Online Childbirth Education Class Four

The Second Stage of Labor - Pushing

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Second Stage: Once you've dilated to 10 centimeters, you are in second stage of labor, the pushing phase. This will end with the birth of the baby. This stage can last a few minutes or several hours.

What You Might Be Feeling

  • Contractions that are very manageable
  • Urge to push
  • Rectal Pressure
  • More energy

Behavior & Attitude

Now that you've come through the hard work of transition, you might get a second wind or burst of energy. After all of that relaxing it feels good to actively help birth your baby.

Ways to Cope

You may find that you have a brief lull in contractions from the harshness of transition to the pushing stage. Remember to use it wisely, as one childbirth educator aptly called it the "Rest and be thankful phase!"

Here are some suggestions of things to do:

  • Remember to relax
  • Find a comfortable, productive position to push in
  • Figure out whether spontaneous or directed pushing works best for you

What Your Partner Might Do

  • Stay with her
  • Encourage her to find a comfortable, productive position
  • Praise her
  • Count for 6-10 seconds, if that is helpful for her

The Birth!

Despite all of the technical information you'll find here, remember to enjoy the birth of your baby. Watch with the use of a mirror, or by looking down. Touch your baby's head as it emerges. Talk to your baby as he or she is laid on your abdomen. Enjoy!

Positions for Pushing

Squatting with the Squat Bar in Labor
Photo © Sara Corman Photography

The position you choose to push in should be mainly productive and comfortable for you. Gravity will really help bring your baby down, particularly when pushing is difficult. If you're having a fast second stage choosing a position to slow the birth is good as well.


This also uses gravity and opens the outlet of your pelvis up to 10% or more. It's jokingly called the midwives forceps, but it's very beneficial. Can be used in conjunction with monitoring equipment. (See picture.)

Hands and Knees:

This is a great position for backache! It allows the baby to come out of the pelvis slightly and encourages it to turn and assume a better position if it is posterior (or facing your front), it also provides some relief for contractions and removes gravity. Being in this position also allows you to do pelvic tilts for comfort and gives your partner great access to your back for massage and counter pressure. Can be used in conjunction with monitoring equipment. (See picture.)

Side Lying:

This is a good relaxation position. It is gravity neutral and can help slow a fast birth or ease the pain of some contractions. It can be used in bed and in conjunction with monitoring equipment or may be requested if you're having complications with your blood pressure. (See picture.)


This position is most frequently used with epidurals and other anesthetics. It does not utilize gravity and can actually make a tear or episiotomy more likely. Even with medications there are better positions that you can assume, for example sitting more upright. Can be used in conjunction with monitoring equipment.

See also: Birth Ball: Pregnancy, Labor & Beyond

Urges to Push - Tips for Pushing in Labor

Man helping woman push in labor
Photo © Scott Handcock/Getty Images

Overwhelming Urge: This is the uncontrollable urge to push. It really takes every ounce you have not to push with the contractions. A gravity neutral position may help decrease this urge if the birth is happening quickly.

So-so Urge: Mom may have the desire to push with every other contraction or only at the peak of the contraction. It may be that this is simply early second stage and the baby hasn't hit all the nerves to signal the overwhelming urge.

No Urge: As with the so-so urge, positioning and time are the best bets if this become a problem. It also might help to switch to directed bearing down.

Ways to Push

Spontaneous Bearing Down: This simply means that mom pushes as she feels the desire to do so. The proponents of this method claim it's less stressful to mom and baby and can make for a shorter second stage. Generally the instinct moms have is to hold their breathe for shorter periods of time and to relax other areas of their bodies.

Directed Bearing Down: This helps the woman who cannot feel her body push more effectively. You simply begin each contraction with a deep breath, blow it out, inhale again and hold the breath, using it to curl over your body and push down, while someone (partner, nurse, doula) counts to ten. You quickly release your breath, inhale again and repeat until the contraction is over.

Laboring Down: This method is gaining popularity with nurses and staff particularly for women who have anesthesia. The mother does no active pushing until the head can be seen. This is less tiring and better, particularly when mom can't feel to push.

More on pushing in labor.

How a Baby Helps Be Born

Homebirth with a midwife
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We often think of the mother as doing all of the work during labor. This is actually not true. During the first stage of labor the baby is twisting and turning trying to find the path of least resistance to allow themselves to be born.

