normal labor: the second stage - glowm · summary of normal second stage of labor it should not...
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Mother Initiative Tutorial
Normal labor: The second stage
Alison James Midwifery Lecturer Margaret Fisher Associate Professor in Midwifery
Plymouth University and The Royal College of Midwives,
United Kingdom
This tutorial is designed to re-inforce previous training – and should,
therefore, not be regared as sufficient guidance by itself 1
This tutorial tells you what happens in the second stage of labor
it follows on directly from the tutorial on the first stage of labor
The second stage of labor
starts from when the cervix
(neck of the womb) has dilated
to 10cm
The second stage of labor
finishes when the baby
is born
2
Signs that the second stage of labor has begun include:
The woman’s contractions are expulsive (strong), may occur less often and may last longer
The woman is likely to feel an urge to push as the fetus descends onto the pelvic floor
A heavy blood-stained mucus vaginal discharge (show) may be seen
There may be external signs including swollen vulva and anal dilation
The presenting part may be visible (head if cephalic, bottom if breech)
Strong contractions
Urge to push
Discharge
External signs
Top of head
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The sequence of events in the second stage of labor
The presenting part (head or
breech) descends into the
pelvis
If everything progresses
normally, passive movements
by the fetus through the birth
canal lead to the ‘mechanism
of labor’
Every presentation or fetal position which can
deliver vaginally has a mechanism of labour.
This tutorial will only explain what
happens in a normal vertex presentation.
See tutorials on ‘Breech delivery’ and
‘Malpositions’for other births.
Mechanism of
labor
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The Mechanism of Labor (1) in the case of normal vertex presentation
There is descent of the fetus
The head, neck and spine flex
(bend forwards)
The fetus rotates (turns) to fit into
the widest part of the mother’s
pelvis
The head is born under the pubic
arch (crowning) and the neck
extends, with the brow, face and
chin being born
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The Mechanism of Labor (2) in the case of normal vertex presentation
The head untwists itself on the
neck (restitution)
The shoulders turn to fit into the
widest part of the mother’s pelvis
(internal rotation) and the head
rotates externally
The shoulders, trunk and limbs
are born by lateral flexion
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What should you see if the second stage of labor is progressing normally?
The mother should continue to
have expulsive contractions
and push with each of these
The presenting part should
advance steadily until the
baby is born
The length of the second stage
may vary from woman to
woman, but should not last
longer than about 2 hours.
It may be very quick if it is her
second or more baby
Strong contractions
Urge to
push
Fetal descent
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What should the midwife do to care for the woman in the second stage of labor?
Continue to care for the woman’s
comfort and support (see tutorial
‘Normal labour: First stage’)
Check that the woman and the
fetus are well– this includes
checking her pulse, blood
pressure and the fetal heart
rate which should be listened to
every 5 minutes or after every
contraction. It may slow down
slightly while she is pushing but
should recover to 110-160 beats
per minute between contractions
Comfort Pulse
Blood pressure
Fetal heart rate
8
What preparations should the midwife make for the birth?
Make sure the area is safe and
warm for the baby to be born
Keep everything as clean as
possible to prevent infection
Make sure there is enough light
for you to see what you are doing
Make sure equipment is
available. This could include:
towels, warm water, gloves,
swabs, cord clamp or tie, cord
scissors, syringe, needle,
oxytocic (such as syntocinon,
syntometrine, ergometrine),
ambubag and mask for
resuscitation of baby, clock
Safe Clean
Light Equipment
9
What care should be given when the baby is born?
If labor progresses normally the
baby should deliver itself.
Support the head and body as
the baby is born
Check that the baby is
breathing and its colour is
becoming normal
Dry the baby and place it on
the mother’s abdomen against
her skin to keep it warm (skin
to skin contact)
10
Delivery of the placenta
If the placenta delivers naturally
(physiological third stage) the
cord does not need to be tied
off until it has come out of the
vulva and stopped pulsating.
Keep the cord clean and do not
apply anything to it
See tutorial ‘Normal labour: The third
stage’ for information about how to
deliver the placenta.
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PROBLEMS (1) The mother may need to be taken to medical assistance
if you identify any problems. These can include:
The fetal heart rate becomes
very fast (more than160bpm)*
or slow (below 100bpm)*
The liquor (fluid from around
the fetus) is green (meconium-
stained) or pink/ red (blood-
stained) or clots are passed
The second stage goes on
too long and an assisted
delivery may be needed (see
tutorials on ‘Vacuum and
forceps deliveries’) [insert link]
160
100
* bpm = beats per minute
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Problems to look for (2)
The presenting part is
not the crown of the
head (vertex), face or
breech (bottom). The
baby may not be able
to be born safely
vaginally, and if this is
the case the woman
needs to be taken to
medical assistance
urgently
With transverse lie the
baby cannot be born
vaginally and urgent
medical assistance
must be sought 13
Problems to look for (3)
Female Genital
Mutilation (FGM)
If the woman has had
FGM you may need to
perform an anterior
episiotomy to give
enough space for the
baby to be born
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Problems to look for (4)
The baby does not breathe
or the heart rate is below 100
beats per minute (see tutorial
on ‘Neonatal resuscitation’)
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Summary of normal second stage of labor
It should not last more than about
2 hours for the first baby, and
1 hour for the second or more
Progress should be seen – the
presenting part should descend
and you should be able to see
signs of the mechanism of labour
The only vaginal loss should be
clear liquor or a mucus ‘show’
The mother and fetus should
remain well
Subsequent
births
First
birth
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The third stage of labor now begins
Third stage of labor
Starts from when the baby
is born
Finishes when the placenta
(afterbirth) has come away
from the mother, and when
her bleeding stops
See the tutorial on ‘Normal labor:
The third stage – physiological and
active management’ for more
information
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