Crowning in childbirth marks a significant milestone in the delivery process, signaling that the baby’s arrival is imminent. This moment occurs during the second stage of labor when the largest diameter of the baby’s head becomes visible at the vaginal opening and remains there. The head no longer slips back between contractions, confirming the progress made in pushing the baby through the birth canal.
The Physical Mechanics of Crowning
Crowning is the culmination of fetal movements necessary for navigating the maternal pelvis. Before crowning, the baby’s head, typically flexed with the chin tucked to the chest, must successfully complete engagement, descent, and rotation. The widest part of the baby’s head needs to pass through the narrowest parts of the bony pelvis.
The final descent positions the occiput, or the back of the baby’s skull, underneath the pubic arch. As the head begins to emerge, the tissue of the perineum—the area between the vagina and the anus—stretches maximally around the fetal head. This stretching prevents the head from retracting back into the vagina once the contraction subsides.
The Sensations Experienced During Crowning
The birthing person experiences intense sensations as the baby’s head reaches the point of crowning. A powerful feeling of pressure is commonly reported in the rectum and perineum, similar to an urgent need to have a bowel movement. This feeling is caused by the baby’s head pressing directly onto the pelvic floor muscles and the nerves surrounding the rectum.
This intense stretching of the perineal tissue gives rise to a sharp, stinging, or burning sensation often referred to as the “ring of fire.” This temporary feeling is a direct result of the skin and nerves being stretched to their maximum capacity. For those without an epidural, this sensation is most pronounced.
The burning feeling typically lasts only for a short time, often a minute or two, before the sensation shifts. As the baby’s head continues to press outward, the nerves in the stretched tissue can become temporarily compressed. This compression creates a localized numbing effect, providing a brief natural anesthesia as the head fully passes through the opening.
Managing Delivery and Perineal Support
Once crowning is achieved, the focus shifts to managing a controlled delivery to minimize the risk of severe perineal tearing. Birthing people are often instructed to stop pushing forcefully, instead utilizing short, gentle pushes or panting breaths to allow for a slow, gradual stretch of the tissue. This controlled expulsion of the head reduces the incidence of third and fourth-degree tears.
Non-Surgical Support
Medical providers use non-surgical interventions to support the perineum during this phase. Applying a warm compress to the perineal area is a common technique, as the heat can increase blood flow and help the tissues soften and relax, improving elasticity. Gentle manual support, sometimes called the “hands-on” method, may also be used to apply counter-pressure to the head, further controlling the rate of delivery.
Episiotomy
The practice of episiotomy, a surgical incision to widen the vaginal opening, is now much rarer than in previous decades. This procedure is generally reserved for situations where there is fetal distress or a high risk of severe tear, such as with an assisted delivery using forceps or a vacuum.