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DEFINITION :�It starts with the full dilatation of the cervix and ends with the expulsion of the fetus from the birth canal.��

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DURATION �On an average 50 mins in primigravidae and 20 minutes in multiparae.�It has two phases: �

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EVENTS IN THE SECOND STAGE OF LABOR

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Diagram showing the increased intra-abdominal pressure augments the downward expulsive force of uterine contraction.

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CLINICAL COURSE OF THE SECOND STAGE OF LABOR

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Pains

The intensity of pain increases. The pain comes at an interval of 2–3 minutes and last for about 1–1½ minutes.

Bearing Down Efforts

It is the additional voluntary expulsive effort that appear during the second stage of labor (expulsive phase). It is initiated by nerve reflex (Ferguson reflex) set up due to stretching of the vagina by the presenting part. In majority, this expulsive effort starts spontaneously with the full dilatation of the cervix. Along with uterine contraction, a woman is instructed to exert downward pressure as done during the straining of stool.

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Membrane Status

Membranes usually rupture with a gush of amniotic fluid per vagina. Sometimes the rupture may occasionally delay till the head bulges out of the introitus.

Descent of the Fetus

It is evident from the abdominal or vaginal examination

Abdominal Examination
Vaginal Examination

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Abdominal Examination

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Vaginal Examination

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Vaginal Signs

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Maternal Signs

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SECOND STAGE MANAGEMENT

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Signs of Imminent Labour �

Vulval gaping.
Thinned-out and bulging perineum.
Anal pouting.
Visibility of the baby’s head at the vulva.
Usually, the above signs of imminent delivery appear within two hours of full dilatation of the cervix in primigravidas and one hour in multigravidas.
Increase in intensity and frequency of contractions

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Intrapartum Monitoring

Intrapartum fetal monitoring means simply watching the fetal behaviour during labor.

Goals of intrapartum fetal monitoring are:

To detect hypoxia in labor.
To initiate management as appropriate.
Severe hypoxia in labor is associated with metabolic acidosis which can cause organ damage.

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Methods of Fetal Monitoring

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BIRTH POSITIONS OF CHOICE

A. Positions for labor

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B. Positions for birth

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CONDUCTION OF NORMAL BIRTH

1. Preparation for Delivery

Position for Delivery
Women on Epidural
Asepsis
Seven Cleans of a Birthing
Catheterization

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2. Delivery of the Head

Ritgen maneuver of delivery of the head

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3. Delivery of the Shoulders

A) Head is born by extension B) Head drops down with the face close to the anus C) Restitution D) External rotation

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Assisted delivery of the shoulders A) anterior shoulder B) posterior shoulder

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4. Delivery of the Trunk

After delivery of the shoulders, the forefinger of each hand is inserted under the axillae and the trunk is delivered by lateral flexion.

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Prevention of the Perineal Tear

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IMMEDIATE ASSESSMENT AND CARE OF NEWBORN

Deliver the Baby on a Warm and Clean Towel
Cord Clamping and Care
Establish and Maintain the Patent Airway
Ensure Warmth
Assessment and Documentation of Infant’s Condition (APGAR)
Care of Eyes
Care of Skin
Administration of Vitamin K
Identification of the Baby
Transfer

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Nursing Diagnosis

Acute pain related to the increasing frequency and intensity of contractions.
Risk for impaired urinary elimination related to sensory impairment secondary to labor.
Risk for ineffective individual coping related to birthing process.
Fatigue related to energy expenditure during labor and birth.
Risk for deficient fluid volume related to decreased fluid intake and increased fluid loss during labor or birth.

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