Second Stage Labor

What the heck does Salt & Pepper have to do with the 2nd Stage of Labor, you ask? (Nothing! If we’re talking about spices… But I’m not TALKING about spices! I’m talking about the AMAZING hip-hop group – Salt-N-Pepa – from the mid-80s, ya’ll! You’ll be rewarded for making it to the end of this blogpost, I promise!)

The 2nd Stage of labor, or pushing the baby out, gets the most screen time in any birth depicted on TV or at the movies. These shows completely bypass all of the 1st Stage of labor (the thinning out and opening up of the cervix) because honestly, it’s way too boring! They would never “waste” precious seconds showing a person walking around the house in early labor grabbing a snack and some water. Not when they could devote an entire 10 minutes to a highly dramatized scene involving a car screeching into the emergency room parking lot, with a birthing person screaming their head off, a clueless partner is running around being no help whatsoever, and finally the skilled medical team races in to save the day because the baby is COMING OUT!

It’s no wonder that when our popular media tell us that birth is all about pushing the baby out, that this becomes such a focus for pregnant people. While they might be looking forward to having the baby in their arms at the end of birth, they’re not too excited about having to Push.It.Out.

I want to try and eliminate any fear or anxiety you might have about the 2nd Stage of labor.

Let’s get honest about what the sensations of pushing might feel like (and what bodily functions might happen as well) so that we can get down to the real business of giving birth.

How will you know it’s time to push? This can be answered easily if there’s no medication on board, because most people will have a very strong urge to push. You’ve probably heard of this “urge to bear down” – but what will it feel like? For some, it will feel similar to having had too much to drink or the stomach flu and finding yourself in front of the toilet the next morning when up and out it comes! You couldn’t stop yourself from throwing up if you tried. It’s similar to this, but instead of up and out – it’s down and out. Others will say that when they started to push it felt like they really, really had to poop. (Enter very obvious segue here.)

Will you poop while pushing your baby out? The short answer is: Yes.

But here’s the longer answer. In the days prior to actually going into labor, pregnant folks will experience some flu-like symptoms that will cause some cramping and maybe some mild diarrhea. This is Mother Nature’s way of saying, “In a few hours or a couple of days you’re going to be pushing a very large something through a very small something and this could result in a huge mess! So, I’m going to take care of that for you and make you poop a little bit more often now, you know, to help clean out your system a bit!” (She’s so nice, that Mother Nature.)

Will you know this as a pre-labor sign of getting ready to give birth? Probably not. Most will think that they shouldn’t have bought that beef and bean burrito at the lunch cart that day, or maybe the date on the yogurt container they had for breakfast was off. But this is actually your body getting ready for the main event.

Even with this nifty gift from Mother Nature, you’ll probably still poop on the table while trying to give birth to your baby. In fact, if you start feeling like you need to poop – you should let your birth team know! It’s an intense feeling and experience, but try not to fight it. If you expend all of your energy trying to keep your bum cheeks tight to avoid pooping, you might not be able to push your baby out! It doesn’t work that way!

If you’ve never been to an actual birth before, you may have no idea how messy the whole thing is going to get at the end. While you’re pushing your baby out, you’ll also be pushing out a lot of amniotic fluid, a little bit of pee, a little bit of blood and a little bit of poop! (Whatever you’re wearing during this 2nd Stage of labor will immediately be thrown into the trash on the other side, just so you know.)

Don’t freak out! Your nurses, doctors and midwives are so used to this happening that they don’t even notice! They might take a washcloth to the area or switch out the blue plastic-backed chuck pads from underneath your bottom every once in a while to keep the area as clean as possible. But they’re really nice people and I swear you’ll never hear any of them say, “We’ve got to get you cleaned up – you just pooped on the table!”

Some of you reading this right now are not laughing, not even cracking a smile – maybe you’re actually getting anxious! You’re the perfect candidate for getting a DIY enema from Walgreen’s and administering it to yourself at home in early labor. Do whatever you need to do to make yourself feel able to really engage in pushing your baby out.

Partners: If they ever ask you on the other side of giving birth if they pooped on the table, the only acceptable answer is, “Nope! First person in the history of giving birth!” You might give them a little fist bump for emphasis, but you will never speak of the truth. Not ever.

Pushing takes a long time. For most, you can expect an average of 1 1/2 hours to move that precious cargo down the 4-5 inches of birth canal (vagina) before the baby’s head will emerge completely. But it’s not uncommon for first time birthing people to push for up to 3 hours and with an epidural on board it could be as long as 4 hours!

So no matter what your thoughts are about pooping, you really need to eat in early labor to fuel your body for the work that’s required to push your baby out. You’ll also want to change positions often throughout pushing so that your baby can make all the twists and turns necessary to be born.

You can do this even when you’re confined to the bed due to epidural medication. I usually tell the partners to remember the phrase, “Rotisserie Chicken” and continue to turn the birthing person from left-side, to right-side, to hands and knees, to squatting (rinse and repeat). This may require more adjustments on the fetal monitor, but can really pay off in the long run in continuing to assist your progress.

Partner, provide some milestones so that the laboring person feels like they’re making progress.

