Changes in Second Stage of Labor

Subject: Midwifery II (Theory)

Overview

The second stage of labor is marked by different types of contractions than the first, including complete cervical dilation, membrane rupture, and the release of a sizable amount of liquid amni. Fundal pressure is administered to the highest part of the uterus during the second stage of labor in an effort to promote spontaneous vaginal birth and prevent a lengthy second stage or the requirement for surgical delivery. The widest diameter of the skull has lowered below the level of the pelvic inlet at the beginning of the normal second stage, where the head is fully engaged in the pelvis. The full ejection of the baby proves that the procedure was successful.

Increase Uterine Contraction

As the cervix fully dilates, the membranes rupture, and a significant amount of liquid amni escapes, the second stage of labor's contractions are different from those in the first stage. The uterine cavity's volume decreases as a result. Concurrently, uterine contractions and retraction intensify and lengthen but become less frequent, occurring every two minutes and lasting one second. This allows for regular recovery times for both mother and fetus. The firm, rounded fetal head can be placed directly into the vaginal tissues due to the liquid drainage.

Pressure like this encourages distention. Increased head flexion brought on by fetal axis pressure leads to smaller presenting diameters, quicker development, and less strain on the mother and fetus. The proportion of moms who are standing up is at its best at this period. The contraction changes from constrictory to expulsive as the fetus moves deeper into the vagina. The Ferguson reflex occurs when pressure from the presenting part stimulates nerve receptors in the pelvic floor, giving the woman the urge to push. This reflex may be somewhat controlled at first, but with each contraction it becomes more compulsive, overwhelming, and automatic.

Abdominal Pressure

Fundal pressure is applied to the topmost part of the uterus during the second stage of labor and is directed toward the birth canal in an effort to promote spontaneous vaginal delivery and prevent a drawn-out second stage or the requirement for surgical delivery. Additionally, fundal pressure was applied using an inflatable girdle. A survey conducted in the US found that 84% of respondents used fundal pressure in their obstetric facilities. The use of fundal pressure may improve maternal and/or newborn outcomes, but there is scant evidence to support this. Fundal pressure may be related to maternal and infant issues such uterine rupture, neonatal fractures, and brain damage, according to anecdotal evidence. It is necessary to conduct an unbiased assessment of the security and efficacy of fundal pressure during the second stage of labor.

Distension of Pelvic Floor

As the strain on the cervix increases, women may sense pelvic pressure and an urge to push. At the beginning of the typical second stage, the head is entirely inserted into the pelvis; the largest width of the skull has descended below the level of the pelvic inlet. The fetal head then enters the pelvis by the vaginal introitus, below the pubic arch (opening). Parental actions like "bearing down" or pressing help with this. The fetal head's appearance at the vaginal opening is referred to as the "crowning." At this point, the woman will feel a severe burning or stinging sensation.

Expulsion of Fetus

Complete baby evacuation signifies effective completion of the second stage of labor.

The second stage of birth will be influenced by a number of variables, including parity (the number of children a woman has had), fetal size, anesthesia, and the presence of infection. Longer labors increase the likelihood of infection, perineal laceration, obstetric hemorrhage, and neonatal intensive care as well as decrease the likelihood of spontaneous vaginal birth.
Things to remember
  • Contrary to the first stage of labor, the second stage of labor is characterized by complete cervical dilating, membrane rupture, and the release of a significant amount of liquid amni.
  • The uterine cavity's volume is reduced.
  • Concurrently, uterine contractions and retraction intensify and lengthen but become less frequent, occurring every two minutes for one second, allowing for regular recuperation times for both mother and fetus.
  • The firm, rounded fetal head can be inserted directly into the vaginal tissues as a result of the liquid drainage.
  • Fundal pressure is used to apply pressure to the topmost part of the uterus and toward the delivery canal in an effort to start labor during the second stage of labor.
  • As the strain on the cervix increases, women may sense pelvic pressure and an urge to push.
  • At the beginning of the typical second stage, the head is entirely inserted into the pelvis; the largest width of the skull has descended below the level of the pelvic inlet.
  • Complete baby evacuation signifies effective completion of the second stage of labor.
Questions and Answers

Changes in Second Stage Labor

Increase Uterine Contraction

With the cervix fully dilated, the membranes often rupturing, and a significant quantity of liquid amni escaping, the nature of the contractions in the second stage of labor change from those in the first. Thereby, the size of the uterine cavity was reduced. Every two minutes and lasting for a second, uterine contractions and retraction intensify and lengthen simultaneously, but they may occur less often, giving the mother and fetus regular recuperation times. The resulting drainage of fluid enables the direct application of the round, hard fetal head to the vaginal tissues.

Distention is aided by this pressure. Fetal axis pressure causes a head to bend more, which leads to smaller presenting diameters, quicker progress, and less stress on the mother and fetus. When the mother is upright, these processes are at their peak. As the fetus moves farther into the vagina, the contraction turns into an expulsive one. "Pressure from the presenting part stimulates pelvic floor nerve receptors, causing the Ferguson reflex and the need for the woman to push." This reflex may be somewhat under control at first, but with each contraction it becomes more and more compulsive, overwhelming, and involuntary.

Abdominal Pressure

In an effort to aid in spontaneous vaginal delivery and prevent a protracted second stage or the necessity for an operation, fundal pressure is the application of physical pressure to the topmost section of the uterus aimed toward the birth canal during the second stage of labor. An inflatable girdle has also been used to provide pressure on the foundation. In an American poll, 84% of respondents said their obstetric centers employed fundal pressure. The effectiveness of using fundal pressure to improve maternal and/or neonatal outcomes is not well supported by the available data. Several anecdotal reports suggest that fundal pressure is associated with maternal and neonatal complications: for example, uterine rupture, neonatal fractures and brain damage. There is a need for objective evaluation of the effectiveness and safety of fundal pressure in the second stage of labour.

Distension of Pelvic Floor

Women may experience pelvic tightness and an impulse to start pushing when pressure on the cervix rises. The largest width of the head has descended below the level of the pelvic inlet at the start of the usual second stage, where the head is entirely engaged in the pelvis. The fetal head then continues to descend through the vaginal introitus, below the pubic arch, into the pelvis. The additional maternal efforts of "bearing down" or pushing help with this. The "crowning" refers to the position of the fetal head at the vaginal orifice. The woman will now experience a severe burning or stinging sensation.

Expulsion of Fetus

Complete expulsion of the baby signals the successful completion of the second stage of labour.

The second stage of birth will vary by factors including parity (the number of children a woman has had), fetal size, anesthesia, and the presence of infection. Longer labours are associated with declining rates of spontaneous vaginal delivery and increasing rates of infection, perineal laceration, and obstetric hemorrhage, as well as the need for intensive care of the neonate.

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