To prevent infection of the genital tract by
careful attention to asepsis and antisepsis.
To ensure that the child is born alive with no
To prevent injury to the perineum.
Physiology of the second phase(refer to
Module Two Unit One) Signs of Second
stage of labor
following signs and symptoms will be observed when a woman reaches the second
phrase of labor
On vaginal Examination: OS fully dilated
Expulsive uterine contractions
Trickling of blood Repture of membranes
Tenseness between coccyx and anus Vulva gapes.
Anus pouts gapes
Urge to push
Presenting part is visible
Perineum stretches and bulges.
should be transferred to the second stage room or lie on her bed in the first
stage room. She should not be left alone.
examination is done to confirm full dilatation of the cervix. Patient can lie
in any position she finds most comfortable for her. If membranes are intact it
should be ruptured artificially using a pair of cockers or artery forceps.
Observations and recordings continues and more frequently between contractions
(1) Uterine contractions (ii) Descent of the presenting part (iii) maternal
pulse 5 – 15 minutes –intervals. Fetal hea rt rate every 5 minutes. Any
irregularity must be reported. As oxygenation to the fetus may be less due to
compression of head or cord.
Bladder must be kept emptied by
catheterization at the end of firststage or at the beginning of second stage,
if the bladder is full as this can cause delay in the engagement of the head
and post partum haemorrhage in third stage. Only a sip of glucose drink is
allowed if the second stage is getting prolonged and the woman’s condition
permits it, because of danger of vomiting. The hands and the face could be
sponged with cold water. Two nurses should do a delivery at a time. One clean
nurse and one assistant. Head should be delivered slowly to prevent injuries to
the perineum. The woman should be discouraged from active pushing until the
head is visible. She can practice breathing exercise – Rhythmic, eas y
breathing, avoid shallow panting, very deep breathing and prolong breath –
holding. She should feel free to express herself – cry, shout, etc. it helps
her to cope.
Position: Depend on maternal & fetal
conditions, motherpreference, the environment, Midwife’s confidence. Positions
include: Dorsal, Left lateral, Squatting, Kneeling, or standing, the birthing