Labour is a beautiful, but challenging experience for many women. Find out how to prepare for this amazing journey.
2nd stage of labour-giving birth
The 2nd stage of labour lasts from when your cervix is fully dilated (10 cm) until the birth of your baby. When the cervix is fully dilated the baby’s head should be low, deep in the pelvis, and crowning. If the baby’s head is still high in the pelvis (despite full dilation) women should still labour and vertical positions should be encouraged. This will influence progression of labour. If you are active in the I stage, the baby moves down and that encourages dilation. Lack of labour progression is when woman worked very hard, tried different positions and did not succeed.
2nd stage stage can last from 5 minutes to 2 hours.
During the 2nd stage of labour:
- you will have strong contractions (pushing contractions)
- you will feel the urge to push (a bit like you need to poo)
- pushing contractions will appear every 1-2 minutes and can last from 80-120 seconds
- your midwife will guide you on how to use your breathing when you have a contraction. It is important to breathe out during the birth to protect your pelvic floor.
Positions for labour
Through movement we can influence pelvis movement therefore help the baby descend, rotate and progress in the birth canal. We know now that active labour provides better outcomes for mums and babies. Labouring position is often intuitive for women. Therefore, try not to memorize certain positions, but rather feel what position you want to get into. Often women start in vertical positions. As the labour progresses, mums often feel the need to lie down.
Positions:
- standing or leaning against a wall or chair (especially early on in labour-stage I), add a posterior pelvic tilt (tuck your tailbone in) on contraction to guide the baby down the pelvis
- sit on a ball – make sure not to bounce on the ball (it will make it more difficult for the baby to move down the pelvis), but rather try and gently do pelvic circles
- kneeling on all fours – it is a good position if you’ve had lots of backache
- squat – some research suggests that squatting with the knees apart might make you prone to pelvic floor tears (if you do want to squat, it is important that your heels are supported on the floor to promote pelvic floor relaxation)
- supported squatting (use a sturdy chair, a birth stool or squatting bar)
- side lying with a ball between your legs, with the top leg hanging off the bed or pulled up towards your shoulder
- supine position (lying on your back) – try and activate your tummy muscles during contractions and relax your jaw and shoulders
It’s a good idea to practice these positions beforehand, therefore linking with women`s health physiotherapist antenatally is really important.
Pushing during labour
This stage of labour is hard work. There are two ways to push during labour:
- Directed pushing means that your midwife gives you directions about when and how to push. Typically, you’re told to take a deep breath at the beginning of every contraction, hold it, then tighten your abdominal muscles and push down with as much force as possible for about 10 seconds. This is also known as the Valsalva method (it may feel like straining to have a bowel movement). Then you take a quick breath and push for another 10 seconds, aiming to get in three pushes during each contraction.
- Spontaneous (or physiological or mother-led) pushing means that you follow your body’s natural urge to push. Women tend not to take a deep breath beforehand, and they often exhale and strongly vocalise while pushing instead of holding their breath (think of athletes when they use they voice to hit a ball, they gather all the strength to send the ball as far as possible). When pushing try imaging your abdominal muscles wrap around your baby, contract and help to push baby down ( your tummy muscles contract while your pelvic floor muscles relax, try and observe yourself when you are sitting on the toilet to feel it). Mums who aren’t being coached generally let a contraction build before bearing down. Your body will help to guide your efforts.
If you have had an epidural, you may find it hard to feel an urge to push.
Pelvic floor and perineum
Pelvic floor and perineum preparation should start around the second trimester. There are many ways you can prepare your pelvic floor and perineum for labour:
- pelvic floor exercises (both contact and relax)- your pelvic floor muscle should be strong, but flexible
- pelvic floor relaxation and diaphragmatic breathing
- pelvic floor offloading throughout the day (positions such as legs up against a wall, on all fours, elbows/knees position, supported squat)
- pelvis mobility exercises
- perineum rolling/external massage – https://www.instagram.com/p/CZ60Ds7grJs/
- antenatal perineal massage from 34 weeks gestation (you can learn how to do it here https://mnaphysiotherapy.com/perineal-massage-in-pregnancy/.
During second stage of labour, women may feel burning or tearing sensation when the baby`s head is crowning. It is important that you continue to breathe and relax your pelvic floor (ideally, you should learn how to do it if you worked with women`s health physiotherapist antenatally). Warm perineal compress can also reduce perineal pain during birthing.
Women`s health physiotherapist can help you prepare for childbirth.
Not sure what to expect on the first visit to a women`s health physiotherapist? Click here: https://mnaphysiotherapy.com/what-happens-at-the-first-womens-health-physiotherapy-appointment/
