Second stage of labour

Series of events that take place in
the genital organs in an effort to
expel the viable products of
conception out of the womb
through the vagina into the outer
world is called Labour,

THERE ARE FOUR STAGES OF LABOR.
1. FIRST STAGE OF LABOR:
THINNING (EFFACEMENT) AND OPENING
(DILATION) OF THE CERVIX
a. EARLY LABOUR
b. ACTIVE LABOUR
c. TRANSITION TO SECOND STAGE

2. SECOND STAGE OF LABOUR:
BABY MOVES THROUGH THE BIRTH CANAL
3. THIRD STAGE OF LABOR:
AFTERBIRTH
4. FOURTH STAGE OF LABOR:
RECOVERY

The second stage of labour (also called ‘the
pushing stage’) starts when cervix (the
opening of womb) is fully open (10cm dilated)
and ends when baby is born. At this stage,
baby is moving from uterus into vagina and
out into the world. The second stage can last
from minutes to two hours (usually second or
subsequent babies are quicker than the first).
Contractions during this stage may be several
minutes apart.

The forces at work in this stage
uterine contractions, which occur
every 2-3 minutes and last 50-60
sec.

The latent phase
The descent phase
The transition phase

1. Presumptive evidence:
 Expulsive uterine contractions
 Expulsive rupture of the forewater
 Dilatation and gaping of the anus
 Anal cleft line.
 Appearance of the rhomboid of michaelis.

UPPER ABDOMINAL PRESSURE
AND EPIDURAL ANALGESIA.
SHOW.
APPEARANCE OF THE
PRESENTING PART

2. CONFIRMATORY EVIDENCE:
It is held that vaginal examination must
be undertaken to confirm full dilatation of
the cervical os.

 BLOOD PRESSURE
 METABOLISM
 PULSE RATE
 TEMPERATURE
 GESTROINTESTINAL CHANGES
 RENAL AND HAEMATOLOGINAL CHANGES

The series of event that occur on
the head in process of adaptation,
during its journey through the
pelvis, is called mechanism of
labour

1. Descent takes place
 Whichever parts leads and first meets the
resistance of the pelvis floor will rotate forwards
until it comes under the symphysis pubis
 Whatever emerges from the pelvis will pivot
around the pubic bone.
 At the onset of labour the most common
presentation is the vertex and the most common
position either left or right occipitoanterior; it is
this mechanism which will be described. In this
instance

2. The lie is longitudinal
The presentation is cephalic
The position is right or left
occipitoanterior
The attitude is one of good flexion
The denominator is the occiput
The presenting part is the posterior part
of the anterior parietal bone

The transition of the first stage to the second
stage is evidenced by the following features:
 Increasing intensity of uterine contractions
 Urge to defecate with descent of the
presenting part
 Complete dilation of the cervix as evidenced
on vaginal examination
 Appearance of bearing down effort

PRINCIPLES:
To assist in the natural expulsion of the
fetus slowly and steadily
To prevent perineal injuries

GENERAL MEASURES:
The patient should be in bed.
Constant supervision is mandatory and
the FHR is recorded at every five
minutes.
To administer inhalation analgesics
Vaginal examination

POSITION: Position of the woman during delivery
may be lateral or partial sitting. Dorsal position
with 15 degree left lateral tilt
 The accoucheur scrubs up and puts on sterile
gown, mask and gloves and stands on the right
side of the table
 Toileting the external genitalia and inner side of
the thighs is done with cotton swabs soaked in
Savlon or Dettol solution.
 To catheterize the bladder.

ASSESSMENT:
 Maternal blood pressure, pulse and respiration
every 5-15 minutes.
 The FHR every 10-15 minutes.
 Labor progress:
 Cervical dilatation.
 Fetal descent.

Uterine contractions.
The amount of bloody show.
The woman’s urge to bear down.
The woman’s response to labor.
The woman’s coping pattern.

NURSING DIAGNOSIS:
Pain
Risk for infection.
Anxiety related to knowledge deficit.
Fatigue.
Impaired skin integrity.

Anxiety related to outcome.
Ineffective individual coping.
Powerlessness.
Impaired adjustment.
Self-care deficit: Bathing/ Hygiene.

PLANNING:
 Promote a quiet, focused environment to
enhance pushing efforts.
 Monitor maternal and fetal status.
 Provide encouragement for pushing efforts.
 Support ongoing comfort measures and
pushing efforts.

IMPLEMENTATION:
 Continue assessment of maternal blood pressure,
FHR and uterine contractions.
 Assist laboring woman into position of comfort
and pushing efforts.
 Observe for approaching birth such as:
 Perineal bulging
 Appearance of fetal head

 Provide comfort measures such as;
 Wiping face with wet washcloth
 Moistening the lips
 Supporting the woman’s body and /
extremities during pushing efforts.
 Prepare for the delivery
 Complete perineal cleansing.

EVALUATION: Ensure that;
The laboring woman is able to remain
focus on pushing.
The woman and fetus maintain physical
parameters within normal limits.
The woman feels encouragement.
The woman feels comfortable.

Second stage of labour

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Second stage of labour