Once the midwife announces that the cervix of the labouring mother is now 10 centimetres dilated, this will be the end of the first stage which leads on to the second stage of labour, namely the actual birth of the baby. For the mother, the announcement of the end of the first stage means that the worst part is practically over. The contractions of the second stage are much easier to work with than those of the first stage.
They are less painful, and, while trying to cope with the difficult ones at the end of transition was by no means easy, the sensation of the second stage contractions is very different. They are not really painful at all. It is simply a question of obeying the body's urge to push, and sure enough, the sensation of pushing is so great, she can hardly keep it in! The first thing that helps or hinders the pushing stage of labour is the mother's position.
As with the first stage, gravity is better used to the mother's advantage. The more upright she is, the better the baby will move down. Also, the least pressure there is on the sacrum and coccyx, that is, the further these flexible bones at the base of the spine are able to move outwards, the more room there is for the baby to descend.
Ironically, most mothers on a bed are usually on their back, a position that causes these bones to move inwards instead. The mother needs to push harder against gravity and through a narrower pelvis, while the baby's descent is slower and the baby could even fail to make it through. Even a few millimetres may determine whether a baby will pass through the pelvis, or not.
Without doubt, squatting is the most favourable position. It combines gravity with the widest possible measurement of the mother's pelvis. It is interesting to note also that while the baby's head is descending, the bones in his skull overlap, so the measurement of the baby's head becomes conveniently smaller.
Nature seems to do what is appropriate at such a crucial time.
It is a pity that most mothers in hospital are not encouraged to squat for the second stage. This could be for several reasons: Most mothers are not used to squatting for long, the mother may be sedated and unable to be actively involved, while the squatting position on the floor does not favour the care-giver who feels the need to control the situation. Many midwives cater for this by getting the mother to squat on the delivery table during contractions, while changing positions in between.
A popular position which also favours a wider opening is pushing while the mother lies on her side. There needs to be absolute coordination which makes life easier for both the mother and her attendant. The way the mother directs her pushing efforts may also affect the result favourably or unfavourably. Some mothers push upwards through their head, causing throat soreness, sometimes temporary deafness, bloodshot eyes or even turn purple in the face. No amount of uphill effort will bring the baby down. During classes it is important for the mother to learn how to direct her energy during pushing, which muscles are most appropriate and effective to use, how to breathe and in what direction to push their efforts.
This will make the mother's pushing much more effective, making the second stage of the birth shorter. Having said this, it is good to say also that a short and quick second stage in a very fast delivery is not necessarily the best for both mother and baby. Slowly but surely coming down is usually the best way for the baby to be born.
With the midwife guiding the mother, and the mother's efforts and cooperation, most babies successfully move down the birth canal, and "crown". This means that the baby's head can now be seen and felt easily. It is very close for the baby to be born. Some mothers show the wish to touch the baby for the first time now, others suggest seeing it in a mirror. At this sensation, mothers are exhilarated, making them want to push harder to get it over and done with! Here is where the midwife's guidance is even more indispensable.
The mother needs to slow down her efforts, to give time for her skin to stretch slowly without tearing. During pregnancy classes, mothers are taught techniques how tearing may be avoided, both by massaging and a learned breathing pattern.
Sometimes midwives feel the need to perform a "controlled" tear, an episiotomy, to make the outlet wider for the baby's head to be born quicker. There are different schools of thought with regards to performing an episiotomy. Some studies say that most of the time, with patience and cooperation from both midwife and mother, a tear or an episiotomy may be avoided. Obviously, both a natural tear and an episiotomy, even when appropriately stitched, cause extreme discomfort for the mother who finds it painful even to sit down and move around. Not an ideal situation, to say the least, when, immediately after the birth of the baby, the important fourth stage of bonding with the baby sets in. The mother now wants and needs to be constantly with the baby, but feels too much pain to be able to enjoy and make the most of it. This bonding stage within the new family is known to be of maximum importance psychologically, and it is really a pity if it is disturbed in any way. The midwife will be closely watching the baby immediately after he is born. She notices his colour, his movements and reflexes, hears his cry. An Apgar score is given to the baby. This shows how well he is thriving at birth, and for the few minutes thereafter. If the midwife sees that the baby does not need any kind of help crucial to these moments, she puts the baby on the mother's abdomen, to the mother's extreme enjoyment. This is the first time they are meeting, albeit being so close for so long.
No words may explain this feeling. The physical and emotional change in the mother, is impressive. She is thrilled to be able to hold and hug her baby so closely. It is indeed a highly emotional instance, never to be forgotten. If she has not been given drugs, her reaction to these moments is extreme. She holds her baby close, ideally skin to skin, keeping him warm while the baby slowly becomes familiar with the person who had been carrying him around, so close and yet so far. He hears her voice, smells her body, and if left alone, will actually crawl to the nipple and start to breastfeed on his own, often without anybody's help. What a wonder, what a joy, what a miracle!
Where does the father come in? Though obviously less physically involved than the mother, the father is not just an observer to this event. Very much emotionally involved, he participates fully in his own way. He too has gone through a rollercoaster ride of sensations and is now relieved, to say the least, that it is all over. Studies show that fathers too need a lot of support. They are often expected to act as a "coach" to the mother, a role they barely feel confident in performing.
When they are well prepared and supported in their specific needs, they perform better, and are better able to be the supporting partner every mother drastically requires during the birth and when she is home catering for the new family's needs.
Birth is much more than simply the taking of a baby out of his mother. It is the birth of a family, with all the physical, psychological, emotional and social connotations that come with it. It is only the start to a chain of events that, occurring in sequence, directly affect and determine what will happen later. As all parents know, the individual experiences of a family will either make it or break it. May each birth of a baby in a family be the positive turning point in the lives of its members, as it deserves to be.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala. The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.
