Monday, July 4, 2011

Bradley Birth: Second Stage Labor

Let's talk about the second stage of labor, shall we?

Here are just some random things I learned in class about Second Stage Labor. Those that have experienced this, please feel free to add your wisdom. It is so important to remember that no two labors are alike, so take all of this with a grain of salt. This is just info to help you become familiar with the birth process and maybe make you less intimidated by it all.

Some Definitions:
  • Afterbirth: The birth of the placenta and membranes after the birth
  • Episiotomy: Surgical incision made in the perineum (the skin and tissues between the vagina and anus) to "prevent tearing"
  • Cord Clamping: Clamping down on the Umbilical cord to stop the flow of blood and oxygen from the mom to baby so you can cut the cord. The baby then starts breathing on its own for the first time. 
  • Ferguson Reflex: When baby presses onto the Ferguson Plexus of nerves, creating Ferguson's reflex, the urge to push
The Second Stage of Labor is when you are ready to push. At this point you are fully dilated (10cm) and fully effaced (100%), which means the cervix is completely thinned and open and ready to let baby out. Baby has descended down the birth canal and is ready to emerge. Some women will feel what is called an urge to push. This is generally caused by the baby pressed onto the Ferguson Plexus of nerves, creating Ferguson's reflex, the urge to push. It is important to note that some women may have a break between becoming completely dilated and feeling the urge to push (this urge feels the same as when you have to "go"). Baby may be getting into a better position. So use this time to rest and get ready for the next stage. 

Upright positioning is usually favorable for the second stage, allowing 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 wonderful and becoming more popular, particularly for women having trouble pushing in the bed. Including:

Squatting (Opens the pelvic outlet an additional 10%)
Birth Stools
Birth Balls
Water Pools
Birth Chair
Side lying positions are used to slow down a very rapid labor and are great for protecting the perineum during a rapid birth.

Semi-reclined, or laying on your back with stirrups are still very common in many hospitals, particularly if you have regional anesthesia, or will be having a forceps or vacuum delivery. This position does not use gravity and increases the length of the pushing stage and increases the use of episiotomy, vacuum extraction, and forceps. You can request a different position.

I would recommend googling "pushing positions for labor" or "positions for second stage labor" to get other ideas. Because all we ever see in movies and mostly in real life is women laying on their backs in the bed, it is hard to figure out what else you could do. 

When you are asked to hold your breath to a count of ten, numerous times during one contractions, we call this purple pushing. Purple pushing came into play as the epidural rates increased and women never got an urge to bear down. We now extend it to nearly everyone having a baby.

The options are:

Laboring Down: Allowing your body to push the baby out on its own. Not really assisting the pushing efforts of the uterus, unless you have an overwhelming urge to push. This is particularly useful for women with epidurals because then they are not pushing against a baby who is still in a malpresentation.

Spontaneous Bearing Down (Positive Pushing): Allowing your body to tell you when to push. When this technique is used we never find mom holding her breath more than about 6 seconds, allowing more oxygen for the baby.

Bradley definitely recommends positive pushing so you are working with your body and contractions to be more effective. 

When baby's head crowns, some people experience the "ring of fire", which is a burning sensation. After baby's head is through the rest of pushing is generally much easier. 

Once the baby is born, the doctors will probably suction out their mouth and cut the cord. You have the option to cut immediately or wait for the cord to stop pulsing. (If baby is having any issues, they will cut immediately so they can move baby to the NICU station and tend to the issues.) Reasons to wait for the pulsing to stop would be that baby is getting the last bit of blood that was intended for them, they are still get oxygen from mom for a moment, and studies have shown the stem cells in the cord (ie why we cord bank now) can protect against lots of crazy sickness. You can ask that baby is immediately laid on mom to do skin to skin at this point (bonding of mom and baby skin to skin, which helps baby regulate their blood temp). 

After this comes the birthing of the placenta. Some call this the third stage. It is when the placenta separates from the wall of the uterus, and is delivered through the vaginal canal. You will still be having contractions at this time, but they are much less intense than before. For some women, they’re still strong enough that it helps to use labor breathing techniques to cope with the discomfort of these contractions.  Some women are so enraptured with the baby that they barely notice the cramping. Your caregiver may ask you to push a few times to deliver the placenta. Again, this pushing is less intense than the delivery of the baby. Third stage usually lasts ten to thirty minutes. If it lasts longer than this, you may be given Pitocin to increase contractions to encourage the delivery of the placenta, and help the uterus to begin involution (shrinking back down to the non-pregnant size.) During third stage is also the time when your caregiver will clean your genital area, examine your perineum, and will stitch up your perineum if you’ve torn or had an episiotomy. A local anesthetic is used if you haven’t had an epidural. In this period after birth, most of the parents’ attention centers on the baby, and not so much on the final stage of labor. In the first hour after birth, you will want to begin breastfeeding.

Ok moms that have been through this- what else can you share with us who haven't??

1 comment:

  1. Getting to the pushing stage rocks! :) For me it was not a urge to push, it was "hey you better get some one in here to catch this baby because I am pushing because I can't help it!" The nurses were counting while I pushed and it drove me crazy!!! I was not in a state to yell at them to stop, but I think this next time I will tell them before we start, no counting. It is useless. I am going to push as hard as I can for as long as I can - then I am going to breathe and do it again. If that means I only go to 9 then so be it! :) Praying for a healthy, quick, and beautiful labor for you and baby!