STAGES OF LABOUR

2nd STAGE

Once the cervix is fully dilated (10cm. diameter) The baby can now pass out of the uterus, through the vagina and be delivered. This part of labour from full dilation of the cervix to delivery of the baby is called the 2^nd stage of labour.
During this stage, the contractions are extremely strong and come every 2 – 3 minutes. You may feel that the second contraction starts before the cessation of the first one.

What do you feel / experience?

Once the cervix is fully dilated, you have entered the 2^nd stage of labour.As the baby’s head descends down into the vagina, it presses on the rectum and bladder. Due to the pressure on the rectum and stretching of the vagina, you may feel an urge to push.  Your contractions are strongest, coming every 2 –3 minutes and lasting for 1 1/2 minutes. You may even feel that they are endless and that the next one is coming on before the 1^st disappears.  As the head is delivered, you may feel a stretching/ tingling sensation, due to stretching of the vulva.
During this stage you may involuntarily pass stools or urine. This is absolutely normal and nothing to feel embarrassed about. You may feel exhausted or sometimes get a “second wind”. This stage may last for a maximum 2 hours If this stage is prolonged instrumental delivery may be necessary .This is done by using either a vacuum or a forceps application. .

What Does Your Doctor Do?

If you have been in your room till now, you may be shifted to the labour ward. During this stage, the nurse or doctor makes record of your baby’s heartbeats more frequently than what they have been doing till now.  An internal examination is done to find out the level of descent of your baby’s head and also to know its position (whether it is occipito posterior or “back labour”)

Depending upon the hospital protocol / policy, you may be given a specific position for delivery. The various positions can be:

• Dorsal – lying on your back.
• Semi reclining.
• Squatting.
• Water birth in a tub (usually practiced in west, not in India).
• Supine with the legs strapped to 2 rods placed at the end of the bed (lithotomy position).

Commonly, the dorsal or lithotomy position is used.

The doctor / nurse will wash up and wear gowns / gloves for conducting the delivery. They will guide you and help you with your delivery. They will tell you “how to ” and  “when to” push or bear down and may tell you how you are doing. Follow their instructions carefully.
Once the head is seen bulging at the Vulva, an Episiotomy may be given if necessary after giving adequate pain relief. This is usually given by injecting local anaesthesia
The doctor / nurse will give support to your perineum while you are bearing down so that the head doesn’t come out suddenly and tear the perineum.  Once the head is delivered, they will suction out the mucus / amniotic fluid from the baby’s mouth / nostrils. At the same time, you will be asked to continue bearing down and perineal support will also be continued till the rest of the baby is delivered.The time of birth is noted by the doctor/nurse.

Once the shoulder of the baby is delivered, you may be given an IV drug or an injection on your buttocks (methergin). This is to help your uterus to contract and thus help in reducing the bleeding and expelling the placenta.Some doctors may wait till the placenta is delivered to give the injection.  Instead, if you have an  IV line, then a drug called “oxytocin” may be added to your drip to the same purpose.   The umbilical cord is tied and cut after its stops pulsating.
The baby may then be taken away for cleaning and drying or may be given to you immediately for nursing. The baby is examined carefully and his/her foot prints may be taken for identification and tags may be tied to his/her wrist as also yours for proper identification.
The baby is dried, weighed, given Vit K injection and then wrapped. The baby will then be shown to those accompanying you and then kept in nursery or with you.

Your Role – Do's & Dont's

During the 1^st stage your have not been an active performer. Now in the 2^nd stage of labour active pushing effects are needed from you so that the baby can be delivered easily.

They can :

• Give you moral support.
• Provide you reassurance in the form of physical contact, by holding your hand, supporting your back while pushing etc.
• Help you to relax in between contractions.
• May be take care of your thirst by giving you few ice chips, if allowed.
• Make you feel comfortable by wiping your face with warm / wet towel and reassure you about your progress.
• If your husband is allowed during labour, he can hold the baby when it is coming out and cut the umbilical cord. This may / may not be permitted by your doctor. But is quite commonly followed in the west (provided he does not feel faint by the sight of fluid, blood, etc.).
• The labour partner / spouse should be aware that you may say things that you don’t mean when you are having painful contractions. You may have strong words, which you normally would not use or which your partner have thought you would use. This is absolutely normal, nothing to feel bad about.

You will have lot of time to apologize later, but it is always best and warn every one before hand.

Episiotomy

Episiotomy is a small incision / cut given on the vagina and vulva so as to facilitate the delivery of the baby.
This is done in women who are delivering for the 1^st time or in women who have a very tight perineum, inspite of previous deliveries. But in women who have had previous deliveries the vagina are usually lax. Another indication for an episiotomy is in cases of an instrumental (Forceps or vacuum) delivery.  Episiotomy is done so that the baby can deliver without irregular and multiple tears of the mother’s birth canal.  An episiotomy is easier to stitch and heals faster than ragged tears caused during birth of the baby when episiotomy is not given.

In short episiotomy is given to any woman during delivery where the doctor / nurse anticipates that the birth canal may tear during delivery of the baby. i.e. the baby size is bigger than the completely stretched birth canal.

Few important points you ought to know about the episiotomy
are as follows:

• It is done during the 2^nd stage of labour.
• Your doctor will give and stitch the episiotomy after injecting a local anaesthetic agent. Hence it is painless.
• Stitching is done immediately after the delivery of the placenta i.e.:
• After stitching, you may not appreciate the pain at the episiotomy site for few minutes due to the action of the local anaesthetic agent. But once the effect wears off there will be certain amount of pain perceived. 

Pain can be reduced by:

•  Medication (painkillers) given by the doctor. 
•  Hot water bath.
•  Ice packs
•  Moving around will help you bear the pain and reduce the swelling. If you do not get up and move around, the pain perception will not be reduced.
•  Infra red light.
• You need to clean the episiotomy wound and apply antiseptic cream 2 – 3 times daily and every time after passing stools / urine. While cleaning or removing pads go from front to behind so as not to soil the area of wound with stools and germs.
• The stitches will usually fall off on their own within 8 – 10 days (some in 2 weeks) and need not be removed or cut.
• If you notice excessive swelling or if the pain has increased considerably or if you have difficulty in passing stools or urine, report to your doctor immediately so that he/she can have a look at the episiotomy wound. And find out what’s wrong.
• Lifting weights, straining, etc. will not put any pressures on the stitches and will not cause the stitches to give way. So don’t worry.

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