Skip to main content

The Second and Third Stage of Labor

  • Chapter
  • First Online:
Epidural Labor Analgesia
  • 1648 Accesses

Abstract

The second stage of labor is generally defined as the time elapsing from the full cervical dilation to the delivery of the fetus [1]. There is, therefore, a wide variability in its accuracy as it depends on the operator’s decision to perform a vaginal examination to determine whether the “diagnosis” of complete dilatation is made.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kilpatrick SJ, Laros RK (1989) Characteristics of normal labor. Obstet Gynecol 74:85–87

    CAS  PubMed  Google Scholar 

  2. Gross MM, Drobnic S, Keirse MJN (2005) Influence of fixed and time­ dependent factors on duration of normal first stage labor. Birth 32:27–33

    Article  PubMed  Google Scholar 

  3. Lydon-Rochelle MT (2006) Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth 33:315–322

    Article  PubMed  Google Scholar 

  4. Allen VM, Baskett TF, O’Connell CM et al (2009) Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol 113:1248–1258

    Article  PubMed  Google Scholar 

  5. National Collaborating Centre for Women’s and Children’s Health (UK) (ed) (2007) National Institute for Health and Clinical Excellence: guidance. Intrapartum care: care of healthy women and their babies during childbirth. RCOG, London

    Google Scholar 

  6. Spong CY, Berghella V, Wenstrom KD et al (2012) Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 120:1181–1193

    PubMed Central  PubMed  Google Scholar 

  7. Atwood RJ (1976) Parturition posture and related birth behavior. Acta Obstet Gynecol Scand 57:3–25

    Article  Google Scholar 

  8. Gupta JK, Hofmeyr GJ, Shehmar M (2012) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev (5):CD002006. doi:10.1002/14651858.CD002006.pub3

  9. Carbonne B, Benachi A, Leveque M et al (1996) Maternal position during labor: effects on fetal oxygen saturation measured by pulse oximetry. Obstet Gynecol 88:797–800

    Article  CAS  PubMed  Google Scholar 

  10. Kemp E, Kingswood CJ, Kibuka M et al (2013) Position in the second stage of labour for women with epidural anaesthesia (Review). Cochrane Database Syst Rev (1):CD008070. doi:10.1002/14651858.CD008070.pub2

  11. Fuchs AR, Romero R, Keefe D et al (1991) Oxytocin secretion and human parturition: pulse frequency and duration increase during spontaneous labor in women. Am J Obstet Gynecol 165:1515–1523

    Article  CAS  PubMed  Google Scholar 

  12. Hellman LM (1956) Anatomic and physiologic considerations. In: Hingson RA, Hellman LM (eds) Anesthesia for obstetrics. JB Lippincott, Philadelphia, PA, p 74

    Google Scholar 

  13. Goodfellow CF, Hull MGR, Swaab DF et al (1983) Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol 99:96–100

    Google Scholar 

  14. Rahm VA, Hallgren A, Hognerg H et al (2002) Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Acta Obstet Gynecol Scand 81:1033–1039

    Article  PubMed  Google Scholar 

  15. Stocche RM, Klamt JG, Antunes-Rodrigues J et al (2001) Effect of intrathecal sufentanil on plasma oxytocin and cortisol concentrations in women during the first stage of labor. Reg Anesth Pain Med 26:545–550

    Article  CAS  PubMed  Google Scholar 

  16. De Geest K, Thiery M, Piron-Possuyt G et al (1985) Plasma oxytocin in human pregnancy and parturition. J Perinat Med 13:3–13

    Article  PubMed  Google Scholar 

  17. Scull TJ, Hemmings GT, Carli F et al (1998) Epidural analgesia in early labour blocks the stress response but uterine contractions remain unchanged. Can J Anaesth 45:626–630

