How will you know when to push and how long will this part of labour last? Here’s what you need to know about the second stage of labour, AKA the one when your baby will come into the world…
Second stage of labour: what is it?
The second stage of labour starts when your cervix is open (dilated) 10cm and ends when your baby is born.
"Not all women feel the urge to push straight away in the second stage so it’s divided into passive and active stages (NICE, 2017)."
During the passive part you might get chance to have a welcome breather and be able to rest and prep for the tougher bit (RCOG, 2012a). Try resting and breathing in a relaxed way in between contractions to save your energy.
It's best to wait for the active phase to begin before you try to push. If you don’t, you probably won’t be able to move your baby down much and that will mean you’ll be exhausted before the active phase kicks in (Downe and Marshall, 2014).
When to start pushing in labour
During the active part of the second stage, you’ll feel this uncontrollable instinct to push with most of your contractions. But only push when you feel an uncontrollable urge to do so (Downe and Marshall, 2014).
Most women will give birth within three hours of active pushing with their first baby and two for later births. Sometimes though, it can be all over in a few minutes (NICE, 2017). And if it does take longer, there’s no harm for your baby (Enkin, 2002). So there’s no need for midwives to intervene, as long as you’re coping (RCM, 2012a).
Best birth positions
Positions can make a crucial difference in labour.
Getting into an upright position could help to make your second stage shorter and more comfortable (Gupta et al, 2012; RCM, 2012a). It gives gravity and movement a chance to help your baby out (RCM 2012a; Simpkin and Anchetta, 2012; NICE, 2017). You’re also less likely to need forceps, ventouse or an episiotomy if you stay upright and keep moving, although you might lose a bit more blood (Gupta et al, 2012).
Examples of upright positions include:
- squatting (either independently or using a hammock, rope or bar to dangle from)
- using a birthing stool
- leaning over a birthing ball.
You might get some back pain during the second stage. So any position that gets you on all fours, like the birthing ball, can help with that too (Hunter et al, 2007).
But in the end, follow your instincts and get in whatever position feels right for you (Simpkin and Ancheta, 2011). Your midwife should help you do that too.
It can also help if the midwife or your birth partner offers physical support or positive updates about your baby’s progress. You might even want to reach down so you can feel your baby’s head.
You might have heard of midwives telling women when or how to push. But this is no longer done in the second stage as it can cause issues (Cooke, 2010; Prins et al, 2011). Instead, your midwife will encourage you to follow your instincts (RCM, 2012a).
The last push
As your baby’s head comes down ready to be born, you’ll feel a stinging sensation that’s known as crowning (Capogna et al, 2010).
At this point it’s a good idea to slow down your pushing efforts so that your baby’s head can come through slowly. Midwives often suggest taking small ‘puff, puff’ breaths to lesson the urge to push.
Doing this can protect the perineum too, which means that you’ll be less likely to need stitches (Downe and Marshall, 2010). Perineal massage in pregnancy can reduce the likelihood of third and fourth degree tears too (Beckmann and Stock, 2013; RCM, 2012b).
Some midwives might use a warm compress on the perineum or support the babies head as it’s born but others will be more hands-off (NICE, 2017). Neither approach is better, it’s just the midwife’s personal style (RCM, 2012b).
After your baby’s head comes out, there will then be a pause between contractions before the shoulders are born. The baby can then be placed on your chest or tummy for skin-to-skin contact (Downe and Marshall, 2014). Soon they’ll have their first feed.
What your birth partner can do during the second stage
Your birth partner’s role in the second stage is a crucial one. Someone to support you can make it more likely that your baby will be born vaginally and without forceps or ventouse (Bohren et al, 2017).
Your birth partner might also help with physical support (and no complaining that your arms are sore, birth partners) or just to encourage you. They can also make sure your views are heard and acted upon or give you a lovely massage, if you fancy it. Not to mention providing constant drinks and food when you need them to keep your strength up (Bohren et al, 2017).
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.
You will also find useful information on NHS Choices here.
Beckmann MM, Stock OM. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev.(4):CD005123. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005123.pub3… [Accessed 13th August 2018]
Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. (2017) Continuous support for women during childbirth. Cochrane Database Syst Rev.(7):CD003766. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6… [Accessed 13th August 2018]
Capogna G, Camorcia M, Stirparo S, et al. (2010) Multidimensional evaluation of pain during early and late labor: a comparison of nulliparous and multiparous women. Int J Obstet Anesthesia. 19(2):167-70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20219349 [Accessed 13th August 2018]
Downe S, Marshall JE. (2014) Physiology and care during the transition and the second stage phases of labour. Marshall JE, Raynor MD. eds. Myles Textbook for Midwives. 16th ed. Churchill Livingstone, Edinburgh: 367-93.
Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev.(4):CD001063. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001063.pub3/full [Accessed 13th August 2018]
NICE. (2017) Intrapartum care: care of healthy women and their babies. Available from: https://www.nice.org.uk/guidance/cg190 [Accessed 13th August 2018]
Prins M, Boxem J, Lucas C, et al. (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials British Journal of Obstetrics and Gynaecology. 118:662-670 Available from: https://www.ncbi.nlm.nih.gov/pubmed/21392242 [Accessed 13th August 2018]
RCM. (2012a) Second stage of labour. Royal College of Midwives, Evidence-based guidelines for midwifery-led care in labour. Available from: www.rcm.org.uk [Accessed 13th August 2018]
RCM. (2012b) Care of the perineum. Royal College of Midwives, Evidence-based guidelines for midwifery-led care in labour. Available from: www.rcm.org.uk [Accessed 13th August 2018]
Cooke A. (2010) When will we change practice and stop directing pushing in labour? British Journal of Midwifery 18(2):77-81. Available from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2010.18.2.46403 [Accessed 13th August 2018]
Enkin M, Keirse MJNC, Neilson J et al. (2000) A guide to effective care in pregnancy and childbirth. Oxford University Press, Oxford. [Accessed 13th August 2018]
Simkin P, Ancheta R. (2011) The labor progress handbook: early interventions to prevent and treat dystocia. 3rd ed. Chichester: Wiley Blackwell. [Accessed 13th August 2018]