The second stage of labor begins when the cervix reaches complete dilatation and effacement and ends with the birth of the baby. Now, the contractions are more like those experienced during the early stages of labor and last about 60 to 75 seconds, about three to five minutes apart. This second stage of labor may last from 10 minutes to two hours -- usually less if she's carrying two or more babies.
At this stage of labor, her mood will probably improve. The patient feels more sociable and talkative and more positive about what she's already achieved and, of course, the birth of her baby. If she's been blowing to combat a premature urge to push, she'll feel the relief of finally being able to work with the contractions. Many women feel an incredible sense of satisfaction and joy as they work hard to push the baby down the birth canal. As her baby descends the birth canal, the patient may notice increased show or discharge, a burning sensation or leg cramps. Moreover, her face may be red and the patient may have a look of intense concentration as she works with the contraction.

While some women experience some pain or discomfort during pushing, it's usually connected with the position of the baby, a large baby, or a pelvic floor that's unrelaxed. The patient may also feel the strong need to have a bowel movement, mostly because her baby's head is pressing against the bowel. Instead of tensing up, relax her bottom. If the patient relaxes her jaw, she'll discover that her pelvic floor also relaxes.

The patient may also feel pressure or burning as the baby nears the perineum. The patient may notice the baby's head--wrinkled and covered with wet hair-- during a contraction . The head will recede during contractions until the top of the baby's head is visible between contractions. This is known as crowning and signals that the head will soon be out. It will then rotate with the face looking toward her thigh. After the healer delivers the shoulders, the baby slides out followed by a large gush of fluid. Once her baby's shoulders are free, the patient or her partner or the healer can reach down and pull the baby onto her stomach.

During this phase, make sure the partner puts the patient in a comfortable pushing position. If she's holding her breath while pushing, make sure he counts for her. Ask him to check her jaw to make sure it's relaxed.

Pushing Positions
The position the patient chooses for pushing will depend on her personal preferences and, of course, the preferences of the healer. While most future mothers choose among squatting, semi-reclining, side-lying, or kneeling on their hands and knees, many healers prefer the semi-reclining position. The healer should discuss all the positions with the patient and have her practice pushing in each position so she will have a sense of what might feel more comfortable during labor. Among her options:

Squatting
Side-lying
Kneeling
Squatting

Squatting is probably the best position to use while pushing. If the patient keeps her feet flat on the floor, she can support herself in a squat by holding onto the handrail or her partner. Ask her partner to sit on a chair. Have her squat between his legs, placing her arms over his thighs. Because some women aren't comfortable in the squat position, the patient may want to use the modified squat position. If the patient uses this position, her uterus will get a boost from gravity and make her contractions more efficient, frequent, and longer. To practice this position, her partner should sit or kneel behind the patient and offer back support. The patient can get more comfortable by placing pillows between her partner's legs and her back.

Side-Lying Position: This is a very comfortable position for most women who might have back labor or leg cramps. If her baby isn't already in a face down position, it can also help in rotating the baby. However, there are drawbacks. The patient won't benefit from the force of gravity and her view of the birth might not be as good.

Kneeling: This position is preferred by some women because it takes advantage of gravity, helps when the baby is slow coming down the birth canal, and alleviates back labor. When the patient pushes, tilt her head so that it actually feels as if she's looking for the baby. Then, have her do the following:

Kneel on the bed facing her partner.
Put her arms around her partner's shoulders.
Push or lean up against the raised head of the birthing bed for support.

As an alternative the patient may want to try getting on her hands and knees. If the patient uses this position, the patient can arch her back or rock back and forth doing a pelvic rock. Women whose babies are in a posterior position, where the baby's head is against the mother's spine, often like this position.


THIRD STAGE


The shortest stage of labor lasts no more than five to 20 minutes. Following the birth of the baby, the uterus will begin to contract -- although certainly not as intensely as during labor contractions. The healer may ask the patient to push out the placenta or use pressure to deliver it. Once the placenta is delivered, the healer will examine it to see if it's intact. In some cases, the healer may do an internal exam of the uterus to see that it hasn't retained any placenta.



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