The second stage of labor is the final stage of childbirth, when the baby moves from the uterus through the birth canal and is born. This stage begins once the cervix is fully dilated to 10 centimeters. While the uterus contracts to move the baby downward, the mother’s active participation through pushing propels the baby out. Understanding the mechanics of this phase can replace anxiety with a grounded sense of partnership with the body.
Recognizing the Signs of the Second Stage
The transition into the second stage is often accompanied by a profound shift in physical sensation. As the baby’s head descends deep into the pelvis, it places intense pressure on the pelvic floor and rectum. This pressure creates a powerful, involuntary urge to bear down, often compared to the feeling of needing a large bowel movement.
This reflexive sensation is sometimes referred to as the Fetal Ejection Reflex. The pressure triggers a release of oxytocin, which intensifies contractions and causes the body to spontaneously push. Medical staff confirm that the cervix has completely effaced and dilated to 10 centimeters before active, coached pushing officially begins. However, these internal signals often precede formal confirmation, indicating the expulsive phase has started.
Techniques for Effective Pushing
The mechanical act of pushing can be approached in two primary ways: physiological or directed. Physiological pushing, also called spontaneous pushing, means the laboring person follows their body’s innate urge. During a contraction, they take several breaths and push a few times, listening to natural cues. This technique honors the body’s rhythm, allowing oxygen to reach both the mother and baby more consistently.
In contrast, directed or coached pushing is frequently employed in hospital settings, especially when an epidural has dulled the natural urge. This method uses the Valsalva maneuver: taking a deep breath and holding it while bearing down forcefully, usually for a count of ten. This is typically repeated two or three times during a contraction, with coaching. While effective when the natural urge is absent, prolonged breath-holding may carry risks.
The most effective approach often blends these techniques, focusing on the quality of the effort. Pushing is a powerful abdominal muscle effort, similar to a deep, sustained grunt, directed downward toward the pelvis. Consciously relaxing the pelvic floor muscles is equally important, as pushing against a tightened floor is counterproductive. The goal is to utilize the diaphragm and abdominal muscles to generate downward force, moving the baby through the birth canal.
Optimizing the Pushing Experience Positions and Environment
The position chosen for pushing significantly affects the process’s efficiency and comfort. Upright positions, such as squatting, kneeling, or sitting on a birthing stool, use gravity to help the baby descend. Squatting, in particular, can increase the diameter of the pelvic outlet by up to 30%, creating more space for the baby’s passage.
Other positions offer specific benefits. Side-lying is helpful for resting between contractions and may reduce the risk of severe perineal tearing. The hands-and-knees position is often recommended to relieve intense back pressure, especially if the baby is positioned “sunny-side up” (occiput posterior). Semi-reclined positions are common in hospital beds, but they can work against gravity and may not be the most mechanically efficient choice.
Creating a supportive environment also optimizes the pushing experience. A calm, private, and dimly lit setting helps the laboring person focus inward and connect with their instinctual process. Minimizing distractions and receiving supportive coaching encourages the natural flow of the expulsive phase. Changing positions every few contractions can also help the baby navigate the curves of the pelvis most effectively.
The Immediate Aftermath of Delivery
As the baby’s head stretches the perineum—the tissue between the vagina and the rectum—mothers often experience a burning or stinging sensation. This intense feeling, commonly referred to as the “ring of fire,” signals that the baby is crowning and the final moments of pushing are at hand. Providers often ask for small, gentle pushes or panting during this time to control the delivery and minimize tearing.
Once the baby is delivered, the third stage of labor immediately follows: the delivery of the placenta. This usually occurs within five to thirty minutes. Uterine contractions resume to separate the placenta from the uterine wall, and a final, gentle push is typically needed for its expulsion. Immediate skin-to-skin contact with the newborn is encouraged. This helps regulate the baby’s temperature and heart rate while triggering oxytocin release, which aids uterine contraction and manages blood loss.