During the second stage as the uterus is pushing the baby, and mom is working on pushing, many times the baby is also pushing itself out through the birth canal. Choosing positions to enhance this stage also help.

Stirrups & Foot Pedals

Breaking the bed down, or the use of instruments to help you push can either be beneficial or not. You can choose to give birth simply with the end of the bed attached.

Stirrups are the most common and are generally used with anesthesia, and sometimes after a very long labor. They hook on to the end of the bed and will support at least the calf area of your leg and sometimes the entire leg and foot. If you prefer to pull your legs towards you as you push you can do this. The drawback is that this can hyperextend your legs (pain later), most women are laying too far back to utilize gravity, and it can increase the pressure on your perineum making the tissue less resistant to tearing.

Foot pedals or heel cups are simply places to rest your feet while pushing. This can make the bed more like a birth chair. Many women, even with anesthesia, can use this type of support.

There are also a variety of other enhancements, like the squat bar, designed to help you squat on the end of the bed. It can also be used to place your feet against while pushing. Be sure to ask around to several people to find out if you have this available.

See also: Why Labor is Good for Babies

Third Stage of Labor

Doctor holding a placenta
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Third Stage

When you've got your baby in your arms this stage often gets neglected, but it begins with the birth of the baby and ends with the birth of the placenta. It generally takes less than an hour, though it can go on longer without complications for some women.

The placenta will detach from the uterine wall and be expelled through the vagina or birth canal. Your practitioner will be able to tell that your placenta is ready to be born either by a small gush of blood or a lengthening of the cord.

The third stage is fairly anticlimactic for most. While you're holding your baby the doctor or midwife may remind you to push gently to help expel the placenta. My midwife with my second baby told me, "Small pushes, this is easy, no bones for this one!" I laughed, and all was said and done.

Sometimes the placenta is delayed. Nursing your baby will help stimulate contractions to help bring the placenta, because it will release oxytocin (hormone) into your body. Also coughing, sneezing and laughing can be used as techniques to help you expel the placenta.

What You Might Be Feeling

  • Contractions that are very manageable
  • Joy, relief, a mixture of emotions

What Your Partner Can Do

  • Hold the baby if mom can't
  • Remind her of relaxation and breathing techniques if need be

Some women and their families wish to see or save the placenta. Your practitioner can give you a quick tour of this amazing organ that nourished baby for so long. In a home birth it may be your responsibility to dispose of the placenta. Be sure to ask.

Planting the placenta is seen as a ritual for some families. You need to dig a deep hole, at least 16 inches deep and bury the placenta. You must wait a year before trying to plant a tree or anything over it because it will be too rich and actually kill the plant.

See also: 6 Things to Do With Your Placenta

Labor Support and Doulas for Labor

New mom and baby with laundry
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A doula is a woman trained to provide families with help during the pregnancy, birth and postpartum period.

What does a doula do?

Doulas do not provide you with any clinical care, so they do not replace your doctor or midwife. Generally your relationship with your doula will begin during pregnancy. As you discuss the desires you have for your upcoming birth your doula will help you find ways to obtain your goals. This may be in the form of finding the appropriate childbirth class, learning techniques, writing a birth plan, or many other things.

Doulas are proficient in massage, positioning, comfort measures, relaxation and breathing. They will help you, and your partner decide which position will help labor along or make labor more comfortable. Along the way she will make suggestions and reminders about simple things that are often forgotten, like going to the bathroom, or drinking fluids.

Your doula will help you remember what plans you had for labor and help you get the things that you wanted. She can also help you when changes need to be made or complications arise.

After your baby is born she can help you with breast feeding and postpartum issues. Some doulas even do postpartum home care, such as light housekeeping and helping with errands and older children. Though sometimes you will find a doula does either postpartum or birth work.

See also: 5 Reasons You Might Need a Postpartum Doula

Who needs a doula?

A newborn skin to skin with doula
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Anyone having a baby can use a doula. Some people believe that doulas are only for women who want an unmedicated birth. This is not true. Doulas have very important roles to play in medicated and surgical births too. There are many reasons a woman hires a doula.