    Article  CAS  PubMed  Google Scholar 

  18. Hanson L (2009) Second-stage labor care: challenges in spontaneous bearing down. J Perinat Neonatal Nurs 23:31–39

    Article  PubMed  Google Scholar 

  19. Roberts J, Hanson L (2007) Best practices in second stage labor care: maternal bearing down and positioning. J Midwifery Womens Health 52:238–245

    Article  PubMed  Google Scholar 

  20. Cosner KR, DeJong E (1993) Physiologic second stage labor. MCN Am J Matern Child Nurs 18:38–43

    Article  CAS  PubMed  Google Scholar 

  21. Barnett MM, Sharron S, Humenick RN (1982) Infant outcome in relation to second stage labor pushing method. Birth 9:221–229

    Article  Google Scholar 

  22. Bloom SL, Casey BM, Schaffer JI et al (2006) A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol 194:10–13

    Article  PubMed  Google Scholar 

  23. Prins M, Boxem J, Lucas C et al (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomized trials. BJOG 118:662–670

    Article  CAS  PubMed  Google Scholar 

  24. Fraser WD et al (2000) Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. Am J Obstet Gynecol 182:1165–1172

    Article  CAS  PubMed  Google Scholar 

  25. Roberts CL, Torvaldsen S, Cameron CA et al (2004) Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis. BJOG 111:1333–1340

    Article  PubMed  Google Scholar 

  26. Fitzpatrick M, Harkin R, Mc Quillan K et al (2002) A randomized clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal incontinence. BJOG 109:1359–1365

    Article  PubMed  Google Scholar 

  27. Hansen SL, Clark SL, Foster JC (2002) Active versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol 99:29–34

    Article  PubMed  Google Scholar 

  28. Simpson KR, James DC (2005) Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial. Nurs Res 54:149–157

    Article  PubMed  Google Scholar 

  29. Altman MR, Lydon-Rochelle MT (2006) Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth 33:315–322

    Article  PubMed  Google Scholar 

  30. Royal College of Obstetricians and Gynaecologists Guidelines and Audit Committee (2011) RCOG Clinical Green Top Guidelines. Instrumental Vaginal Delivery No. 26

    Google Scholar 

  31. FIGO Safe Motherhood and Newborn Health (SMNH) Committee (2012) Management of the second stage of labor. Int J Gynaecol Obstet 119:111–116

    Article  Google Scholar 

  32. Le Ray C, Audibert F, Goffinet F et al (2009) When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. Am J Obstet Gynecol 201:361.e1–361.e7

    Google Scholar 

  33. Mc Donald JS (2000) Pain of childbirth. In: Loeser JD (ed) Bonica’s management of Pain, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, PA, pp 1388–1410

    Google Scholar 

  34. Brown ST, Campbell D, Kurtz A (1989) Characteristics of labour pain at two stages of cervical dilation. Pain 38:289–295

    Article  CAS  PubMed  Google Scholar 

  35. Lowe NK (1992) Differences in first and second stage labour pain between nulliparous and multiparous women. J Psychosom Obstet Gynaecol 13:243–253

    Article  Google Scholar 

  36. Capogna G, Celleno D, Lyons G (1998) Minumum local anaesthetic concentration of extradural bupivacaine increases with progression of labour. Br J Anaesth 89:11–13

    Article  Google Scholar 

  37. Chua NP, Sia AT, Ocampo CE (2001) Parturient-controlled epidural analgesia during labour: bupivacaine vs ropivacaine. Anaesthesia 56:1169–1173

    Article  CAS  PubMed  Google Scholar 

  38. Gambling DR, McMorland GH, Yu P et al (1990) Comparison of patient-controlled epidural analgesia and conventional intermittent “top- up” injections during labor. Anesth Analg 70:256–261

    Article  CAS  PubMed  Google Scholar 

  39. Gambling D, Berkowitz J, Farrell TR et al (2013) A randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery. Anesth Analg 116:636–643

