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2ND STAGE OF LABOR: Three phases to a spontaneous ,non-instrument delivery of the foetus in a vertex presentation.

a) Delivery of the head b) Delivery of the shoulders c) Delivery of the body and extremities The occiput generally rotates anteriorly and with voluntary bearing down efforts, the head distends the introitus The head crowns when its widest part (the biparietal diameter) distends the vulva just before birth. Immediately before delivery, the perineal musculature becomes greatly distended. If an episiotomy is necessary, it is done at this time to minimize soft tissue damage. DELIVERY OF THE HEAD: The vertex first appears followed by the forehead,face,chin and neck. The nurse modify controls the birth of the head by applying pressure against the rectum drawing downward to aid in flexions The head as the back of the neck catches under the symphsis pubis. Then applying upward pressure from the coccygeal region(modified Ritgen manenver)to extend the head during the actual delivery,thereby protecting the musculature of the perineum assisting the mother with voluntary control of the bearing-down efforts by coaching her to pain. In addition to protecting maternal tissue gradual delivery is imperative The cord often encircles the neck but rarely so tightly as to cause critical hypoxia Slight downward traction is applied to the head to delivery the anterior shoulder and arm. During the 2nd stage,each contraction is monitored for frequency ,strength ,duration ,intensity and fetal response. The amniotic fluid is checked for meconium staining angamount. Flexion of the head is to be maintained till the subocciput comes under the symphysis pubis so that lesser suboccipito frontal 10c, diameter emerges out of the introitus

Donot be hasty in delivery of the shoulders.wat for the uterinecontraction to come and for the movements of restitution and external roation of the head to occur. Traction on the head should be gentle to avoid excessive stretching of the neck causing injury to the brachial plexius,haematoma of the neck or fracture of the clavicle. DELIVERY OF THE TRUNK: After the delivery of the shoulders,the forefinger of each hand are inserted under the axillae and the trunk is delivered gently by lateral flexion. She may lie on her left side in order to relieve pressure on the rectum and improve placental blodd flow. Breathing exercise may help her to control her urge. Radiological evidence demonstrates an increase of 1cm in the anteroposterior diameter of the pelvic outlet when the squatting position is adopted.this produces a 28%increase in the overall area of the outlet when comparing the supine with the squatting positons,resulting in obvious benefits to the progress and ease of delivery. Leg cramp is a common occurrence whenever posture is adopted.it can by relieved by massaging the calf muscle,extended the leg and dorsiflexing the foot. Uterine contractions every 2 or 3mins and last 50-60seconds Once the head reaches the pelvic floor (the outlet)fewer than 10contraction probably will be required for delivery if the women previously has given birth to full term infant. For the first delivery 20 contractions will be necessary. One must be ready for the delivery when the head reaches the introitus.