GNM 3rd YEAR B.SC (N) 4th YEAR

1. SECOND STAGE OF LABOUR
MS. BEENA VAZA

2. 2ND STAGE
 It is the stage of expulsion of the fetus. It begins
with full cervical dilatation and ends with the
delivery of the fetus.
 Duration : about 1 hour in primigravida and ½ hour
in multipara.

3. PHASES IN 2ND STAGE IN LABOUR
1.PROPULSIVE : From full dilatation of cervix to fetal
head touches the pelvic floor.
2.EXPULSIVE : From mother has irrespectible desire to
bear down and push until the baby is delivered.

4. SIGNS OF 2ND STAGE OF LABOR
1.Positive signs : Cervix does not felt in vaginal
examination
2.Probable signs :
A) EXPULSIVE UTERINE CONTRACTION : Mother has
strong desire of bear down. trickling of blood vaginal
mucosa is stretched and lacerated while head pushes
downward.

5. CONT…
B) Membrane is ruptured
C) POUTING AND GAPING OF THE ANUS : When head
touches the pelvic floor, pouting and gaping of the anus
are happened. Usually cervix dilated.
D) Tenseness between anus and coccyx is occurred due to
pressure of descending head on pelvic floor.
E) Congestion and gaping of vulva
F) Presenting part is appeared.

6. CONT…
3. IMPENDING SIGNS
A)Nausea and retching
B)Irritability and uncooperativeness
C)Complaints of severe discomfort
D)Please for relief

7. MECHANISM OF LABOUR OR MOVEMENT OF LABOUR
 The series of passive movement of the fetus in its
passage through the birth canal is known as
mechanism of labour.

8. CONT…
1. Engagement of the head
2. Descent
3. Flexion
4. Internal rotation
5. Crowning of the head
6. Extension of the head
7. Restitution
8. External rotation of head and internal rotation of shoulder
9. Birth of shoulders and trunk

9. 1. ENGAGEMENT OF THE HEAD
 This is when the widest part of the fetal head
descents into the maternal pelvis.
 Engagement is identified by abdominal palpation,
where the fetal head is 3/5th palpable.

10. 2. DESCENT
 In the primigravida, this is likely to occur from 38 weeks
gestation onward, there is no practically descent in the first
stage.
 Descent is encouraged by:
 Increased abdominal muscle tone
 Braxton hicks contractions in late stages of pregnancy
 Uterine contraction and retraction
 Bearing down efforts
 Straightening of fetal spine after rupture of membranes.

11. 3. FLEXION OF THE HEAD
 Flexion is necessary for further descent. As the fetus
descents through the pelvis, fundal dominance of
uterine contraction exerts pressure down the fetal
spine towards the occiput, forcing the occiput to
come into contact with the pelvic floor.

12. 4. INTERNAL ROTATION OF THE HEAD
 This is the forward turning of the part of fetus, occiput
rotates forward.
5. CROWNING OF THE HEAD
 After internal rotation of the head further descent occurs
until the occipital prominence escapes under the
symphysis pubis and the head no longer recedes between
uterine contractions.

13. 6. EXTENSION
 It is a movement by which flexion of the head is
undone.
 Delivery of the head takes place by extension
through “ couple of force” theory.

14. 7. RESTITUTION
 The turning of the head to untwisting of the neck
that took place during internal rotation of the head
is called restitution.

15. 8. EXTERNAL ROTATION OF THE HEAD
 When the uterine contraction takes place after the
head is born, internal rotation of shoulders, a
movement similar to the internal rotation of the
head takes place.

16. 9. BIRTH OF SHOULDER AND TRUNK
 After the shoulders are occupied in antero-posterior
diameter of the outlet, further descent takes place
until the anterior shoulder escapes under the
symphysis pubis, the posterior shoulder passes
under the perineum and the rest of the trunk is
born by lateral flexion.

17. MANAGEMENT OF 2ND STAGE OF LABOUR
1.Observation for labour progress
2.Fetal condition
3.Physical – Bladder care, bowel care, pain relief etc..
4. psychological care