How will you know when to push and how long does the second stage of labour last? Here’s what you need to know about the stage when your baby will be born.
Second stage of labour: what is it?
The second stage of labour starts when your cervix is open (dilated) fully and ends when your baby is born (NICE, 2017; Hofmeyr and Singata-Madliki, 2020; Häggsgård et al, 2021).
There may be some time between when the cervix is open and when the pushing contractions begin, and this is known as the passive second stage of labour. Once the baby is visible and the pushing contractions begin, that is known as the active second stage of labour (NICE, 2017).
While most people feel the urge to push in the second stage of labour, not everyone experiences this. For some the first and second stages of labour may be a continuous, rather than a two-stage, process (Häggsgård et al, 2021).
For those who do notice a difference in the second stage of labour, it can feel intense and powerful, as you experience a strong pressure pushing the baby downwards. Some people find these contractions easier to cope with as they follow their body’s impulses. Others can feel overwhelmed and out of control as their body takes over (Häggsgård et al, 2021).
How long does the second stage of labour last?
Usually, your baby will be born within three hours of active pushing if it’s your first baby, and within two hours for second and subsequent births (NICE, 2017; Hofmeyr and Singata-Madliki, 2020). But it can be much quicker.
What can I do to make the second stage of labour easier?
Finding the right position in the second stage of labour may be beneficial and your midwife and birth partner can support you to move into the most comfortable position.
Getting into an upright or side-lying position could help to make the second stage of labour shorter and more comfortable (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020). These positions aid gravity, and mean your pelvis can be more flexible so movement will help your baby out.
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.
If you are experiencing back pain then a position that gets you on all fours, like using the birthing ball, can help with that (Hunter et al, 2007). Being in water can help, too.
In the end, follow your instincts and get in whatever position feels right for you, asking your midwife or birth partner to support you to move (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020).
It may help if the midwife and your birth partner offer physical support or positive updates about your baby’s progress during the pushing stage of labour. Feeling cared for is particularly important at this time (Häggsgård et al, 2021). Some women may like to be told what is happening, (Häggsgård et al, 2021) while some may not.
It could be a good idea to discuss beforehand how you think you’d like your birth partner to care for you and how much you’d like them to tell you about what they can see happening. Remember, however, that this might change in the moment, so acknowledge that possibility too.
When the time comes, you might want to reach down so you can feel your baby’s head. Some people find this boosts their energy levels and can make the birth seem more real (Häggsgård et al, 2021). If things are going slowly, you could ask to be supported to change positions or go to the toilet to create more space for the baby to be born (NICE, 2017).
You might have seen on TV or heard of midwives telling women when or how to push. But this is no longer done as it makes the pushing stage longer, more tiring and can make the experience feel more negative rather than listening to your own body (Prins et al, 2011; Ibrahim et al, 2017; Häggsgård et al, 2021). Instead, your midwife will encourage you to work with your body (Häggsgård et al, 2021).
What if I have an epidural?
If you’re experiencing the second stage of labour with an epidural, it may be harder to recognise the changing sensations. So this is when it might help to be guided by your midwife. Once the cervix is open, you could be encouraged to wait for an hour or until the baby’s head is visible before beginning to push (NICE, 2017).
You should be supported to find a position that is comfortable for you, such as lying on your side, or leaning over the end of the bed (NICE, 2017; Walker et al, 2018). For more about epidurals and their effect on labour, read our article.
The last push
As your baby’s head comes down ready to be born, you may experience a burning or stinging pain in the soft tissue between vagina and anus. You might have concerns about perineal tearing (Häggsgård et al, 2021).
At this point you can slow down your pushing efforts so that your baby’s head is born slowly. Your midwife may suggest gently blowing out (like cooling a hot drink) as this can protect the perineum and reduce the chance of tearing (Ibrahim et al, 2017).
Some midwives might use a warm compress on the perineum or support the baby’s head as they are born, but others will be more hands-off (NICE, 2017). Neither approach has been shown to be better, and you can say what your preference is. You may find it helpful to have a mirror to see what’s happening, as this can help you to feel more in control.
After your baby’s head comes out, there could be a pause between contractions before the shoulders are born. When they are fully born, you can then bring your baby to your chest or tummy for skin-to-skin contact, or ask the midwife to do that for you.
What can my birth partner do
Your birth partner might help with physical support or massage, encouragement, or just to sit quietly by if you prefer. They can also make sure your views are heard and acted upon (Bohren et al, 2017). Not to mention providing constant drinks and food when you need them to keep your strength up.
How can I prepare for the second stage of labour?
Some research has found that using breathing techniques involving deep breaths in and out can shorten the second stage of labour and reduce pain (Yuksel et al, 2017). You may wish to practise these techniques in advance.
Perineal massage in the last month of pregnancy can reduce the likelihood of tearing or needing an episiotomy (a cut made in the tissue between the vaginal opening and the anus during childbirth) (Beckman and Stock, 2013).
What if I still feel anxious about the second stage of labour?
Some people may feel particularly apprehensive about the second stage of labour, for example if you have had a previous difficult birth or have experienced sexual violence. Talk to your midwife about your concerns and they will give you information, options and support you in your decisions (NICE, 2017).
This page was last reviewed in September 2022.
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 M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available at: https://doi.org/10.1002/14651858.CD005123.pub3
Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M. (2019) Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis. BMC Pregnancy Childbirth. 19(1):466. Available at: https://doi.org/10.1186/s12884-019-2620-0
Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. (2017) Continuous support for women during childbirth. Cochrane Database Syst Rev. (7):CD003766. Available at: https://doi.org/10.1002/14651858.CD003766.pub6
Ibrahim H, Ghattas V, Abd H, Kandeel E. (2017) Effect of breathing technique (blowing) on the integrity of perineum and duration of the second stage of labor among primiparous women. World Journal of Nursing Sciences. 3(3). https://www.researchgate.net/publication/348610324_Effect_of_Breathing_Technique_Blowing_on_the_Integrity_of_Perineum_and_Duration_of_the_Second_Stage_of_Labor_among_Primiparous_Women
Häggsgård C, Nilsson C, Teleman P, Rubertsson C, Edqvist M. (2021) Women’s experiences of the second stage of labour. Women Birth. 35(5):e464-e470. Available at: https://doi.org/10.1016/j.wombi.2021.11.005
Hofmeyr G, Singata-Madliki M. (2020) The Second Stage of Labour. Best Practice Research Clinical Obstetrics Gynaecology. 67:53-64. Available at: https://doi.org/10.1016/j.bpobgyn.2020.03.012
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 at: https://doi.org/10.1002/14651858.CD001063.pub3
NICE. (2017) Intrapartum care: care of healthy women and their babies. Available from: https://www.nice.org.uk/guidance/cg190 [Accessed 6th August 2022]
Prins M, Boxem J, Lucas C, Hutton E. (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG. 118(6):662-670. Available at: https://doi.org/10.1111/j.1471-0528.2011.02910.x
Walker K, Kibuka M, Thornton J, Jones N. (2018) Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 11(11):CD008070. Available at: https://doi.org/10.1002/14651858.CD008070.pub4
Yuksel H, Cayir Y, Kosan Z, Tastan K. (2017) Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 15(6):456-461. Available at: https://doi.org/10.1016/S2095-4964(17)60368-6