Hooray! Your cervix has finally dilated to 10 cm. after 14 hours of labor. You may have thought that you were exhausted, but hearing this good news gives you a second wind. This is very important because the real work of labor is about to begin. It's time to push the baby out. Your practitioner may tell you that the baby's head is at +3 station. That means there are only 2 cm. between the baby and the outside world. Station refers to the actual location of the diameter of the baby's skull in relation to the midpoint of the mother's pelvis. The baby's head can be anywhere from -3 station to +5 station. The head achieves +5 station at delivery.
During the first stage of labor, as your cervix dilated from 0 to 10 cm., you were a spectator to the powerful forces that are unleashed in labor. The second stage of labor, in which the baby is pushed out, depends on your pushing efforts. Although the uterus is still contracting approximately every 2 minutes, and pushing the baby further down, the most important force in the second stage is maternal pushing. This means that the harder you push during each contraction, the faster and more efficiently your baby will descend.
For some women, particularly those who have not had epidural anesthesia, pushing provides real relief. They may have struggled through transition against the almost unbearable urge to push. Now they do not have to resist the urge any longer and they can give in completely, following the natural cues of their bodies. However, other women do not find that pushing brings any relief. For them, the intense pressure caused by the baby's head as it descends just continues to increase the pain. Nevertheless, the thought that labor is almost over motivates them to push through the added pain and hastens the moment of their baby's birth.
A woman who has chosen epidural anesthesia does not feel these sensations. She may encounter a different problem, however. Because she does not feel the urge to push, she may not know when to push. She must rely on an assistant, such as the labor nurse or her coach, to let her know when each contraction starts, so she can coordinate her efforts. The assistant can tell when contractions are starting by feeling the mother's abdomen. In addition, some women experience a motor block as well as a sensory block when they receive epidural anesthesia. In other words, the epidural diminishes their muscle power even as it controls the sensation of pain. Although they may push with all their might, their pushing efforts are not nearly as strong as they might be without receiving an epidural. The fetal monitor can be especially helpful if you have an epidural, because you may not feel your contractions. Watching the monitor lets you know when they are starting, so you can coordinate your pushing efforts with the contractions. Pushing is effective only during the contractions.
This may pose a problem if there is a relatively tight fit between the fetal head and the mother's pelvis. The mother cannot push hard enough to push the baby out. That's why many practitioners recommend decreasing the amount of medication in the epidural, or even turning it off, in the second stage. Although there is increased pain along with the increased muscle power, it is often all that is needed to avoid a Caesarean section or a forceps delivery.
As the baby's head descends, the excitement in the room increases. This process usually takes from 1 to 2 hours in first-time labors, though it may be as brief as a few minutes if you have given birth before. Everyone can tell when the time for delivery draws near. First, the baby's head appears at the opening of the vagina during contractions. Then, as the head descends even lower, it remains visible even between contractions. You may experience intense sensations of burning and stretching as the baby's head fills the lower vagina.
It's important to push past the pain. Sometimes it's hard to know exactly where to direct the pushing, and you can waste your efforts by pushing into your legs or against the bed. This position minimizes wasted effort. Also, opening your legs wide makes more room for the baby as its head descends.In the second stage, the fetal monitor is used more frequently and for longer periods of time-sometimes continuously. That's because this stage is often the most stressful for the baby as well as the most demanding for the mother. Some babies may demonstrate signs of mild distress during pushing. Usually, supplemental oxygen given to the mother is enough to correct this problem.
There's no such thing as too much encouragement when you're pushing. It's hard work, and progress is often made slowly. Lots of love and support can make all the difference when your spirits are flagging.