SECOND STAGE OF LABOR

o Is the period from full dilatation and cervical effacement to birth of the
infant

o With uncomplicated birth, this stage takes about 1-2 hours (Cheng at
al.,2004)

o Contractions change from the characteristic crescendo-decrescendo

pattern to an overwhelming, uncontrollable urge to push or bear down
with each contraction as if to move her bowels.

o A woman may experience momentary nausea or vomiting because

pressure is no longer exerted on her stomach as the fetus descends in
the pelvis. She pushes with such force that she perspires and the blood
vessels in her neck may become distended.

As the fetal head touches the internal side of the perineum:

 Perineum begins to bulge

 Appears tense

 Anus may become averted and stool may be expelled

As fetal head pushes against the perineum:

 Vaginal introitus opens

 Fetal scalp appears at the opening to the vagina.

Vagina: at first, the opening is slitlike, then becomes oval, and then circular .

Crowning – the circle enlarges from the size of a dime, then a quarter, then a
half-dollar.

CARE OF A WOMAN DURING THE SECOND STAGE OF LABOR

The second stage of labor is the time from full dilatation to birth of the
newborn. Even women who have taken childbirth education classes are
surprised at the intensity of the contractions in this phase of labor. Because
the feeling to push is so strong, some women react to this change in
contractions by growing increasingly argumentative and angry, or by crying
and screaming. Other women react by tensing their abdominal muscles and
trying to resist, making the sensation even more painful and frightening.

Assess fetal heart sounds at the beginning of the second stage of labor
to be certain that the start of the baby’s passage in the birth canal is not
occluding the cord and interfering with fetal circulation.

Perineal Cleaning

- Clean the perineum with a warm antiseptic (cold solution causes

cramping)
 - Rinse it with a designated solution before birth, according to the policy
of the physician, nurse-midwife, or agency.

- Always clean from the outward (so that microorganisms are moved
away from the vagina, not toward it)

- Using a clean compress for each stroke.

- Be sure and include a wide area (vulva, upper inner thighs, pubis, and
anus)

- After cleaning, help place sterile drapes around the perineum.

Commonly used DR instruments:

 1 bandage scissors- Used in episiotomy, to cut through custom fit

bandages, to cut through medical gauze, to cut through bandages already in
place.

 2 peans – used to clamp umbilical cord

 1 suture scissors – specifically designed to remove sutures through the

design of the tip.

 1 needle holder - A forceps used to hold and pass the needle through the tissue while
suturing with a suture forceps.

 1 tissue forcep - A thumb forceps; an instrument with one or more fine teeth at the tip of
each blade for controlling tissues during surgery, especially during suturing.

Cardinal Movements:

o Descent

o Flexion

o Internal rotation

o Extension

o External rotation

o Expulsion

Episiotomy

- Is a surgical incision of the perineum that is made both to prevent

tearing of the perineum and to release pressure on the fetal head with
birth.
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 Midline episiotomy – episiotomy incision is made with blunt-tipped

scissors in the midline of the perineum

- increases risk for tears into or through the anal muscle

- appear to heal more easily

- cause less blood loss

- result in less postpartal discomfort.

 Mediolateral episiotomy- is begun in the midline but laterally away

from the rectum.

- mediolateral episiotomies have the advantage

over midline cuts in that, if tearing occurs beyond the
incision, it will be away from the rectum, creating
less danger of complication from rectal mucosa
tears.

Advantage of Episiotomy :

 Substitutes a clean cut for a ragged tear

 Minimizes pressure on the fetal head

 May shorten the last portion of the second stage of labor.

Nursing management:

o Try several positions (squatting, lying on your side with your leg up or resting
on your hands and knees).

o Take deep breaths in and out before and after contractions.