5.1  Recognising the signs of second stage labour

The only positive sign in diagnosing second stage of labour is full dilatation of the cervix. The only way you can be certain the cervix is dilated all the way is to do a vaginal examination. But remember: repeated vaginal exams can cause infection. It is better not to do a vaginal exam frequently (less than 4 hours interval) unless:

  • When you count the fetal heart beat it is outside the normal range (outside 120–160 beats per minute).
  • There is a sudden gush of amniotic fluid, which may indicate that there is a risk for cord prolapse or placental abruption.
  • You detect signs of second stage of labour beginning before the next scheduled vaginal examination. (See Box 5.1 for signs of second stage.)

With experience, you can usually tell when the mother is ready to push without doing a vaginal exam.

Box 5.1  Signs of second stage

If the mother has two or more of these signs, she is probably in second stage of labour:

  • She feels an uncontrollable urge to push (she may say she needs to pass stool)
  • She may hold her breath or grunt during contractions
  • She starts to sweat
  • Her mood changes — she may become sleepy or more focused
  • Her external genitals or anus begin to bulge out during contractions
  • She feels the baby’s head begin to move into the vagina
  • A purple line appears between the mother’s buttocks as they spread apart from the pressure of the baby’s head.

Learning Outcomes for Study Session 5

5.1.1  What happens during second stage of labour?