-Child Nursing, 845 South Damen Avenue, Chicago, IL 60612.

Abstract

This article focuses on the primary clinical issues during the second stage of labor: diagnosis, duration, maternal bearing-down efforts, and fetal descent, and ways to help women with their expulsive efforts during this time. A pattern of progression for the second stage/expulsive phase of labor is presented, with an emphasis on the importance of delaying direction to or encouragement of the woman to push until the obstetric conditions are optimal for descent and the women has entered the active phase of the second stage. Ongoing assessment of fetal status and descent, the quality of uterine contractions, and maternal condition are emphasized, rather than arbitrary time limits for the second stage. The use of various care practices, including maternal position and alternative bearing-down techniques, which optimize maternal and fetal outcomes, is described. Finally, women's concerns about this major life experience are considered in the context of the care that they receive during the second stage of labor.

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