How To Manage A Woman In Second Stage of Labour

Would you like to know what second stage of labour is all about and how to recognize it,  if yes then you have come to the right place.

Second stage of labour is a stage of expulsion of fetus which begins from full dilatation of the cervix till the baby is born.

 

How To Recognise The Onset Of Second Stage of Labour

• Presence of expulsive uterine contractions
• The nature of the woman’s cry changes; she screams in pain and becomes more apprehensive.
• The presence of strong urge to bear down.
• She experiences nausea and may vomit too.
• Her face becomes congested.
• Membrane ruptures if still intact.
• Trickling of blood from the genital tract due to placental separation.
• External signs or pressure signs which include; gaping of the vulva, pouting of the anus, stretching of the perineum.
• Appearance of the presenting part on the vulva
• Full dilatation of cervix.

Physiological Changes That Occurs During Second Stage Of Labour

• Uterine contraction becomes stronger and longer but may be less frequent to allow mother and fetus regular recovery period.
• The membranes may rupture with consequent drainage of liquor and continuous descent of the presenting part.
• The pressure from the presenting part stimulates the nerve receptors in the pelvic floor making the woman experience more urge to bear down.
• Pelvic floor displacement known as swing-door-action occurs as the fetus descends viz;

Anteriorly; the bladder is pushed upward to avoid being injured and also to give space for the fetus to pass through.

Posteriorly; the rectum flattens into the sacral curve

Laterally; the levator ani muscle dilates and thins out.

• The perineal body becomes flattened, straightened and thinned.
• The fetal head now becomes visible at the vulva, advancing with each contraction and receding between contractions until crowning occurs.
• The fetal head is the born followed by the shoulder and the rest of the body.

 

Management of a Patient in Second Stage of Labour

As a medical practitioner(nurse), below are the following methods you can use to manage a patient in second stage of labour.

Staying with the mother;

• Ensure that you stay throughout from the time she comes in, to the onset of second stage to prevent and manage any complication that may arise and in case precipitate delivery occurs.

Prevention of Infection;

• The woman is predisposed to infection at this stage, therefore strict aseptic technique should be maintained.
• Change birth mat if soiled especially with faeces.
• Maintain hand washing and gloving throughout as appropriate.

Phyiological Care;

• Reassure her that her pains will soon be over and that she will have her baby within a short while.
• Give tactful and genuine answers to her questions.
• Encourage her to be strong and to cooperate.
• Praise and congratulate her for the effort she is making to have a successful delivery.

Physical Support;

• Help her in the performance of any activity she cannot perform without assistance.
• Encourage her relative of choice such as her husband to rub her back to soothe her pains.

Nutrition;

• Wet her lips with water if she complains of thirst
• Do not give anything orally
• If labour is prolonged and she is exhausted, administer intravenous fluid to sustain her

Observation;

• Observe and record the strength, frequency and duration of uterine contraction.
• Check her pulse and fetal heart rate at every contraction.
• Check her blood pressure and respiration when necessary.

Bladder care;

• Don’t allow her to enter second stage with a full bladder
• If she cannot empty her bladder on her own, catheterize her to create enough room for rotation of the baby.

 

Transfer to delivery room;

• Patient should be transferred to the second stage room soon as second stage is confirmed to avoid conducting delivery in an unsterile environment..

Preparation of equipment;

• Prepare your equipment such as trolley, delivery kit, drugs t.c

Conduct delivery;

• Place her in lateral or dorsal position.
• Don your apron, scrub your hands and don gloves.
• Swab the vulva and perform vaginal examination to confirm full dilatation of the cervix.
• Drape her with sterile mackintosh and towel.
• As the head becomes visible at the vulva, ask her to bear down with contraction and rest in between contraction to avoid exhaustion.
• Ask her to hold her ankles with both hands and her chin towards her chest in a compact position before each push.
• Perform episiotomy at the height of contraction if need be.
• Cover and support the anus with pad to prevent soiling of the delivery field with faecal matter.
• When the head is crowned, grip the baby’s head by the side and instruct the mother to stop bearing down but to pant or breathe out the head.
• Clear the baby’s airway immediately and clean the eyes from the medial to lateral canthus with wet swab.
• Fell the neck for cord. If the cord is present and loose, slip it over the head, but if tight, apply artery forceps about 5cm apart and cut in between.
• Allow restitution to take place.
• Deliver the shoulder one after the other.
• Splint the head with both hands and deliver the baby towards mother’s abdomen.
• Note the time of delivery and APGAR score at 1 minute and 5 minutes after birth.
• Give syntometrin injection.
• Separate the baby from the mother by cutting the cord if this had not been done.
• Show baby to mother to identify sex.
• Weigh baby.
• Clean the baby and put her to the breast to enhance placental separation.
• Cover the baby to promote warmth.
• Put identification tag with mother’s name, baby’s sex, time of delivery and weight.

 

 Complications That May Occur During Second Stage Labour

• Increased intracranial pressure of the baby.
• Maternal exhaustion.
• Perineal laceration.
• Infection.
• Cord prolapse and compression.
• Caput succedenum.
• Cephal haematoma.

We hope this information was helpful to you. Feel free to ask your questions in the comment section.