Today, we are joined by Dr. Kirstin Leitner, an Ob/Gyn, who answers our questions about what happens when we are 10 cm dilated, or what we call "the second stage of labor." What is the second stage of labor and how long does it take? Before we talk about the second stage of labor, let’s go back and talk about how labor is divided up. The first stage of labor is when someone is contracting, and the cervix is changing, from 0 to 10 cm. This, I think, is what people traditionally think of as “labor.” The second stage of labor starts when the person is 10 cm dilated, and ends when they give birth to their baby. And finally, the third stage of labor is after the baby is born, up until the placenta, or the afterbirth, is delivered. What can patients expect as they are giving birth? People’s experience of second stage sometimes depends on if they are a first time mom or if they have had babies before. I want to highlight that pushing during the second stage is a hard process. It’s lots of work, just like exercising! Also, for a first time mom with an epidural, it can be normal to push for up to four hours, as long as they are making progress and pushing the baby’s head down in the pelvis. Not everyone needs four hours, of course! But most first time moms need maybe one or two hours of pushing, especially with an epidural, before they give birth. With people who have had babies before, this is usually a shorter process. It can still be normal to push for up to 3 hours with an epidural, but many times, for people who have had babies before, it can even be just a few pushes before birth. This time is also shorter for people who don’t have epidurals, simply because sometimes with an epidural, it may be difficult to feel exactly where to push. But without an epidural, you can’t mistake it! What is key here is that we want you to listen to the guidance of your nurse, midwife, or doctor during this part of labor. Pushing can be different for everyone. If something is working for that person, and the baby’s head is coming down through the birth canal, then that is the correct way for them! But, I also understand that for first time moms, this may be a challenge and they may need some more guidance. We usually tell people to wait for a contraction to push, so that they are working with their bodies to give birth. We usually ask people to take in a big deep breath, hold the breath in their lungs, curl up around their belly, and push downward, into their bottom, almost as if they have to poop. The most effective way to push is to hold the push for as long as possible, usually about 10 seconds is what most people can manage. Then, because most contractions last anywhere between 30 seconds to 1.5 minutes, we ask our patient to try and push three times with each contraction. That means three times taking a big deep breath and pushing down, for a total of 30 seconds of pushing with each contraction. What are episiotomies, and do we still cut them? So first, what is an episiotomy? An episiotomy is when your midwife or doctor uses scissors to cut a small portion of the skin or muscle on the perineum, which is the area between the vagina and the anus. This is usually done to allow for the baby’s head to deliver more quickly or to allow for other necessary procedures to be performed. Also, the thought used to be that if we cut an episiotomy, mom will have less tearing from the baby’s head coming out. That being said, we don’t normally cut episiotomies anymore if everything is going well. We have many studies that now show that it is better for mom if we allow there to be natural tearing of the area from the baby’s head instead of cutting an episiotomy. If you do need to have an episiotomy, your doctor or midwife will tell you and explain why. But again, this is not something that we routinely do anymore. Why do mom and baby need to be monitored during second stage of labor? Sometimes, pushing can be a very easy process, but sometimes, even though birth is natural, there are some things that can go wrong. That is why we always keep monitors on the baby. In the Induction of Labor podcast, we talked about different types of monitors, including the contraction monitor and the fetal heart rate monitor. Both of these monitors can be placed either inside the uterus or on mom’s belly, whichever is best to keep track of the contractions or the baby’s heartbeat. If we compare labor to a marathon, the second stage of labor, or when mom is pushing, is very much like that last leg of the marathon. We know that both mom and baby are tired. This can be a very vulnerable time for the baby, and we always want to make sure by looking at the heart rate monitor, that the baby is not becoming too stressed out. We want to make sure that the baby is still getting good oxygen from the placenta. Any time that we are afraid a baby is not getting enough oxygen from the placenta during labor, we have to think ...
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May 30 202121 min