Available from: www.rcm.org.uk [Accessed 13th August 2018], Cooke A. In the absence thereof, there should be a written document enabling the care provider to intervene appropriately and definition of the circumstances under which this can be done. These cookies will be stored in your browser only with your consent. Royal College of Midwives, Evidence-based guidelines for midwifery-led care in labour.

The Journal of Maternal-Fetal & Neonatal Medicine. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. (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. Contractions push the baby down the birth canal, and you may feel intense pressure, similar … [Accessed 13th August 2018]. You will also find useful information on NHS Choices here. The second stage of labour starts when your cervix is open (dilated) 10cm and ends when your baby is born. Health system planning requires consideration of the resources needed for acquisition and maintenance of clinical skills for conduct of deliveries. Here’s what you need to know about the stage when your baby will be born Second stage of labour: what is it? Sometimes though, it can be all over in a few minutes (NICE, 2017). The baby can then be placed on your chest or tummy for skin-to-skin contact (Downe and Marshall, 2014). Important potential complications arising in the second stage of labor are fetal hypoxia and acidemia leading to “birth asphyxia,” failure of the presenting part to rotate or descend appropriately leading to obstructed labor, and worsening or new manifestations of maternal hypertension leading to eclampsia. Getting into an upright position could help to make your second stage shorter and more comfortable (Gupta et al, 2012; RCM, 2012a). Local anesthetic should always be given for any episiotomy, episiotomy/laceration repair, or forceps delivery. The care provider should have the skills to interpret the fetal heart rate and take appropriate action when needed. Handheld vacuum devices such as the Kiwi OmniCup have become popular as these are easy to use, with the attendant able to control the suction. Provision of critical skills for second stage management needs to be supported by policies as well as training, simulations (drills), and linkage with a functioning referral system. As transfer to another facility during the second stage of labor is very problematic and is likely to be associated with poor outcomes because of the additional delay, every effort should be made to provide the assisted vaginal delivery component of Basic Emergency Obstetric Care so that delivery can be effected at health center level without the need for transfer. If the conditions deviate from normal, options for immediate intervention or referral depending on the care setting should be defined clearly in protocols and guidelines to allow timely access to emergency obstetric and neonatal care. Monitoring of the fetal heart beat must be continued during the second stage to allow early detection of bradycardia. Encourage active pushing once the urge to bear down is present, with encouragement to adopt any position for pushing preferred by the woman, except lying supine which risks aortocaval compression and reduced uteroplacental perfusion. These cookies do not store any personal information. 3).

The first stage is the longest part of labor and can last up to 20 hours.

During the second stage, delaying pushing for 1–2 hours or until the woman has a strong urge to push reduces the need for rotational and midcavity interventions [4]. Global recommendations and guidelines, Impact of pain level on second‐stage delivery outcomes among women with epidural analgesia: results from the PEOPLE study, Outcomes of routine episiotomy: a systematic review, The cost‐effectiveness of routine versus restrictive episiotomy in Argentina, A comparison between midline and mediolateral episiotomies, Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy, Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery, Waterbirths compared with landbirths: an observational study of nine years, Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand, National Institute for Health and Clinical Excellence, Intrapartum Care. 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. There is no evidence that a policy of routine episiotomy resulted in significant reductions in laceration severity, pain, or pelvic organ prolapse compared with a policy of restricted use [19].

Donate To Make Motherhood a Healthy Reality. Management of the passive phase of the second stage of labor in nulliparous women - focus group discussions with Swedish midwives. We also use third-party cookies that help us analyze and understand how you use this website. What are the health benefits for mothers and infants of an appropriate women‐centered package of second stage care? While you are experiencing labor, your baby is taking certain steps to enter this world. For example, surveys in health facilities in southern Tanzania showed limited use of blood pressure checking but frequent use of auscultation of the fetal heart during labor. The frequency of fetal heart auscultation should be every 5–10 minutes or more often when bradycardia is suspected.

Beckmann MM, Stock OM. William’s Obstetrics Twenty-Second Ed. Pregnancy, Childbirth and the Newborn: The Complete Guide. It may be used by any trained healthcare provider. Special consideration is needed for culturally based birth preferences, especially where these are unusual or a minority within a particular healthcare setting. And if it does take longer, there’s no harm for your baby (Enkin, 2002). Not to mention providing constant drinks and food when you need them to keep your strength up (Bohren et al, 2017). Clinical interventions during the second stage of labor should not be offered or advised where labor is progressing normally and the woman and baby are well, and should only be initiated when the appropriately trained staff and equipment are in place [26].

Update on Maternal Mortality in the Developed World, https://doi.org/10.1016/j.ijgo.2012.08.002, http://whqlibdoc.who.int/publications/2004/9241591692.pdf, http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf, http://www.who.int/healthsystems/TTR‐TaskShifting.pdf, http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf, http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf, http://www.childinfo.org/files/maternal_mortality_finalgui.pdf. Second stage: from full dilatation of the cervix up to the birth of the singleton baby or the last baby in a multiple pregnancy. In conclusion, planning and management of health facilities offering maternity care should always include participation from community members, who can help to guide health professionals toward meeting cultural and social expectations and needs during labor and delivery, and thus contribute to maximizing utilization and quality of care. Doing this can protect the perineum too, which means that you’ll be less likely to need stitches (Downe and Marshall, 2010). But in the end, follow your instincts and get in whatever position feels right for you (Simpkin and Ancheta, 2011). The practice of “double episiotomy” is damaging and should be avoided. Use of upright or lateral positions during delivery compared with supine or lithotomy (18 trials; n = 5506; RR 0.84, 95% CI, 0.73–0.98) [10]. So there’s no need for midwives to intervene, as long as you’re coping (RCM, 2012a). 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). A joint statement by WHO, ICM and FIGO, Best practices in second stage labor care: maternal bearing down and positioning, A randomized trial of coached versus uncoached maternal pushing during the second stage of labor, Delayed pushing in labour reduced the rate of difficult deliveries in nulliparous women with epidural analgesia: intrapartum care costs more with a policy of delayed pushing during labour in nulliparous women with epidural analgesia, When to stop pushing: effects of duration of second‐stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia, Second‐stage labor management: Promotion of evidence‐based practice and a collaborative approach to patient care, Position for women during second stage of labour, Managing complications in pregnancy and childbirth. As with all aspects of maternity care in accordance with a rights‐based approach, the individual needs of the woman and her companion during the second stage of labor should be taken into consideration, tailoring care to an individual's needs while offering the highest quality, evidence‐based care. and you may need to create a new Wiley Online Library account. A guide for midwives and doctors, Continuous support for women during childbirth, The disappearing art of instrumental delivery: time to reverse the trend, Reducing stillbirths: interventions during labour, Is vacuum extraction still known, taught and practiced?

Local anesthesia should be used for perineal infiltration prior to cutting an episiotomy, and the practice of cutting an incision without anesthesia is to be deprecated.

We'll only contact you in the ways you want, and we'll keep your data safe. Continuous support for women during childbirth by one‐to‐one birth attendants especially when the care provider is not a member of staff (14 trials; n = 12 757; RR 0.89, 95% CI, 0.83–0.96) [12]. Second stage: Pushing.


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