| STAGES OF LABOUR
second stage
Feeling | What does
your doctor do | Do's and Don'ts |
Episiotomy.
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 2nd 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 2nd 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 1st 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. Link to
Forceps and Vacuum delivery.
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 Link
to Eprisiotomy in Delivery may be given if necessary
after giving adequate pain relief.link to episiotomy in delivery.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. Link to care
of new born 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. Link to Breast-feeding. 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 and Don’ts: (2ND STAGE)
During the 1st stage your have not been an
active performer. Now in the 2nd stage of labour active pushing effects are
needed from you so that the baby can be delivered easily.
Get into a comfortable pushing position as allowed by
your doctor.
Push only when you have contractions or when your
doctor tells you to.
Relax
and take deep breaths in between contractions. Relax not just your buttocks, thighs and
perineum but your entire body. This will help to reduce fatigue or exhaustion.
While you are pushing, some amount of stools and urine
is bound to be expelled. Don’t be embarrassed and let this inhibit you. This HAPPENS
TO EVERYONE and is NORMAL. The doctor and nurse are used to this and it will be quite
nonchalantly cleaned.
While pushing try to maintain the push for as long as
possible. Pushing is done in a manner similar (but more strongly) to when you are
constipated and trying to pass stools. If you can not hold your breath and maintain the
push for the entire duration of contration, don’t despair. Just try your level best
and follow your own urges to push, give it all that you’ve got. Think about your baby
and like “NIKE” says “JUST DO IT!” If it is allowed by your hospital and
doctor’s policy, ask your husband or labour partner (mother, sister, close friend,
etc.) to be present with you in the delivery room .In all the hospitals, they can be with
you in the first stage of labour
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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 1st 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 2nd stage of labour. Link to 2nd
stage of labour in Delivery.
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.: 3rd stage of
labour. Link to 3rd stage in Delivery.
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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