Guide to the Second Stage of Labor and Pushing

This active phase of labor is when you'll deliver your baby

Woman having labor pains
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The first time you have a child, you probably don't know what to expect. After all, no one really knows how labor will feel until they're in the thick of it. Perhaps you worry primarily about whether you'll be able to handle the contractions during the first stage of labor when the cervix is opening up so that the baby can descend into the birth canal. But what about the second stage? What happens when it comes time to push?

The Active Phase of Labor

The second, pushing phase of labor continues after the cervix is fully dilated (open) to 10 cm until the delivery of your baby. It's usually shorter than the first phase, lasting from 20 minutes to 2 hours, according to the American Pregnancy Association. It can take longer if you're a first-time mom or you've had an epidural, and also depends on things like the position and size of the baby.

"The Rest and Be Thankful" Phase

Once you're completely dilated, you may experience up to an hour of no contractions. This lull in labor has been fondly named "the rest and be thankful" phase. In some hospitals and birth centers, moms are asked to push during this phase even if they don't feel the urge—something that's not always beneficial to either mom or the baby.

The Urge to Push

Whereas in the first phase of labor you were likely told to "stay out of the way" of your contractions, now is when you'll help move your baby down the birth canal by pushing through the contractions.

Once in active labor, most women will feel a strong natural urge to bear down as if having a bowel movement. This is generally caused by the baby being pressed onto the Ferguson Plexus of nerves, creating Ferguson's reflex: the urge to push. Not all women will feel this urge. Whether or not you do may be affected by your use of regional anesthesia (epidural), which can make you feel numb and unable to respond to your body's signals. At this point, some doctors will dial back the epidural so as to enable the woman to push.

Contractions will last about 45 to 90 seconds at intervals of 3 to 5 minutes of rest in between. As they become longer and stronger (that is, more painful), you'll have less opportunity to rest in between contractions, so try to rest and relax when you can to get ready for the next one. To conserve energy while pushing, try to focus your energy into the pelvic or rectal area, rather than holding tension in your face.

Other important details: You'll feel strong pressure at your rectum and will likely have a minor bowel or urination accident. When your baby's head eventually becomes visible (aka crowning), you'll feel a burning, stinging sensation. It's normal for the baby's head to emerge and then slip back into the vagina, so don't be discouraged if this happens. Ask if you can use a mirror to view your progress or to feel the baby's head between your legs—either or both can keep you motivated.

Labor Positioning

Upright positioning can be favorable during the second stage of labor, as it allows gravity to assist the mother. There are numerous positions available in modern birth beds, including the squat bar and foot pedals.

Out-of-bed positions are also becoming more popular. These include:

  • Squatting (opens the pelvis an additional 10 percent)
  • Standing
  • Kneeling
  • Birth stools
  • Birth balls
  • Water pools
  • Birth chair
  • Dangling

Side-lying positions are also sometimes used to slow down a very rapid labor and are great for protecting the perineum (and avoiding the need for an episiotomy, a surgical cut at the opening of the vagina to aid delivery) during a rapid birth.

Semi-reclined, or laying on your back with stirrups, is still very common in many hospitals, particularly if you have regional anesthesia or will be having a forceps or vacuum delivery. This position doesn't use gravity and increases the length of the pushing stage and increases the necessity of an episiotomy, vacuum extraction, and forceps. You can request a different position if you're uncomfortable with this option. Keep in mind, too, that changing positions frequently and even walking around (if you don't have an epidural) is considered an effective way to cope during this intense period of labor.

Purple Pushing

When you're asked to hold your breath for a count of 10 during contractions, you're purple pushing. The practice (aka directed pushing) got its name due to the attractive image of poor mom turning purple, eyes bulging out, blood vessels breaking, and a room full of people screaming, "PUSH!"

Purple pushing came into play with increased use of epidurals, which can limit or inhibit the natural pushing urge, but it's now requested of nearly everyone having a baby. Though common, this style of pushing isn't considered ideal. According to Lamaze.org, it can deprive your body of oxygen, add undue stress to you and your baby, increase your risk for perineal tears, and further weaken your pelvic floor muscles after birth.

A healthier way to push, the organization states, is to follow your body's instincts and cues to push, taking breaks when needed and bearing down when you feel the urge (aka laboring down or delayed pushing). In 2017, the American College of Obstetricians and Gynecologists weighed in. The organization issued new recommendations for labor and birth, including one that stated that each woman should be encouraged to use the pushing technique she prefers and is most effective for her.

A Word From Verywell

It's important to remember that once you're completely dilated it's anyone's guess as to how you'll respond to the second stage of labor. Some women have very short pushing stages, while others push for quite a while. With the use of various positions and bearing-down techniques, you can become as comfortable as possible as you work to complete your special delivery.

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