Birth

The second stage of labour is the pushing and birth phase of labour and covers the time and events from when your cervix is fully dilated, including any passive second stage where there is no pushing, until your baby is born. You can learn more about the stages of labour on the NHS website here or at one of our Free  or Paid Birth and Beyond Parent Education Courses .

Your midwife will continue to monitor your's and your baby's well-being, however the recommended frequency of the checks will increase.

Wherever possible your care providers will encourage you to follow your body and push when you have the urge. This spontaneous (natural) pushing is associated with improved blood flow to the uterus, less chance of becoming fatigued and reduced chance of significant perineal trauma (Learn more about 3rd or 4th degree tears in our Physical and Emotional Preparation for birth page ). Pushing this way can take some time. If it is your first baby (or vaginal birth) we expect the baby to be born within three hours of this kind of pushing, if you have birth before we expect the baby to be born within two hours.

If you have an Epidural and are fully dilated without a strong urge to push, and there are no well being concerns, you are likely to be advised to delay the onset for pushing for 1-2 hours (depending on birth experience)as this my shorten the second stage of labour. For people that have birthed before this passive second stage may reduce the likelihood of an assisted birth (Ventouse or Forceps).

Sometime staff direction and conscious effort is required i.e., if there isn’t an urge to push due to an epidural, or if the baby ‘s progress isn’t as expected. In this instance your midwife or doctor may provide verbal instructions and guidance. This is called directed pushing. For people experiencing their first vaginal birth with an Epidural, directed pushing rather than spontaneous pushing may reduce the likelihood of having an unplanned caesarean birth. Directed pushing requires more energy and is more forceful. If the baby is not born within an hour of directed pushing it is likely that your midwife will recommend an obstetric (maternity doctor) review.

Your Midwife will continue to encourage you to keep your bladder empty and support you to use positions you find comfortable. They will advise you to avoid lying flat on your back as this can lead to a decrease in your blood pressure and may reduce blood flow to the placenta/baby. Upright positions and keeping mobile may be beneficial for people without an Epidural as they are associated with reduce fetal heart rate abnormalities and episiotomy rates. Upright positions have also been found to improve your birthing experience.

Research suggests that lying on your side to may increase your chance of an unassisted birth if you have had an Epidural.

Just before your baby’s head is about to be born your doctor or midwife may encourage you to stop pushing and breathe out (like blowing out a candle) repeatedly to slow down the birth of the baby’s head and reduce your chance of having a significant tear. They may also provide a warm compress or hands on counter pressure to ease the birth of the head. Talk to your team midwife in pregnancy about the OASI bundle and the steps your Midwife can take to help reduce the likelihood of significant tears. You can also read more here .

This is sometime called a “normal” or "spontaneous" birth and  means that the mother/birthing person pushed their baby out without any help from instruments. Unassisted birth includes birth following an induction and those helped with directed pushing. Unassisted birth may occur on dry land or in water and includes both headfirst (Vertex) and bottom first (breech) vaginal births.

An Episiotomy is a cut to the perineum (the tissues between the vagina and anus) made by a doctor or midwife to make more space for the birth or to reduce the likelihood of more significant tears involving the anal sphincter muscles. The National Institute for Health and Care Excellence (NICE) recommend that an Episiotomy may needed if:

• The baby is in distress and needs to be born quickly
• There is a need for an assisted birth (Forceps or Ventouse)
• There is a risk of a tear to the anus

Before performing an Episiotomy, your midwife or doctor will gain your consent and ensure that you have adequate pain relief such as; topping up an existing Epidural with something stronger or by injecting local anaesthetic in to the area.