Pushing is a two steps forward, one step back process for a really long time. When they get to the point where the baby’s head stays put and doesn’t seem to be getting sucked back in – tell them! When the opening around the baby’s head is about the size of a quarter, let them know. If you can see the baby’s hair, describe it. When the baby’s head is crowning, do not, I repeat, do not start humming “Ring of Fire” by Johnny Cash! (I am the only person alive who would find that funny.)

This “ring of fire” causes a lot of anxiety. This makes complete sense to me. This part of the birth process has such a warm, welcoming name that many people are completely freaked out about it! Because I know what happens in your mind, plays out in your body we need to make sure that you don’t get too far ahead of yourself or too anxious at the thought of the baby’s head crowning.

So, stop what you’re doing right now and if you’re someplace where this won’t be too embarrassing, take your two index fingers and place them inside the outer corners of your mouth. Then stretch your mouth open wide and hold there for just a moment or two. You can feel the skin stretching and it’s not an incredibly pleasant feeling, but if you hold it long enough you’ll realize that when you release your fingers, your mouth now feels numb where you felt stretching before.

The same thing will happen to your vaginal tissues as the baby’s head is crowning. Just on a much more intense scale, I’m not going to lie! But that same numbing sensation also occurs – think of it as little firefighters racing to the scene to put out that ring of fire. It’s momentary and not something to be afraid of.

As your baby’s head is crowning, if your provider is concerned the vaginal tissues are very tight around the emerging head of your baby, this would be when they might talk to you about performing an episiotomy. An episiotomy is an incision made in the perineum (area between the vagina and anus) to enlarge the vaginal opening. This doesn’t happen very often these days (WOOHOO!) More and more providers are really wanting you to have an intact perineum when you leave the hospital, so they really should only be performing one if they feel that it will decrease the likelihood of a large tear.

How can you help prevent a large tear or need for an episiotomy?

~ Have you heard of “perineal massage?” This involves using oil to lubricate and stretch the perineum. You can do this on your own or with your partner’s help. A quick internet search will give you all the details. (Might not want to do this search on the office computer!)

~ You should make sure to eat well and to drink lots of water throughout your pregnancy and birth – skin tissue has much more elasticity if it’s well nourished and hydrated.

~ You want to listen to your provider throughout your pushing stage for what’s called “directed pushing.” This is not the old school style of holding your breath and pushing to a count of ten, this is listening to your provider tell you when to hold off on a big push, or just to give a little push here and there. They will be guarding your perineum at this point and trying to do some massage and stretching as you push. Think of directed pushing as a way to ease your baby out.

~ You can try to sit in a tub of warm water during you labor – not just because it will make you feel better, but those who deliver in water have lower episiotomy rates than those who deliver out of the tub. If you were in the water for comfort earlier, but aren’t planning an actual water birth or got out after an epidural was placed, then when you start feeling “pushy” you could have a warm, wet washcloth placed right up against your bottom. Warm water will bring blood flow back to that area and increase elasticity of the tissues.

~ Consider lots of pushing and delivery positions. Semi-sitting will put a lot of pressure on your perineum, but side-lying or hands and knees positions take a lot that pressure off the part of your body that is involved in episiotomy and tearing.

~ And last, but not least, let me share a story about one person’s way of working with their mind AND body in the 2nd Stage of Labor. A first-time Momma is in that moment of crowning. Her midwife can see that the fit doesn’t seem very favorable. Just as she’s thinking to herself, “I’m probably going to be stitching things up for quite awhile after this baby is born” the laboring Momma takes a deep breath and releases it completely. On the exhale, everything opens up and there’s not even a small tear as the baby passes through easily. The midwife is astounded and asks the woman what just happened. The new Momma replies, “I could feel myself tensing up around the baby’s head, so I said to myself – ‘I’m going to get huge!’ – over and over again.”

The mind body connection is so strong that in her effort to open up she imagined getting wider and lo’ and behold it worked! So imagining that you’re getting huge, you’re like melting butter, you’re an opening rose, you’re a 3-car garage – whatever makes your mind think O-P-E-N and it just might have the same effect for you. (It certainly won’t make you close up tight.)

As soon as the baby’s head is crowning, get ready! A baby is very narrow through the torso and hips, so after the delivery of the shoulders, the rest of the body will slip out super fast! I’m always blown away by how long it takes that head to be born, but then the rest of the baby takes only moments!

Enjoy an incredible sense of relief and pressure once the baby is out of you. It can be intense for sure – even when you have an epidural on board! I think some people are surprised to find out that they’ll feel a lot of pressure and even the baby’s head crowning despite the fact that they’re medicated. Don’t worry… the epidural hasn’t “worn off!” It’s really good that you have pain coverage for the contractions, but you still need to have enough sensation in order to figure out how and where to push when it’s time to give birth.

The 2nd Stage of labor gets all the glory in TV shows and at the movies, but this can also cause a lot of anxiety about how it’s all going to play out. Now that I’ve covered pushing in detail, I hope you know what to expect, and you feel prepared for the hard work of bringing your baby into the world!

Don’t be afraid of pushing, get excited about making it that far. Soon, your baby will be in your arms!

And if you need a little music to get you in the mood…


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