INTRAPARTUM

2nd STAGE of LABOR

BSN Level 2
SY 2021-2022
The second stage of labor (Fetal Expulsion

 Begins when the cervix is completely opened and ends

with the delivery of the baby.
 Is often referred to as the "pushing" stage.
 At the start of the second stage, the fetal presenting
part may or may not be fully engaged and the women
may or may not have to urge to push.
 During the second stage, the woman becomes actively
involved by pushing the baby through the birth canal
to the outside world.
Contractions in second-stage labor are:
 Powerful
 Coming every two to three minutes and lasting 60 to
90 seconds.
 splitting and burning sensation on the
perineum( bulging) or vagina as these parts of body
stretch to accommodate baby's head (crowning)
 What is delivery room ?

 The Delivery Room is a special unit in the hospital where

pregnant women give birth to babies. Prior to transfer of
the patient to the DR, the patient may need to stay inside
the Labor Room where the mother is being assessed and
monitored.
 Assessment for Second Stage
 1. FHR with every contraction (positioning and oxygen)
 2. Observe for increase bloody show, bulging perineum
and anus, visibility of the presenting part (crowning)
 3. palpate bladder for distention (empty if needed)
 4. assess amniotic fluid for color and consistency
Preparing the place of Birth ( Delivery Room)

 is usually done by the Midwife/Nurses on duty and strict

aseptic technique is maintained.
 The room ( which is the delivery room) is prepared while
the patient is in the first stage of labor( latent phase, active
phase, transition phase.
 It is usually 2 to 12 hours if the tables are covered and the
room is closed.
B. Position of the women during the second stage of labor
 Lithotomy Position
 Dorsal Recumbent
 Side Lying Position
 Squatting
 Upright position
 Kneeling Position
Promoting Effective pushing
 1. For effective pushing, the women should fell the urge to
push even though the pelvic exam revealed that she is
fully dilated.
 2. Best done when semi-Fowler’s position with the legs
raised again the abdomen
 3. Prevent the women from holding breath by urging her
to grunt or breath out during pushing effort
 4. In case of nuchal cord, teach the mother to pant(puffing,
blow) to prevent her from pushing.
 A nuchal cord is a complication that occurs when the
umbilical cord wraps around the baby's neck one or more
times. This is common and occurs in about 15 to 35 percent
of pregnancies.
 5. Pushing is involuntary -When the cervix is fully dilated
the mother’s body will push the baby out. Some healthcare
provider get very excited during the pushing stage. they
yell at mothers Push! Push!
D. Perineal cleaning

Goal : To prepare the tissues to stretch over the baby’s

head and the body during vaginal delivery.
E. Episiotomy-
- also known as perineotomy a surgical incision of the
perineum and the posterior vaginal wall generally done by a
midwife or obstetrician.
 To facilitate easier delivery of the baby
 Assist the physician during the procedure. (Instruments,
drape’s gloves and sutures should be layed out.)
Two types of episiotomy incision
 Midline ( median)incision
-is done vertically
-easier to repair but it has a higher risk of extending into the
anal canal
 Mediolateral incision
-is done at an angle
 Fourth degree laceration is involves the anterior rectal wall
 Special attention needs to be paid to third and fourth
degree laceration to prevent future fecal incontinence
 Both episiotomies and perineal lacerations require stitches
to repair and ensure the best healing.
 (Chromic 2-0 double arm)
Types of episiotomy
 F. Birth

 Do not apply fundal pressure to help push the baby out.

 Fundal pressure can cause the placenta to detach or the
uterus to rupture.
 First babies may take a full 2 hours of strong contractions
and good pushing to be born.
 Second and later babies usually takes 1 hour of pushing.
As long as the baby continues to move down even very
slowly and the baby’s heart beat is normal and healthy.
 The mother should continue to push until the head crowns.
 Assessment during the Second Stage of labor
1. FHR with every contraction (positioning and oxygen)
2. Observe for increase bloody show, bulging perineum and
anus, visibility of the presenting part (crowning)
3. palpate bladder for distention (empty if needed)
4. assess amniotic fluid for color and consistency
 https://www.youtube.com/watch?v=dYu-0rOnLpA
 Mechanism of labor
 -is a series of passive,adaptive movements of the fetal
head and shoulders smallest diameter to pass through the
birth canal.
- the mechanism of labor are the positional movements
that the fetus undergoes to accommodate itself to the
maternal pelvis.
1.Ritgen’s Maneuver is done for the Prevention of Anal
Sphincter Tears at Delivery
Ritgen’s Maneuver is done as soon as the head of the fetus is
crowning.
2. Ask the woman to continue pushing until the fetal head is
gently born
3.Immediately after the delivery of the fetal head, pass the
fingers around the head of the fetus to feel if there is a
“Nuchal Cord”
 If single –coiled, loosen and drawn over the fetal head.
 If multiple coiled or tightly coiled, clumped and cut before
the shoulder are born.
 Exert gentle downward pressure on the side of the fetal
head to facilitate the birth of the anterior shoulder, then
slight upward pressure for the posterior shoulder.
 The time of the birth and the gender will be announced
when the whole-body of the child is born.
Management During the Second Stage of Labor
 Support the woman and her husband in making decision
about he care and labor management.
 Assessment is continuous during the second stage of
labor involves identifying the sign of:
 Increase of apprehension or irritability
 Spontaneous rupture of membranes
 Sudden appearance of sweat on upper lip
 Increase in blood -tinged show
 Low granting sounds from the woman
 Complain of rectal and perineal pressure
 Beginning of involuntary bearing down efforts
 Assessment focuses on determining the progress of labor.
Associated signs include:
 Bulging of the perineum
 Labial separation Advancing and retreating of the
newborn’s head during and between bearing down effort.
 Crowning( Fetal head is visible a vaginal opening)
Delivery instruments (sterile)
 Scissors.
 Needle holder.
 Artery forceps or clamp( Kelly Forceps)
 Dissecting forceps (Tissue Forceps)
 Sponge forceps.
 Vaginal speculum.
 Nursing interventions for Second Stage of labor
 1.VS every 15 minutes between contractions
 2. continuous FHR
 3. teach client with positioning (squat, lithotomy, side to side
pushing)
 4. teach client to hold breath for no longer than 5 seconds
during pushing
 5. set up delivery table (bulb syringe, cord clap, ID bands),
baby warmer turned on
 6. Record the exact delivery time, and the gender
 Congratulations on the
arrival of your new baby
boy/girl !!!
THANK YOU FOR LISTENING!!!
 3rd stage of labor