Transition and second stage of labour

You've nearly made it from the first to the second stage of labour. The final, hardest (but, thankfully, usually shortest) chunk of the first stage of labour, transition, is when you dilate from about 7cm to 10cm.

Contractions will be incredibly intense and you may have very little time to rest between each one. You may feel faint, sick, wobbly, hot and sweaty or cold and chilly.

Don't be surprised if you completely zone out during this phase and become unaware of your surroundings. (It's also traditionally the point where some mums lose the plot, decide they really can't be bothered anymore and try to walk out.)

You may feel an intense urge to push during transition, but don't. Pushing too early, before your cervix is fully dilated, can cause complications. Puffing and blowing - get your midwife to guide you - can help until you're given the green light.

Transition usually lasts between 15 minutes to a few hours - so hold on. (It's more likely to be quick if this isn't your first vaginal delivery.)

With a bit of luck, once you're fully dilated, your contractions may stop for a short while before you feel the need to push, giving you the chance to get your breath back.

Things to do during transition

  • Take it one contraction at a time - don't worry about the next ones
  • Change position - you might find a more comfortable one
  • Don't push - puff and blow instead
  • Get rid of any distractions - be that the radio or your partner
  • Whatever helps you through - yelling, moaning, telling your partner to "go away" - even listening to James Blunt - are all totally acceptable at this point


What Mumsnetters say about transition

  • I regressed 3 billion years into primitive cavewoman during transition and tried to escape into the air vents. It was very important to me to get into those air vents, without anyone noticing, and I needed to get out of the pool, but I didn't know why. I didn't know what I wanted - I was just confused and distressed. Joolyjoolyjoo
  • I was shaking and clammy and staring into space. It was horrid. MamaG
  • I demanded an epidural during transition. It was pointed out that I couldn't have one as I was at home! thisisyesterday
     


Second stage of labour

The second stage is the most exciting part of labour: it starts once your cervix is fully dilated (10cm) and you start to feel an intense urge to push and ends with the birth of your baby.

Until now, you've had limited control over your labour but now you can play an active part and help to push your baby out through the birth canal. Typically, contractions slow down now to a couple of minutes apart: the trick is to push at regular intervals - usually three pushes per contraction - but do what feels natural and, if you need help, get your midwife to guide you (especially if you've had an epidural as you won't have much of a clue as to when to push or how hard you're actually pushing).

It may feel as though you're getting nowhere - with each contraction your baby goes a little bit further down the birth canal, only to slip back a bit before the next one - but just remember: two steps forward, one step back.

Once the top of your baby's head reaches the opening of your vagina and no longer slips back between each contraction - what's known as crowning - you'll (unsurprisingly) feel a strong stinging sensation. 

It's important to listen to your midwife's instructions now as your vagina needs time to stretch; she'll advise on when or when not to push and how hard to do so to try to minimise the chance of you tearing.

If your midwife thinks you may tear particularly badly - or if your baby is in distress and needs to be born quickly - she may suggest you have an episiotomy at this point.

A deliberate surgical cut in the perineum, the area of skin between the vagina and anus, episiotomies are done under local anaesthetic and used to be incredibly common (roughly 90% of women had them). The reasoning was that a controlled incision would help avoid a serious, uncontrolled tear that might extend into the rectum or anal passage.

But research now suggests they're largely unnecessary and of little benefit for most women other than in the above instances.

Once your baby has crowned, a few more contractions are usually all that are needed before the head is fully out. The shoulders and head then turn sideways and with a few more pushes and some guidance from your midwife, hey presto, out he or she pops.

The umbilical cord will usually be clamped and cut now (by the midwife or your partner if he fancies it) and, providing all's well, you'll finally get your first cuddle.

The second stage can take anything from a few minutes to several hours. Your position, your baby's position, whether you've had any pain relief and whether this is your first vaginal birth all have a bearing on how quickly you two will get to meet for the first time.

Things to do during the second stage

  • Don't take labour lying down - being flat on your back is the least effective position to labour in, so, if you're able, try to remain as upright as possible whether you're squatting, standing, kneeling or down on all fours
  • Relax between contractions - there'll be another one along any minute so rest up when you can
  • Listen to your body: Mother Nature's rather incredible, so do what feels right for you unless you're being told otherwise
  • Listen to your midwife - unless you're a Yogi, you won't be able to keep an eye on what's going on down there, but she'll advise on when or when not to push, and how hard to do so, to try to minimise the chance of you tearing (your midwife might ask you to withhold some pushes to coordinate them with your breathing, or to breathe through some of the urges to prevent a tear in your perineum, which might happen if the baby comes out too quickly)
  • Pretend you're on the loo - don't push from your upper body, instead relax your face and push from below your waist as though you're doing an enormous poo
  • Ditch your dignity - don't worry about doing a poo, most of us do at this point and midwives are used to it
  • Don't lose hope - if you feel too exhausted to push, take a rest for a contraction or two and if you need a boost see if you can feel your baby's head, or ask for a mirror so you can take a peek at him or her emerging


What Mumsnetters say about the second stage of labour

  • I'd had an epidural, so my lovely midwife told me when to push - but I could feel the necessary pressure anyway. Absolutely awe-struck, I felt my daughter's head coming out and caught her under her arms and brought her up onto my chest. Poledra
  • I really didn't want to push!! The midwife had to persuade me before I would open my legs. Keevamum
  • I enjoyed this bit... it was the calmest point of my labour since 5cm. It was probably the pethadine, but I don't remember much pain, just being calm and collected and listening to the midwife to do my stuff. TheHedgeWitch

 

Last updated: 13-Feb-2013 at 10:53 AM