Midwifery (RM)
Management of the 2nd Stage of Labour
The second stage begins with full cervical dilatation and ends with birth. Management supports maternal choice, fetal wellbeing, effective pushing, controlled birth, prevention of trauma, and timely escalation for delay or compromise.
Purpose
- Support safe vaginal birth
- Monitor mother and fetus and identify complications
- Provide emotional support, comfort, and respectful care
Indications
- Confirmed second stage of labour
- Visible presenting part or involuntary expulsive urge with full dilatation
- Operative or referral planning when progress or wellbeing is abnormal
Equipment
- Clean birth environment and delivery pack
- PPE, sterile gloves, drapes, and newborn-resuscitation equipment
- Fetal and maternal monitoring equipment
- Warm towels, cord clamps, uterotonics, and documentation materials
Preparation
- Check delivery and resuscitation equipment, staffing, and emergency drugs.
- Explain birth positions and ensure privacy and warmth.
Procedure steps
- Confirm full dilatation and assess maternal and fetal condition, presentation, position, station, and readiness for birth.
- Explain options, obtain consent, and support the woman’s chosen safe position and birth companion.
- Encourage effective breathing and pushing with the woman’s urge; avoid routine directed breath-holding.
- Monitor fetal heart and maternal observations at the required frequency.
- Prepare clean equipment, warm towels, neonatal resuscitation area, and emergency support.
- Support controlled birth of the head, protect the perineum according to local practice, and check for a nuchal cord.
- Assist birth of shoulders and body without excessive traction; note time and condition.
- Dry and assess the newborn, maintain warmth, and proceed to delayed cord clamping when appropriate.
- Recognize delay, maternal exhaustion, abnormal fetal heart, malpresentation, or shoulder dystocia and call for help.
- Document labour progress, observations, birth, interventions, newborn condition, and handover.
Precautions
- Never pull forcefully on the fetal head or neck.
- Prepare for neonatal resuscitation and shoulder dystocia.
- Avoid routine episiotomy and unnecessary vaginal examinations.
- Escalate prolonged second stage, abnormal fetal heart, maternal deterioration, or bleeding.
Aftercare
- Continue maternal and newborn assessment and initiate skin-to-skin when stable.
- Prepare for active management of the third stage.
Nursing considerations
- Maintain one-to-one support where possible.
- Use calm closed-loop communication during emergencies.
Patient education
- Explain pushing, positions, breathing, perineal sensations, and when to call for help.
- Support the woman’s informed choices and comfort.
Documentation
- Record full dilatation, fetal and maternal observations, position, birth time, interventions, tears, newborn condition, and handover.
- Document escalation and response.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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