Labour stages

1. Second Stage of Labor -
Management
Dr. S. Kalavathi
Professor
RMCON, AU.

2. Introduction
 The main aim of MCH is reduction of Maternal & Perinatal
morbidity and mortality
 The function of midwifery is preventive
 Every mother would like to deliver a healthy baby
 Every midwife should aim to fulfil her wish
 The close monitoring of fetal condition intelligent care
during labour will help us to identify the complications
early and help in achieving our goal
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3. Second Stage
The transition from the first stage to the second stage is evidenced by
the following features:
 Increasing intensity of uterine contractions
 Bearing-down efforts
 Urge to push or defecate with descent of the presenting part
 Complete dilatation of the cervix as evidenced on vaginal
examination
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4. Second Stage of Labor – Management - Principles
 To assist in the natural expulsion of the fetus slowly and steadily,
 To prevent perineal injuries.
GENERAL MEASURES
 Patient should be in bed
 Constant supervision & care
 Administration of analgesics if needed
 Vaginal examination – to confirm onset of second stage, position of
the fetus etc. 4

5. Second Stage of Labor – Management
Preperation
 Articles –
 Health Personnel
 Mother – Physical
Psychological
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6. Second Stage of Labor – Management (Cont..)
Articles
 For mother
 For Health personnel
 For conduction of labour
 For resuscitation of the newborn
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7. Second Stage of Labor – Management (Cont..)
Articles for Health Personnel
 Hand washing facility
 Plastic apron
 Sterile gown, gloves, (Mask, cap)
 Adequate light
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8. Second Stage of Labor – Management (Cont..)
For Mother
 For Draping – sterile green sheet – 2 or central hole
towel
 Leggings
 Mackintosh or trough
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9. Second Stage of Labor – Management (Cont..)
For Conduction of Labour
 For Cleaning –
 Sterile bowl with cotton swabs or gauze
 Antiseptic solution for cleaning the perineum
 Long artery forceps or sponge holding forceps
 Kidney tray (Used swabs can be discarded in the
bucket also)
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10. Second Stage of Labor – Management (Cont..)
For Conduction of labor
 Obstetric cream (for lubrication of fingers)
 Episiotomy tray (if needed)
 Cotton Pads (to support the perineum)
 Sterile sheet (to wrap the baby)
 Two artery clamp and cord cutting scissors
 Tray or bowl to receive the placenta
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12. Second Stage of Labor – Management (Cont..)
For Newborn
 A tray with sterile towel
 Sterile swab, Gauze (to clean the eyes & mouth)
 Suction bulb (for suctioning the secretion )
 Cord clamp
 Identification tag
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13. Second Stage of Labor – Management (Cont..)
Psychological Preparation of the Mother
 Explanation about how to bear down & when to bear
down
 Relaxation in between contractions
 Reassurance
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14. Second Stage of Labor – Management (Cont..)
Physical Preparation of the Mother
 Position:
 Woman can be delivered in lateral, squatting or
partial sitting.
 Dorsal position with 150 left lateral tilt – commonly
used position
 Toileting the external genitalia
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15. Second Stage of Labor – Management (Cont..)
Physical Preparation of the Mother(Cont..)
 Place one sterile sheet under the buttocks and one over the
abdomen
 Put on the leggings
 Essential Aseptic Precautions:
 Clean hands
 Clean surface
 Clean cutting & ligaturing of cord
 Catheterize the bladder if full
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16. Second Stage of Labor – Management (Cont..)
Conduction of Delivery
 Delivery of the head
 Delivery of the shoulder
 Delivery of the trunk
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17. Second Stage of Labor – Management (Cont..)
Conduction of Delivery: Delivery of the head
 Principles –
 Maintain flexion of the head to prevent early
extension
 To regulate its slow escape out of the vulval outlet
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18. Second Stage of Labor – Management (Cont..)
Conduction of Delivery: Delivery of the head (Cont..)
 Encourage the mother to bear down during
contractions
 When the head is visible for 5 cm in diameter
maintain flexion during contractions
 If the stool comes out it should be removed without
contaminating the sterile field
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21. Descent of the Head – ‘in fifths’

22. Abdominal Assessment of Descent of
Head (Cont..)
 In 0/5 – no poles felt abdominally
 In 1/5 – only sinciput felt abdominally
 In 5/5 – Head floating above the brim…..
Advantage
 Excludes the variability due to caput
 Assessment is quantitative – can be reproduced
 Avoids repeated PV

23. Second Stage of Labor – Management (Cont..)
Conduction of Delivery: Delivery of the head (Cont..)
 Maintain flexion during contraction – till crowning
 During crowning if perineum threatens to tear ,
Episiotomy may be given to enlarge the vulval outlet
 After crowning , tell the mother not to bear down
 Slow delivery of the head in between the contractions
 The forehead, nose, mouth and chin are born successively
over the stretched perineum by extension
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25. Second Stage of Labor – Management (Cont..)
Care Following Delivery of the Head
 the mucus and blood in mouth and pharynx are to be
wiped with sterile gauze piece on a little finger.
 Alternatively, mechanical or electrical sucker may be used
 The eyelids are then wiped with sterile dry cotton swabs
 The neck is then palpated to exclude the presence of any
loop of cord (20– 25%). If loose – slip; If tight - cut
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26. Second Stage of Labor – Management (Cont..)
Prevention of Perineal Laceration
 Delivery by early extension is to be avoided
 Spontaneous forcible delivery of the head is to be avoided by
assuring the patient not to bear down during contractions.
 To deliver the head in between contractions.
 To perform timely episiotomy (when indicated).
 To take care during delivery of the shoulders as the wider
bisacromial diameter (12 cm)
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27. Second Stage of Labor – Management (Cont..)
Conduction of Delivery: Delivery of the Shoulder
 The shoulder should be delivered after external
rotation of the head ( External rotation of the head
indicated that the shoulder has rotated internally)
 Deliver one shoulder at a time
 Anterior shoulder delivered by posterior flexion and
posterior shoulder by anterior flexion
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30. Second Stage of Labor – Management (Cont..)
Conduction of Delivery: Delivery of the Trunk
 After shoulder delivery, the trunk is delivered by
lateral flextion
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31. Second Stage of Labor – Management (Cont..)
Immediate Care of Newborn
 Establishment of Respiration. Clear air passage
 Position
 Warmth
 Cord clamping – delayed for 2 – 3 minutes or till cord pulsation
stops to allow addition blood from placenta to come to the
newborn
 Apgar rating at 1 & 5 minutes
 Identification and show the baby to the mother
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32. Summary & Conclusion
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