Second Stage of Labour

Second Stage of Labour

                                                            

Second stage of  labour is the stage of fetal expulsion. It begins with full dilation of cervical os and ends with the birth of the baby. Second stage lasts for 2 hours for nullipara and 20-30 minutes in multipara.

Changes taking place during the second stage of the labour:

1. The second stage is clinically manifested by increased frequency and intensity of uterine contractions every 2-3 minutes lasting for 60-90minutes.

2.    The long axis of the fetus is parallel to the long axis of the pelvis.

3.    Pelvic floor muscles exert some pressure over the fetus as it descends down.

4.  The mother exerts pressure with her abdominal muscles at the peak of inspiration with glottis closed called as “bearing down” efforts with pursed lips, distension of neck veins, rapid pulse rate, increased respiratory rateand increased perspiration which result in expulsion of the fetus

5.    The mother may show features of exhaustion.

Equipments for conduction of delivery

·         Sterile gloves

·         Sterile drapes

·         Sterile leggings

·         Sterile towels

·         Sterile sponges

·         Steel Basin

·         Cord clamp

·         Suture cutting Scissors

·         Allies Tissue Forceps

·         Episiotomy Scissors

·         Suture material

·         Bulb Syringe

·         Rubber Catheter

·         Needle holder

·         Spot light

Signs of Delivery

• Distension of perineum which becomes tense and glistening
• Vulval opening looks like a slit through which scalp hairs are visible
• Fetal head will not reside back even after the cessation of uterine contraction called ‘Crowning’.
• Anal sphincter gets stretched with visibility of anterior rectal wall.

Management of the Second Stage of Labour

• The second stage of labor, as noted previously, is characterized by complete cervical dilation; descent of the fetal vertex; and in patients without anesthesia, a sensation of pelvic pressure and the urge to bear down.
• Internal examination should confirm complete dilation, as well as the fetal position and station, prior to the commencement of maternal pushing efforts.
• Women should be encouraged to continue to labor in the position that is most comfortable for them and those results in the most effective pushing efforts.
• Obstetric lacerations are minimized by keeping the baby's head well flexed until the occiput passes beyond the subpubic arch.
• As the head appears beneath the symphysis, the perineum is supported by direct pressure over the coccygeal region.
• As the head delivers, it often will rotate to a transverse position, at which time gentle downward traction combined with maternal pushing effort will achieve delivery of the anterior shoulder.
• Delivery of the posterior shoulder is conducted by upward traction after which the rest of the baby is delivered. 
•  The baby can be placed immediately on the maternal abdomen or handed directly to the neonatal care providers depending on the clinical situation or according to maternal preference.
• While delayed clamping of the cord is associated with higher newborn hematocrit levels.

The role of nurse in caring the woman in the second stage of labour

• Notifying the delivery team
• Setting up trays for delivery
• Providing a warm environment for the newborn
• Checking for the working condition of the neonatal resusucitation
• Preparation of delivery room
• To assist in the natural expulsion of the fetus slowly and steadily.
• To prevent perineal injures.
• To assist labour under aseptic precautions
• Vigilant monitoring of maternal vital sign and fetal heart rate.
• Encouraging spontaneous bearing-down efforts for second stage
• Evaluating pushing efforts and length of time in second stage