Second Stage of Labor PDF

Second Stage of Labor and Birth  Introduction oMidwives create a circle of support and safety during labor and birth that encourages, rather than disrupts, the normal processes that facilitate healthy outcomes for families. o The midwife anticipates needs and provides vigilance in the assessment...

Second Stage of Labor and Birth  Introduction oMidwives create a circle of support and safety during labor and birth that encourages, rather than disrupts, the normal processes that facilitate healthy outcomes for families. o The midwife anticipates needs and provides vigilance in the assessments conducted for women and their support persons during labor and birth, while remaining cognizant of the wide range of what constitutes normal and where the boundaries of abnormal begin.  Definition of Second-Stage Labor oAnatomically, second-stage labor is defined as beginning with complete dilation of the cervix (10 cm) and ending with expulsion of the fetus. oHowever, the clinical and physiologic demarcation between the final dynamics of first-stage labor and the beginning of second-stage labor is less distinct. oAlthough the anatomic definition is the one most commonly used in clinical practice, from a physiologic perspective second-stage labor may be defined as the onset of the urge to bear down until the birth of the infant. oThe physiologic urge to push typically occurs when the fetal presenting part reaches +1 station.  Signs and Symptoms of Second-Stage Labor oThe most common symptom that heralds the onset of the second stage is an urge to push or bear down. Women who are not using epidural analgesia usually have an irresistible need to push or bear down, but this is not universally true, as many women interpret this feeling as needing to have a bowel movement. oSigns of second-stage labor also include: finding the FHR in progressively lower locations on the maternal abdomen rectal bulging Perineal bulging progressive visibility of the fetal head at the vaginal introitus. There may be an increase in bloody show the FHR pattern may demonstrate variable decelerations secondary to the vertex descending with maternal bearing- down efforts. Interestingly, an almost infallible signal of imminent birth is the woman saying, “The baby’s coming!”—a verbal expression that occurs in most cultures and languages.  Duration of Second-Stage Labor oAccording to Freidman, the average length of the second stage was around 46 minutes for a woman having a first vaginal birth and 14 minutes for women having subsequent births. oThe parameters used to define the duration of second-stage labor have changed, in part due to the widespread use of epidural analgesia for pain management and the effect of epidural analgesia on maternal bearing-down efforts. oWomen who enter the second stage of labor with effective epidural analgesia have diminished or absent pelvic and rectal sensation and, therefore, experience lessened or no urge to push, often resulting in a second stage that is longer than the parameters established by Friedman.  Factors That Influence the Duration of the Second Stage of Labor Parity Fetal position Epidural analgesia Fetal station at complete cervical dilation First-stage labor dystocia Uterine contraction activity: strength and frequency of contractions Presence or absence of infection Effectiveness of maternal pushing efforts Pelvic architecture Birth weight Maternal weight or high body mass index Induction of labor Maternal fear or anxiety Maternal pain or discomfort Maternal history of sexual abuse or trauma  Maternal Complications Associated with Prolonged Second-Stage Labor Prolonged 2nd stage increased risk of maternal morbidity. Specifically, actively pushing for more than 2 to 3 hours has been associated with an increased risk for: -intra-amniotic infection -postpartum hemorrhage -operative birth -third- and fourth-degree lacerations. -Prolonged pushing may also contribute to long-term In multiparous women, had a higher risk of shoulder dystocia. Intra-amniotic infection may be both a cause and effect of prolonged labor.  Fetal Complications Associated with Prolonged Second- Stage Labor Many studies found that prolonged second-stage labor was associated with a significant increased risk for: -5-minute Apgar score less than 4 -neonatal sepsis -admission to the NICU -perinatal mortality. However, the absolute risk of adverse neonatal outcomes was quite low for all the newborn outcomes. Nonetheless, as second-stage labor progresses beyond the recommended guidelines, ongoing fetal assessment should be part of the consideration in balancing the risks versus the benefits of a spontaneous vaginal birth.  Definition of Prolonged Second-Stage Labor prolonged second-stage labor has been defined as longer than 2 hours for a primgravida and longer than 1 hour for a multigravida. No progress in descent or rotation for: ≥ 4 hours in nulliparous women with an epidural ≥ 3 hours in nulliparous women without an epidural ≥ 3 hours in multiparous women with an epidural ≥ 2 hours in multiparous women without an epidural Second-stage labor abnormalities prolonged duration Persistent Occiput Posterior Position protracted arrest of failure of descent descent descent Presenting anterior posterior fetal skull diameters in occiput anterior and occiput posterior positions.