* The second stage of labour starts when your cervix is fully dilated and you are ready to push. It terminates in the birth of your baby.
* You will have an immense urge to push and this is the time when you will be asked to push as hard as you can.
* This stage may take anywhere between half hour to 2 hours or more.
* First a bulge can be seen where the baby's head is pushing against the vaginal opening.
* As you push with each contraction, the baby's head will begin to be visible. However, as each contraction fades, the head may recede back a little, only to come forward again with the following contraction.
* Once 'crowning' (the time when the top of the baby's head is visible) occurs, the midwife will ask you not to push but pant. This allows the head to be delivered as slowly as possible and the skin and muscle of the perineum stretch.
* You may be offered an episiotomy (a small cut to widen the vaginal opening and to prevent a tear) at this stage if there is a risk of your skin tearing.
* The baby's head is delivered and the midwife checks the umbilical cord to see whether or not it is looped around the baby's head. If it is, it can be slid over the baby's head to prevent it from strangling the little one.
* The body is delivered soon after the head and the baby may be delivered onto your stomach (if you wish), still attached to the umbilical cord.
Sometimes, it helps during this period to adopt a kneeling forward position. When the cervix is fully dilated the midwife will guide you in pushing with your contractions and (if hospital policy permits) will be happy for you to adopt the position of your choice. Listen to your body and be ready to change position if you feel the need. Some recommended positions include:
* supported squatting
* sll fours
* high kneeling
* high sitting
* lying on your left side
* If you have a premature urge to push before full dilation, try to control it by one of the following:
- The Entonox inhaler
- S.O.S." breathing with a partner
- "Pant-pant-blow" breathing with a partner
* If you have had any pain in the joint at the front of your pelvis during pregnancy, be sure to tell the midwife who is delivering you.
* Breathe gently in and out as the contraction starts and when the urge overwhelms you, tuck your chin in and bear down towards your vagina keeping the pelvic floor relaxed.
* Try to keep your mouth and face slack and try not to hold your breath (unless you are instructed to do so by the midwife).
* As the baby's head is about to emerge, work with your midwife to control the speed of the delivery. You will do this by alternately pushing and panting or doing your "S.O.S." breathing as she directs you. The baby can usually be delivered onto your tummy if this is your wish.