A WORD ABOUT ‘PUSHING’! – NO WOMAN SHOULD EVER PUSH HER BABY OUT!  The word should never be used (there are some exceptional circumstances like ‘foetal distress’).  Talk to a woman about gently and quietly easing her baby down and out, in her own way, at her own pace, working with baby.  Pushing can cause damage to the pelvic floor, bladder, perineum and baby’s don’t like it.

During the first stage of labour the cervix has thinned out and opened.  At the end of the first stage it is open to 10cm., making the uterus and vagina one birth canal.  Second stage is described from ‘fully’ dilated to the birth of the baby.

Women often express ‘relief’ when they arrive at 10cms. As there is usually a ‘lull’ during this stage.  Waves (contractions) slow, as they ease the baby’s head down further and there is a longer rest period.

The overwhelming urge to bear down with each wave, for many women, is passionate, intense and exciting, and for some it is positively orgasmic.

For others it is uncontrollable, and they often confuse this feeling with wanting to have their bowels open.  However, in some Delivery Suites you will find that women are told to start ‘pushing’ as soon as the cervix is fully dilated.

Some women do not get any urge to bear down.  Maybe she does not have the urge because the baby is not yet rotated into the correct position for birth.  If she is doing forceful pushes and is straining, this can push the head down too soon and result in deep transverse arrest, i.e. the baby can get stuck.  She has also wasted a lot of energy.  For those women who don’t have the urge to bear down, it is O.K. to wait.  Some women arrive at 10cms. And then are quite fearful of the sudden sensation to bear down.  Changing position and focusing on ‘opening up’ may help.  Also leaving her alone for a while, reassuring her that all is well with her and her baby.  Encourage her to trust her body and enjoy this resting phase.

After full dilation of the cervix, the baby’s head is free of the uterus and the waves bring the head to the middle of the pelvic canal.  At this point rotation begins as the head meets the pelvic floor.

Descent continues, and there is further rotation as the head comes down under the pubic bone in front.  This may take time, and the rotation is usually complete before the back of the head reaches the vulva, although it may still be turning as it is born.