They are less painful, and, while trying to cope with the difficult ones at the end of transition was by no means easy, the sensation of the second stage contractions is very different. They are not really painful at all. It is simply a question of obeying the body's urge to push, and sure enough, the sensation of pushing is so great, she can hardly keep it in! The first thing that helps or hinders the pushing stage of labour is the mother's position.
As with the first stage, gravity is better used to the mother's advantage. The more upright she is, the better the baby will move down. Also, the least pressure there is on the sacrum and coccyx, that is, the further these flexible bones at the base of the spine are able to move outwards, the more room there is for the baby to descend.
Ironically, most mothers on a bed are usually on their back, a position that causes these bones to move inwards instead. The mother needs to push harder against gravity and through a narrower pelvis, while the baby's descent is slower and the baby could even fail to make it through. Even a few millimetres may determine whether a baby will pass through the pelvis, or not.
Without doubt, squatting is the most favourable position. It combines gravity with the widest possible measurement of the mother's pelvis. It is interesting to note also that while the baby's head is descending, the bones in his skull overlap, so the measurement of the baby's head becomes conveniently smaller.
Nature seems to do what is appropriate at such a crucial time.
It is a pity that most mothers in hospital are not encouraged to squat for the second stage. This could be for several reasons: Most mothers are not used to squatting for long, the mother may be sedated and unable to be actively involved, while the squatting position on the floor does not favour the care-giver who feels the need to control the situation. Many midwives cater for this by getting the mother to squat on the delivery table during contractions, while changing positions in between.
A popular position which also favours a wider opening is pushing while the mother lies on her side. There needs to be absolute coordination which makes life easier for both the mother and her attendant. The way the mother directs her pushing efforts may also affect the result favourably or unfavourably. Some mothers push upwards through their head, causing throat soreness, sometimes temporary deafness, bloodshot eyes or even turn purple in the face. No amount of uphill effort will bring the baby down. During classes it is important for the mother to learn how to direct her energy during pushing, which muscles are most appropriate and effective to use, how to breathe and in what direction to push their efforts.
This will make the mother's pushing much more effective, making the second stage of the birth shorter. Having said this, it is good to say also that a short and quick second stage in a very fast delivery is not necessarily the best for both mother and baby. Slowly but surely coming down is usually the best way for the baby to be born.
With the midwife guiding the mother, and the mother's efforts and cooperation, most babies successfully move down the birth canal, and "crown". This means that the baby's head can now be seen and felt easily. It is very close for the baby to be born. Some mothers show the wish to touch the baby for the first time now, others suggest seeing it in a mirror. At this sensation, mothers are exhilarated, making them want to push harder to get it over and done with! Here is where the midwife's guidance is even more indispensable.
The mother needs to slow down her efforts, to give time for her skin to stretch slowly without tearing. During pregnancy classes, mothers are taught techniques how tearing may be avoided, both by massaging and a learned breathing pattern.
Sometimes midwives feel the need to perform a "controlled" tear, an episiotomy, to make the outlet wider for the baby's head to be born quicker. There are different schools of thought with regards to performing an episiotomy. Some studies say that most of the time, with patience and cooperation from both midwife and mother, a tear or an episiotomy may be avoided. Obviously, both a natural tear and an episiotomy, even when appropriately stitched, cause extreme discomfort for the mother who finds it painful even to sit down and move around. Not an ideal situation, to say the least, when, immediately after the birth of the baby, the important fourth stage of bonding with the baby sets in. The mother now wants and needs to be constantly with the baby, but feels too much pain to be able to enjoy and make the most of it. This bonding stage within the new family is known to be of maximum importance psychologically, and it is really a pity if it is disturbed in any way. The midwife will be closely watching the baby immediately after he is born. She notices his colour, his movements and reflexes, hears his cry. An Apgar score is given to the baby. This shows how well he is thriving at birth, and for the few minutes thereafter. If the midwife sees that the baby does not need any kind of help crucial to these moments, she puts the baby on the mother's abdomen, to the mother's extreme enjoyment. This is the first time they are meeting, albeit being so close for so long.
No words may explain this feeling. The physical and emotional change in the mother, is impressive. She is thrilled to be able to hold and hug her baby so closely. It is indeed a highly emotional instance, never to be forgotten. If she has not been given drugs, her reaction to these moments is extreme. She holds her baby close, ideally skin to skin, keeping him warm while the baby slowly becomes familiar with the person who had been carrying him around, so close and yet so far. He hears her voice, smells her body, and if left alone, will actually crawl to the nipple and start to breastfeed on his own, often without anybody's help. What a wonder, what a joy, what a miracle!
Where does the father come in? Though obviously less physically involved than the mother, the father is not just an observer to this event. Very much emotionally involved, he participates fully in his own way. He too has gone through a rollercoaster ride of sensations and is now relieved, to say the least, that it is all over. Studies show that fathers too need a lot of support. They are often expected to act as a "coach" to the mother, a role they barely feel confident in performing.
When they are well prepared and supported in their specific needs, they perform better, and are better able to be the supporting partner every mother drastically requires during the birth and when she is home catering for the new family's needs.
Birth is much more than simply the taking of a baby out of his mother. It is the birth of a family, with all the physical, psychological, emotional and social connotations that come with it. It is only the start to a chain of events that, occurring in sequence, directly affect and determine what will happen later. As all parents know, the individual experiences of a family will either make it or break it. May each birth of a baby in a family be the positive turning point in the lives of its members, as it deserves to be.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala. The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.