Second and Third Stages of Labor and Delivery

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Labor and Delivery: Second and Third Stages
Pushing
How will you know exactly how to push if you've never done it before? You can't really practice pushing until it's time to do so. Pushing requires the use of the entire body so being in good shape certainly helps.

When you've reached ten centimeters and complete effacement of the cervix, your doctor or delivery nurse will tell you it's time to push, but you may recognize this instinctually. Many women feel the urge to push when the time is right. There are a variety of positions which you can use to push, though most women will push reclining on their backs, in a semi-elevated head and shoulder position. Some will squat. Some will push up on all fours. Some hospitals even have water birthing suites where you can labor and do your pushing in a tub.

Pushing for counts of ten seconds, holding your breath, while your partner or birth coach helps you hold your legs may not sound that hard, but when you're doing it, it's hard work. Maybe the hardest you've ever done. You also have the greatest motivation of all time: meeting your little bundle of joy. That's sure to get you through.

Everyone in the room will be encouraging you, and that encouragement helps. Your doctors, nurses and loved ones will cheer you on. In the end, it's all about your accomplishment, your stamina, your amazing ability to bring your child into the world. You will push and push and push, maybe until you feel you can't push any more, but you will have the strength. You just will.

Crowning
When the top of baby's head is visible at the opening of the vagina, the term crowning is used. This is an exciting moment and means that you are minutes away from holding your baby. Earlier on, the nurses may have offered to place a mirror at the foot of the bed. This is a great time to use it. Even squeamish moms (who can only see this miraculous crowning with the assistance of a mirror) and dads (who don't need the mirror) are amazed by this first glimpse of baby.

Episiotomy/Tearing of the Perineum
When baby comes charging through, your body will do its best to expand enough for that head, for those shoulders. But how much stretching can one body do? Even babies on the small side sometimes leave their marks on mom's perineum, the muscle and tissue between the vagina and the rectum. Often, the perineum tears during delivery. It's uncomfortable, but it's common. Any tears must be sutured.

Your doctor may choose to do an episiotomy as a preventative measure. An episiotomy is the intentional cutting of the perineum. Episiotomy is done with surgical scissors . After baby and placenta are delivered, the perineum is closed with sutures which dissolve in a few weeks.

Some doctors perform what's called a perineal massage to stretch the perineal opening. This will help accommodate the baby's head and lessen the likelihood of tearing or the need for an episiotomy. Talk to your doctor about his or her views on episiotomy and perineal massage and which is preferred to avoid tearing.

Cutting the cord
Dad, labor coach, even some eager moms are given the opportunity to cut the umbilical cord, previously baby's life support line. Before the cord is cut, the baby is still attached to the placenta which, in turn, is still attached to the mother's uterus. The severing of the cord actually separates mother and baby for the first time. That makes it a very special moment, indeed.

Baby is examined
Procedures vary from practitioner to practitioner. Typically, I immediately place the baby on the mother's chest with the umbilical cord in tact. This way, mom can immediately comfort the newborn. Dad can cut the cord and a nurse dries and stimulates the baby to cry.

Mother holds the baby for a few minutes. Baby is then removed and brought to the warmer where a more complete assessment of health can be made.

Apgar scores are given at this point. Drops are placed in the baby's eyes and a shot of Vitamin K is administered. Hand and foot prints are taken for identification, at which point baby is wrapped warmly and returned to the loving arms of the mother. The whole process takes just minutes.

Delivering the placenta
Once baby's delivered, you may not realize that there's a bit more work to do. A few more pushes (maybe with a little help from the doctor) and the placenta is delivered.

Cesarean section
Sometimes baby and mother need some assistance. If baby is in distress or mom can not push baby out for any reason, doctors may perform a cesarean section. And today, many moms-to-be opt for an Elective Primary C-Section to make planning a whole lot easier.

Mother is taken to an operating room and prepped for the procedure. Dad will be allowed inside in time for the big event. Anesthesia is given, usually an epidural or spinal. In cases of extreme emergency, general anesthesia may be used, in which case Dad may not be in the delivery room.

Next, a sheet is draped over the expecting mother's body, with the abdomen exposed. A surgical incision is made and baby is pulled out through that incision. The mother may feel pressure and tugging, but should not feel any pain. The couple can watch the delivery via an overhead mirror. Once baby emerges from its former home in mom's uterus, care for the baby follows the same procedures listed above. The c-section incision is closed and mom is off to the recovery room to, well, recover. Many new moms simply fall asleep. When she awakens, she will be sore, but the excitement of bonding with baby is a powerful pain killer. Staples put in to close the cesarean site are removed after a few days. Recovery from c-section is no more difficult than from a vaginal delivery.