Hesperian Health Guides

Hesperian Health Guides

Chapter 12: Pushing: stage 2 of labor

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HealthWiki > A Book for Midwives > Chapter 12: Pushing: stage 2 of labor


Stage 2 is the part of labor when the mother pushes the baby out of the womb and down the vagina, and the baby is born. Stage 2 begins when the cervix is completely open and ends when the baby is outside of the mother. It is normal for stage 2 to be as short as a few minutes or as long as 2 hours.

Watch for signs that stage 2 is near or starting
a woman in labor speaking.
Unnh!
I have to push!
I have to push!

It is safe for the mother to start pushing her baby out when her cervix has opened all the way and she has a strong urge to push. The only way you can be certain the cervix is open all the way is to do a vaginal exam. But remember: vaginal exams can cause infection. It is better not to do a vaginal exam. With experience, you can usually tell when the mother is ready to push without doing an exam.

Instead of doing a vaginal exam, look for the following signs. If the mother has 2 or more of these signs, she is probably in stage 2.

a woman's buttocks, with an arrow showing where a purple line appears.
A purple line will appear here.
  • The mother feels an uncontrollable urge to push (she may say she needs to pass stool). She may hold her breath or grunt during contractions.
  • Contractions come less often. But the contractions stay strong or get stronger.
  • The mother’s mood changes. She may become sleepy or more focused.
  • A purple line appears between the mother’s buttocks as they spread apart from the pressure of the baby’s head.
  • The mother’s outer genitals or anus begin to bulge out during contractions.
  • The mother feels the baby’s head begin to move into the vagina.

Pushing too early

If the mother starts pushing before her cervix is fully open, the baby will not be able to come out because the partially closed cervix will block the way. Pushing too early can also make the cervix swell and stop opening. This will make labor longer. Even if you know that the cervix is fully open, do not encourage the mother to push until she is overwhelmed by the urge. Pushing too early will only tire the mother.

a woman with head, knees, and elbows on the floor.

If the mother has been pushing without progress for more than 30 minutes and you have been trained to do vaginal exams, you can do one now. If you feel even a little of the cervix, put the mother in the knee-chest position. This position lifts the baby off the cervix so that the swelling can go down, and the cervix can start opening again.
Help the mother stay in this position without pushing for an hour or so. When the cervix is fully open, she can try pushing again.


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