The second stage of labor begins when the cervix is fully dilated at 10 centimeters and ends with the complete birth of the baby. Midwives must remain vigilant during this period, monitoring maternal well-being and fetal heart rate closely. Preparation involves gathering sterile instruments, ensuring adequate lighting, and positioning the mother comfortably, often in a semi-recumbent, left lateral, or all-fours position depending on her preference and clinical needs. Clean drapes are placed under the buttocks to maintain a hygienic field. Universal precautions, including the use of sterile gloves and protective aprons, safeguard both the woman and the birth attendant against infection. Communication remains a vital tool; encouraging the mother and explaining each upcoming action helps reduce anxiety and secures her active cooperation during pushing.
Protecting the perineum during crowning minimizes severe tearing and reduces postpartum morbidity. Midwives generally employ two primary maneuvers: the modified Ritgen maneuver and hands-on guarding.
Routine episiotomy is discouraged by the World Health Organization. It should only be performed for specific indications such as fetal distress or an anticipated shoulder dystocia, rather than as a preventive measure for all primigravidae.
As the fetal head crowns, the widest diameter distends the vulval ring. The midwife must resist the urge to pull or traction the head. Instead, encourage the mother to pant or push gently during contractions to allow slow, controlled delivery. Once the occiput is born, the head normally undergoes restitution, aligning itself naturally with the shoulders. The midwife then checks gently around the baby's neck for a nuchal cord. If a loop of umbilical cord is present and loose, it can be gently slipped over the baby's head. If it is tight, it may be clamped twice and cut before delivery of the rest of the body can proceed safely.
Following restitution, the shoulders rotate internally into the anteroposterior diameter of the pelvis. The midwife places hands on the sides of the baby's head, over the parietal bones, and applies gentle downward traction to deliver the anterior shoulder underneath the pubic symphysis. Once the anterior shoulder is visible, upward traction is applied cautiously to guide the posterior shoulder over the perineum. After both shoulders are born, the rest of the trunk and lower limbs deliver smoothly and rapidly along the curve of Carus due to their smaller diameter. The newborn is received onto a clean towel placed on the mother's abdomen or between her thighs, marking the transition to the third stage of labor.
As soon as the baby is born, note the exact time and place the infant in skin-to-skin contact with the mother, provided the baby is crying or breathing well and has good tone. Assess breathing, heart rate, and color within the first minute to determine the Apgar score. Dry the baby thoroughly with a warm towel and remove wet linens to prevent heat loss through evaporation. Cover the baby's head with a cap to maintain core body temperature. Meanwhile, palpate the maternal abdomen to rule out the presence of a second twin before administering any uterotonic drugs. Clamp and cut the cord once pulsation stops or after one to three minutes, unless resuscitation is urgently required.