Giving birth
For the majority of women childbirth is a natural, joyful process as they welcome their baby or babies into the world. It is normal for women and couples to feel excited and elated but at the same time to feel a little anxious and perhaps fearful anticipating the enormity of this life-changing event. If you have had a difficult birthing experience in the past it is understandable to feel apprehensive because memories can come flooding back. However, each birth is different and it is important that you are fully informed, can be involved in decisions about your birth and know what options you have in how you birth your baby.
Additionally, your midwife and obstetrician are there to encourage and support you both emotionally and physically. It is important to develop trusting relationships with them as they support you through childbirth. They will work with you to provide information, guidance, and calm reassurance as you progress through your birthing experience. Developing a trusting partnership with your obstetrician and midwife can help you to remain positive, confident and focussed on your birth.
The second stage of labour commences when the cervix is fully dilated and ends with the birth of the baby. You may experience any of the following signs and symptoms during this time:
- longer and stronger contractions with a one to two minute break
- increased anal (back passage) pressure and the desire or urge to push or bear down
- shaky cramps
- nausea and vomiting
- stretching and burning feelings in your vagina and perineal area (area between the vagina and anus or back passage)
The second stage is likely to be confirmed by your midwife or obstetrician when they perform a vaginal examination.
As for the first stage of labour, there are also two phases of the second stage: a passive phase that starts with full dilation of the cervix and ends when the urge to bear down or push commences; and, the active phase, when the urge to push results in the birth of the baby. Again, it is important to conserve energy by not commencing active pushing until the passive phase has passed. The length of time in second stage until the baby is born varies for different women and pregnancies but generally speaking, if you have had a baby before, the active pushing phase is quicker (up to 30 minutes) than for first time mothers (up to an hour).
If you have an epidural you can expect to wait a little longer to allow for optimal birthing conditions, such as when the baby has descended deeper into your pelvis and vagina, you can feel more and your urge to push is maximally effective. Your midwife can advise you and guide you through this phase.
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Birthing your baby
Once it is clear that you are in second stage, your midwife and/or obstetrician will guide and positively support you through birthing your baby and facilitate involvement of your birth partner or support person. There may be other members of the Maternity Team present making preparations to welcome the baby and their role will depend on how you have progressed in labour. The required equipment will be organised and monitoring of your vital signs and the baby’s heart rate will continue throughout the birth. The following points are a general guide for pushing in the second stage:
Follow your own instincts for the active phase of pushing. Your body will naturally tell you when to push.
Feel free to express yourself and to be in control of your birth experience. It is important that you trust your body’s ability to birth your baby and that those around you are supporting you to do this.
Try to breathe regularly and deeply (but do not hold your breath) to promote oxygen flow to you and your baby and to help you to relax.
Adopt whatever position is most comfortable for you. There is no ‘one right birthing position’ so you can change between positions to find what is best for you. Semi-supported sitting, squatting or upright positions are more likely to promote effective pushing and progress than lying positions. Lying flat on your back is not good for you or for your baby due to the compression on your blood vessels causing your blood pressure to drop. Some women find the ‘all fours’ position on hands and knees useful for backache or when the baby is lying in the ‘posterior position’. Your midwife can advise and support you in these options.
Feel free to use whatever birthing supports and environmental effects you require (e.g. birthing balls, cushions, pillows, low lighting, soft music, aromatherapy) to make you feel relaxed and comfortable.
Keep cool. If you feel hot and sweaty your support person can help you take sips of cold water or wipe your face and neck with a cool flannel in between pushing.
Trust your obstetrician and midwife. Your midwife and obstetrician will reassure you, support you, ensure your privacy and dignity, and guide you. They will keep you informed of progress and instruct you on what to do when necessary. For example, when to stop pushing and to gently blow or sigh as the baby’s head emerges and when to give another push as required.
Once you have completely birthed your baby, she/he will usually be given to you and your support person for a cuddle and breast feed, if this is your preferred method of infant feeding. The importance of skin-to-skin contact for you and your baby at this special moment cannot be overestimated. Your midwife may place a wrap over your baby to keep your baby warm and assess your baby’s Apgar Score during this time.
The Apgar score is an assessment of a baby’s overall condition, including how they look, their breathing, heart rate, and colour. The Apgar score is taken at one minute and the five minutes after the birth and is a good measure of how well your baby has made the transition from the womb (intrauterine) to the world (extrauterine).
Depending on your preferences, who is assisting your birth, the circumstances of your birth, and the condition of your baby, your baby’s cord will be clamped and your birth partner may cut the cord if they so desire. If your baby has shown signs of fetal compromise, the Neonatal Team may be ready to assess and resuscitate your baby if necessary at this time. Your midwife and obstetrician will then commence preparations for the third stage of labour: birthing the placenta and membranes. Please see this section below for more detailed information about the interval between birthing the baby and birthing the placenta and membranes.
A note about photos and video
It’s natural to want photos and video of your new baby’s journey prior to, during and after birth. However, it is very important that your and your baby’s clinical care and safety are not compromised. It is also important that the privacy of staff, doctors and other patients is respected.
For this reason, there are some things you need to know about taking photographs and videos with cameras, phones and video recorders in our maternity facilities.
In the birth suite and operating suite
- Still photography is permitted if members of the team present agree
- Video recording is not permitted
In the special care nursery
- Still photography is permitted if members of the team involved in your baby’s care agree
- Video recording is permitted at the discretion of the hospital and must be confined to the patient care area
On the post-natal ward
- Still photography and video recording is permitted in the privacy of your own room
- Professional photography
