The document discusses the second stage of labor and normal childbirth procedures. It describes: 1) The second stage of labor involves full dilation of the cervix over 1 hour followed by birth of the fetus. The fetus is born through a series of movements including extension, restitution, and external rotation of the head. 2) Proper techniques for assisting a normal vaginal delivery include encouraging the woman to push in her preferred position, suctioning the baby's mouth and nose after crowning, and gently guiding the shoulders and rest of the baby out one at a time to avoid tears. 3) Standard steps after birth include promptly placing the baby skin to skin on the mother, clamping and

1. Dr. Yin Moe Han
Senior Lecturer
Obstetrics & Gynaecology Department
School of Medicine, UCSI university

2. SECOND STAGE OF LABOUR
full dilatation of the cervix
up to 1 hour
birth of the foetus
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3. MECHANISM OF NORMAL LABOUR
Cardinal movements of labour (LOA)
Head is borned by Extension Restitution
External rotation
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4. Head is borned by EXTENSION
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5. RESTITUTION
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6. EXTERNAL ROTATION
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7. NORMAL CHILDBIRTH
Positions that a woman may
 General methods of adopt during childbirth
supportive care during
labour are most useful in
helping the woman
tolerate labour pains
 Once the cervix is fully
dilated and the woman is in
the expulsive phase of the
second stage, encourage the
woman to assume the position
she prefers and encourage her
to push
There must be enough room
in front of mom to care for the infant
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8. POSITIONING FOR DELIVERY
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9. PERINEAL CLEANSING
Need 6 swab balls
Clean sequentially as
shown by the numbers
Clean according to the
direction shown by the
Arrows
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10. CREATE A STERILE FIELD
AROUND THE VAGINAL OPENING
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11. CROWNING OF THE HEAD
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12. EPISIOTOMY
 Note:  Considered only in:
 Not a routine procedure  complicated vaginal
delivery
 Do not decrease  breech
 perineal damage  shoulder dystocia
 future vaginal prolapse  forceps
 urinary incontinence
 vacuum
 Associated with  scarring from female
 an increase of 3rd & 4th
genital mutilation or
degree tears poorly healed third or
fourth degree tears
 subsequent anal
sphincter muscle
dysfunction.  fetal distress.
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13. ASSISTING WITH DELIVERY
 As crowning occurs, place
a hand on the top of the
baby’s head and apply
light pressure
 Instruct the mother to
focus on her breathing.
Have her “pant like a
dog” to help her stop
pushing and prevent a
forceful birth.
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14. DELIVERY OF THE HEAD
 Ask the woman to pant or give
only small pushes with
contractions as the baby’s
head delivers
 To control birth of the head,
place the fingers of one hand
against the baby’s head to
keep it flexed (bent)
 Continue to gently support the
perineum as the baby’s head
delivers
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15. DELIVERY OF THE HEAD
2nd stage of labour
Head is borned by extension
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16. SUCTION THE BABY’S MOUTH
AND NOSE
 Once the baby’s head
delivers, ask the
woman not to push
 Suction the baby’s
mouth and nose
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17. SUCTION THE AIRWAY
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18. CORD AROUND THE NECK
Feel around the
baby’s neck
for the umbilical cord
If the cord is around the
neck, attempt to slip it
over the baby’s head
If the cord is tight
around the neck, doubly
clamp and cut it before
unwinding it from
around the neck
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19. ASSISTING WITH DELIVERY
As the head emerges, the baby
will turn to one side (for easier
passage of shoulders through
birth canal)
Check to see if the umbilical
cord is looped around the
baby’s neck. If so, gently slip
it over the head
Use a clean towel to catch
the baby
Note the time, if possible
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20. DELIVERY OF FETAL HEAD WITH
ROL POSITION
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21. DELIVERY OF ANTERIOR SHOULDER
Anterior shoulder
wedged
behind the pubic
symphysis
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22. DELIVERY OF ANTERIOR SHOULDER
Direction of traction
- should be in the direction of the axis of the body
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23. COMPLETION OF DELIVERY
 Allow the baby’s head to
turn spontaneously.
 After the head turns,
place a hand on each side
of the baby’s head. Tell
the woman to push
gently with the next
contraction.
 Move the baby’s head
Reduce tears by delivering posteriorly to deliver the
shoulder that is anterior
one shoulder at a time
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24. DELIVERY OF POSTERIOR SHOULDER
 Lift the baby’s head
anteriorly to deliver
the shoulder that is
posterior
 Support the rest of the
baby’s body with one
hand as it slides out
 Place the baby on the
mother’s abdomen
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25. DELIVERY OF POSTERIOR SHOULDER
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26. BABY DELIVERED
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27. FIRST BODY CONTACT OF MOTHER AND
BABY AND CORD CLAMPING
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28. CLAMPING UMBILICAL CORD
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29. CLAMPING, CUTTING AND TYING
OF
UMBILICAL CORD
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