Women who are planning a natural birth often do hire doulas to help increase their support team. High risk mothers often feel the need to have someone taking care of her family emotionally while she is receiving the best in high technological care from her clinical staff. Sometimes single mothers will choose doulas because of the lack of support from family or her partner.

Current research has shown us that using a professional doula during labor provides you many benefits including:

  • reduction in the cesarean rate
  • shorter labor
  • reduction in epidural requests
  • reduction in oxytocin use
  • reduction in analgesia use
  • reduction in forceps delivery

Do dads feel left out?

No! Doulas do not replace the father in any way, shape or form. In fact many of the dads that I work with say that they are very happy to have me there. It is often forgotten that dads are going through this labor too, while not physically, they are emotionally invested. Some have a hard time remembering what was taught in class, or others did not attend classes, so are trained in labor support. Doulas can take that pressure off by allowing them to do what they do best, love their partner.

Do I need a doula for a c-section?

Birth Plans

Mom in Labor, Dad Helping
A birth plan is a communication tool since labor isn't a time to talk.. Photo © Flying Colours Ltd / Getty Images

Birth plans are ideas and hopes that you have about the birth. They are used to help people, who come into contact with you in labor, know a bit more about you and what you want from the birth.

Most people have preferences for how things are to be done during the labor and birth. A birth plan might address some of the following issues:

  • Do you want mobility or do you wish to be confined to a bed?
  • Do you want a routine IV, a heparin lock, or nothing at all?
  • Do you want to wear your own clothing?
  • Listen to music?
  • Use the tub or shower?
  • Do you want pain medications or do you want to avoid them?
  • Do you have preferences for which pain medications you want?
  • Would you prefer a certain position in which to give birth?
  • Would you like an episiotomy? Or, are there certain measures you want used to avoid one?
  • If you need a cesarean, do you have any special requests?
  • For home and birth center births, what are your plans in case of transport?

As you can see there are many topics that may be addressed in a birth plan. All of these topics should be discussed prenatally with your care provider. I prefer that they are written down and even signed by your care provider if you are going to a birth center or hospital, so that the people that you don't know, with whom you will come into contact with, will know your preferences.

There are many types of birth plans in written format. Some are many pages long, and some are just a single paragraph that simply "set the tone" for the birth. There is always a happy medium and only you will know what works for you.

The best birth plan is one that you and your partner write together and keep in a short, bullet format. It should include not only plans for labor and birth, but information on baby care/postpartum and what your preferences are if you should require interventions like a cesarean.

7 Things to Consider for Your Birth Plan

Visualization Techniques for Labor and Birth

Woman using exercise ball in labor
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Visualization is a great relaxation technique for nearly everyone. It can be done in many situations and has great potential to be very individualized.

When we talk about visualization most people are going to think of things like reading scenarios of walking through the forest or laying on the beach listening to waves. That can be a visualization exercise. However, what works best is usually something personal.

Many people tell me that they enjoy reliving a positive experience, a date, a vacation, their wedding. This is done by the retelling of the story by your partner. Being sure to include all of the details to actually help remember, like sights, smells, tastes, sounds. Utilizing all of the senses is important.

Other people find this to be annoying and use visualization to produce a scene that they desire, for instance their ideal birth. This is actually a personal favorite of mine. My husband will get me into a relaxing position, spend a few minutes checking for tension and then begin to tell me the birth of the baby. I can then process the birth and he can observe for tension. Did I tense when he said anything particular? Sometimes I notice and sometimes I don't. If it's something I have control over we can pin point that as an issue to deal with.

Explaining what is going on in the body and using those images as a relaxation tool is also beneficial. For some woman knowing that what she is feeling is her cervix opening, and giving her an image of a baby help to dilate the cervix or of an abstract object like a flower bud opening often work well.

Some women will even choose a single, inanimate object. It might be a photo, a special relaxation card, solid sheet of paper, basically whatever works.


Pregnant woman learning relaxation
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Using your voice during labor and birth can be very useful. Making grunting noises while pushing (much like weight lifters) is done almost involuntarily. Any noise that works for you is probably good, the only exception tends to be high pitched noises.

Try this:

Make a high pitched squeal. Can you feel your bottom and throat tighten. Now make a low moan. Can you feel your body loosen? The same principal applies in labor.

See you in Class Five!

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