Giving birth - second stage of labour

The second stage of labour begins when your cervix is fully open (dilated) to 10 centimetres and ends when your baby is born. Your midwife or doctor may ask to check on your cervical dilatation (opening) by doing a vaginal examination. There are signs and behaviours your midwife and doctor can assess for them to know if you may be in the second stage of labour — some of these do not involve vaginal examination.

You can talk with your midwife or doctor about how you prefer to be assessed during labour.

This stage has 2 parts:

• a passive stage, where you are fully dilated but do not feel an urge to push, usually when an epidural block is being used
• an active stage, when you feel the urge to push, which ends with your baby's birth

In the second stage of labour, you may notice these signs:

• Strong, longer contractions, with longer intervals between the contractions. This is the natural way for your body to rest and build up energy for each push in the second stage.
• Increased pressure in your bottom, and an urge to push.
• Your baby's head moving down through your pelvic area.

The second stage can also be recognised by:

• a natural 'purple line' that may appear between the buttocks in some births
• the baby's head or membranes becoming visible
• changes in behaviour, such as grunting during contractions
• the length and frequency of your contractions
• often involuntary pushing or bearing down

Generally, birth is expected to happen within 3 hours of full dilatation if it is your first birth, or within 2 hours if you have given birth before. If you have an epidural, this usually includes about 1 hour of passive descent, followed by 1 to 2 hours of active pushing for a first birth, or 30 minutes to 1 hour of active pushing. Both depend on the process and baby's wellbeing.

If the second stage lasts longer, it is known as prolonged second stage of labour.

If birth is not close after 2 hours if it is your first birth, and up to an hour if you have had a baby before, your care team will call a doctor to review how things are progressing.

The exact length of the second stage can vary greatly between pregnancies. If you have an epidural, it could make this stage take longer.

There are many pain relief options when giving birth, including non-medical pain relief options such as:

• relaxation
• transcutaneous electrical nerve stimulation (TENS)
• massage
• heat
• warm water

Medicines for pain relief include:

• laughing gas (nitrous oxide with oxygen)
• fentanyl
• epidural

Different options may be available depending on your circumstances. For example, some hospitals and birthing centres may not have a bath for pain relief, and epidurals aren't offered in some settings.

You may prefer specific pain relief options for labour and birth. It's a good idea to plan ahead with your doctor, midwife and birth partner during your pregnancy, to make sure your choices are available in your situation and at your birth location.

During the second stage of labour your birth partner can continue to support you. They might do this by:

• giving you sips of water to drink
• helping you change position
• providing emotional support and encouragement
• advocating for you, by being involved in discussions with your midwife or doctor

During pregnancy, it's a good idea to discuss with your birth partner about how you'd like them to support you during labour.

Your midwife will also continue to support and encourage you, as well as looking after your health and the health of your baby.

Pushing when you feel a contraction helps your labour progress. Only start pushing when you feel ready and when your midwife says you are fully dilated. Your body is the best guide — you will usually feel an urge to push at the right time.

If you have had an epidural, you will not feel an urge to push, or the sensation may not be as strong. Your midwife will guide you regarding when to push and for how long.

It is more effective to push in upright positions such as:

• squatting
• kneeling
• sitting
• standing
• using a pool or bath

It is your right to choose how you birth your baby. Having an epidural will limit some of your movement when birthing your baby.

At the end of the second stage, your baby is born. Your midwife or doctor will help ease your baby out. With your consent, they may apply gentle pressure to your baby's head. This will help your baby emerge slowly and reduce the chance of tearing into the muscle and skin around your vagina (perineum). They may offer a warm compress to protect the skin between your vagina and anus (perineum) from tearing.

Your health team will ask you to give informed consent for all treatment or procedures, including in an emergency situation. If your doctor or midwife feel it is necessary, they may ask for your permission to perform an episiotomy. This is a surgical cut made to prevent the skin of the perineum from uncontrolled tearing and to help deliver your baby. It is helpful to speak with your midwife and doctor about possible treatments and procedures before your baby is born, to be able to make informed decisions when you are in labour.

Read the GLOSSARY OF PREGNANCY AND LABOUR — a list of common terms and abbreviations used by health professionals in pregnancy and labour.

After your baby is born, your midwife will check that your baby does not need any immediate medical care. If your baby is well, they will give you your baby to hold and cuddle. This skin-to-skin contact, also called 'kangaroo care', helps to create a bond between you and your baby and can encourage your baby to breastfeed.

Your midwife will check you and your baby, staying close by in the birth room to support you.

Every labour is unique, and sometimes things don't go according to plan. You may have to adjust your birth preferences if the situation changes.

There can be labour complications and you or your baby may need extra medical support.

If pushing is difficult, your baby's position is tricky or they are distressed, your midwife or doctor might use forceps, a vacuum cup or kiwi cup to assist the birth. It is often a decision that needs to be made in the moment. Your midwife or doctor will explain what will happen and any possible side effects and ask for your consent.

A caesarean section may be offered if:

• your baby is in distress
• the baby is in an abnormal position
• you or your baby are at risk and birth needs to happen quickly
• labour is not progressing

Your midwife or doctor will work with you to make the best decisions and the safest outcomes for you and your baby.

If you'd like more information or support, the following organisations and services can help:

• The Australian Government has a range of pregnancy information resources (Opens in new tab).
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists provides a pamphlet on labour and birth. (Opens in new tab)

Languages other than English

• The Multicultural Centre for Women's Health (Opens in new tab) offers a library of pregnancy, birth and postpartum resources in many languages.
• Monash Health (Opens in new tab) has health information translated into many languages, including pregnancy-care topics.

Information for Aboriginal and/or Torres Strait Islander peoples

• Birthing on Country (Opens in new tab) supports culturally safe, community-led maternity care for First Nations families.
• Find an Aboriginal Community Controlled Health Organisation (ACCHO) (Opens in new tab) near you.

Information for sexually and gender-diverse families

• Rainbow Health Australia (Opens in new tab) has a library of practical resources on services for LGBTIQ+ and gender-diverse families.
• QLife (Opens in new tab) is a free, national phone and webchat service that provides anonymous peer support and referrals for LGBTIQ+ people and their families.