What is the second stage of labour?

The second stage of labour begins when your cervix is 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.

This stage has 2 parts:

• a passive stage, where you may not feel an urge to push straightaway
• an active stage, when you feel the urge to push, which ends with your baby's birth

What are signs of the second stage of labour?

In the second stage of labour, you may feel:

• strong, longer contractions, with short 1 to 2 minute breaks to give your body time to rest
• increased pressure in your bottom and an urge to push, due to the baby's head pressing down on your pelvic area
• your baby's head moving through your pelvis, with stretching or burning around your vagina and perineum, making room for your baby to be born

How long can the second stage last?

The active stage can take up to 2 hours if this is your first birth and up to an hour if you have had a baby before. If you have an epidural, it could make this stage take longer.

The exact length of the second stage can vary greatly between pregnancies.

What pain relief might be available and when can I have it?

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

• relaxation
• TENS
• massage
• heat
• warm water

Medicines for pain relief include:

• paracetamol
• laughing gas (Nitrous Oxide)
• morphine
• 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.

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.

What is the role of my birth partner during the second stage of labour?

During the second stage of labour your birth partner can continue to support and 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 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.

Why is it important to push during labour?

Push when you feel a contraction to help your labour progress. The best way is to push 2 or 3 times with each contraction. Then breathe and rest between each one.

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 may 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.

What happens as my baby is being born?

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 around your vagina (perineum). They may use a warm compress to protect the skin around your vagina (perineum) from tearing.

Your health team will ask you to give informed consent for all treatment or procedures, unless it is an emergency. If they feel it is necessary, your doctor of midwife may ask for your permission to perform an episiotomy. This is a cut made to prevent the skin of the perineum from uncontrolled tearing — especially during assisted delivery (with forceps or vacuum).

What happens once my baby is born?

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, or 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.

What happens if something goes wrong?

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

There can be labour complications in which extra medical support is needed.

If pushing is difficult, your baby's position is tricky or they are distressed, your midwife or doctor might use forceps or suction 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, if there is time, ask for your consent.

A caesarean section may be needed if:

• your baby is in distress
• the baby is in an awkward position
• your baby is at risk and needs to be delivered quickly
• labour is not progressing

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

Resources and support

• Speak to your doctor or midwife during a prenatal visit about what to expect in the second stage of labour and birth.
• You can also listen to our podcast on understanding your choices when having a baby.
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists provides a pamphlet on labour and birth.
• Health NSW has created a labour and birth booklet outlining the various stages, what to expect at each stage of the birthing process and as well as how you can be supported.