Management of second stage of labour

Introduction

During the second stage of labour, the cervix reaches full dilation, culminating in the fetus’s expulsion. Medical or midwifery professionals ascertain the stage’s duration by diagnosing complete cervical dilation in the woman.

Objectives

1. To ensure the birth of a live and healthy baby
2. To provide comprehensive care to mother and baby
3. To prevent injury to both baby and mother
4. To prevent complications
5. To identify earlier and prompt management of complications

Principles

The principles guiding the care during the second stage of labour encompass;

1. The application of infection prevention measures for the well-being of both mother and baby,
2. Diligent and vigilant monitoring of  mother and baby’s conditions and labour progress,
3. Maintaining a constant presence and support for women in labour,
4. Offering consistent emotional and physical comfort to the mother,
5. Proactively anticipating the stages and mechanisms of normal childbirth,
6. Facilitate woman for the natural birthing process,
7. Minimizing the need for surgical interventions whenever possible.

Management

Constant supervision of maternal and fetal condition and progress of labour

Maternal condition

During this stage, it is important to monitor the maternal condition. Observe the mother’s emotional coping ability and assessing her overall well-being. Record maternal pulse rate every half an hour, blood pressure every 4 hours, and temperature every 2 hours. Additionally, evaluating the mother’s hydration status and positioning is crucial during this phase.

Fetal condition

In the second stage of labour, listen to the fetal heart rate (FHR) immediately after contractions. Count FHS for a full minute at least once every 30 minutes. If the FHR falls below <100/min or rises above >180/min, fetal distress should be suspected.

In cases where the membranes have ruptured, it is important to note the colour of the draining amniotic fluid. The presence of thick meconium indicates the necessity for close monitoring and potential intervention to manage fetal distress. Absence of draining fluid after membrane rupture suggests reduced amniotic fluid, possibly linked to fetal distress.

During fetal descent, oxygenation compromised by cord or head compression. In normal labor, assess fetal well-being with intermittent, not continuous, monitoring.. In the second stage of labour, this assessment is typically conducted immediately after a contraction.

Changes in the Fetal Heart

Late deceleration, indicated by a failure to return to the normal baseline, an elevation in baseline rate, or a reduction in beat-to-beat variation, raises concerns. If these patterns emerge for the first time during the second stage of labour, they could be attributed to cord or head compression, potentially alleviated by altering the woman’s position.

Should these patterns persist even after a change in position, it is advisable to seek guidance from experienced obstetric professionals. In cases where imminent birth is anticipated, the consideration of an episiotomy might be warranted. A midwife trained in ventouse-assisted birth may also be engaged for the delivery.

Progress of Labour

Uterine Contraction

The intensity, duration, and frequency of contractions should be consistently evaluated through observation of maternal reactions and periodically through uterine palpation. Contractions in the second stage of labour typically exhibit greater strength and duration compared to the first stage, often lasting up to one minute with extended intervals of rest between contractions. The maternal posture and position assumed can have an impact on the nature of contractions during this stage.

Descent, Rotation and Flexion

Initially, the descent of the fetus often occurs gradually, particularly in nulliparous women, although acceleration typically take place during the active phase. In multigravid women, descent can occur very rapidly. If there is a delay in descent despite consistent strong uterine contractions and maternal pushing, a vaginal examination may be conducted with the mother’s consent. The objective is to ascertain whether internal rotation of the head has transpired, appraise the station of the presenting part, and ascertain whether a caput succedaneum has developed.

If the occiput has rotated to an anterior position, indicating proper head flexion, progress with the caput formation will likely continue. However, if there’s insufficient rotation and flexion, weakened uterine contractions, or a combination of both, it might be advisable to explore options such as changing the woman’s position, addressing her nutrition and hydration, or utilizing optimal fetal positioning techniques.

Should there be indications of compromised fetal or maternal conditions, it is imperative to seek counsel from an experienced obstetrician.

For details click here

Dounload here