    Article  CAS  PubMed  Google Scholar 

  40. Rathinam S, Tilakaratna P, Plaat F (2008) Pain relief in the second stage of labour: room for improvement? Intern J Obstet Anaesth, P25

    Google Scholar 

  41. Lim Y, Ocampo CE, Supandji M et al (2008) A randomized controlled trial of three patient-controlled epidural analgesia regimens for labor. Anesth Analg 107:1968–1972

    Article  CAS  PubMed  Google Scholar 

  42. Carvalho B, Cohen SE, Giarrusso M (2005) “Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload. Anesth Analg 14:223–229

    CAS  Google Scholar 

  43. Thornton JG, Capogna G (2001) Reducing likelihood of instrumental delivery with epidural anaesthesia. Lancet 358:2

    Article  CAS  PubMed  Google Scholar 

  44. Torvaldsen S, Roberts CL, Bell JC et al (2010) Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia Cochrane Database Syst Rev (4):CD004457. doi: 10.1002/14651858.CD004457.pub2

  45. Simmons SW, Taghizadeh N, Dennis AT et al (2012) Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev (10):CD003401. doi: 10.1002/14651858.CD003401.pub3

  46. Minty RG, Kelly L, Minty A et al (2007) Single-dose intrathecal analgesia to control labour pain: is it a useful alternative to epidural analgesia? Can Fam Physician 53:437–442

    PubMed Central  CAS  PubMed  Google Scholar 

  47. Palmer CM (2010) Continuous spinal anesthesia and analgesia in obstetrics. Anesth Analg 111:1476–1479

    Article  PubMed  Google Scholar 

  48. Herman A, Zimerman A, Arieli S et al (2002) Down-up sequential separation of the placenta. Ultrasound Obstet Gynecol 19:278–281

    Article  CAS  PubMed  Google Scholar 

  49. Inch S (1985) Management of third stage of labour-another cascade of intervention? Midwifery 1:114–122

    Article  Google Scholar 

  50. BonnarJ MNGP, Douglas AS (1970) Coagulation and fibrinolysis mechanisms during and after normal childbirth. BMJ 103:200–203

    Article  Google Scholar 

  51. Reynders FC, Senten I, Tjalma W et al (2006) Postpartum hemorrhage: a practical approach to a life- threatening complication. Clin Exp Obstet Gynecol 33:81–84

    CAS  PubMed  Google Scholar 

  52. Ramanathan G, Arulkumaran S (2006) Postpartum hemorrhage. Curr Obstet Gynecol 16:6–13

    Article  Google Scholar 

  53. Prendiville WJ, Elbourne DR (1989) Care during the third stage of labour. In: Chalmers I, Enkin M, Keirse MJNC (eds) Effective care in pregnancy and childbirth. Oxford University Press, Oxford, pp 1145–1169

    Google Scholar 

  54. Prendiville WJ, Elbourne D, McDonald S (2009) Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev (3):CD000007. doi:10.1002/14651858.CD000007.pub2

  55. Rogers J, Wood J, McCandlish R et al (1998) Active versus expectant management of third stage of labour: the Hinchingbrooke randomized controlled trial. Lancet 351:693–699

    Article  CAS  PubMed  Google Scholar 

  56. Begley CM, Gyte GM, Devane D et al (2011) Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev (11):CD007412. doi:10.1002/14651858.CD007412.pub3

  57. Brucker MC (2001) Management of the third stage of labor: an evidence-based approach. J Midwifery Womens Health 46:381–392

    Article  CAS  PubMed  Google Scholar 

  58. MaughanKL HSW, Galazka SS (2006) Preventing postpartum hemorrhage: managing the third stage of labor. Am Fam Physician 73:1025–1028

    Google Scholar 

  59. McDonald S, Abbott JM, Higgins SP (2007) Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labor. The Cochrane database Syst Rev (1):CD000201. doi:10.1002/14651858.cd000201.pub2

  60. Soltani H, Hutchon DR, Poulose TA (2010) Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database Syst Rev (8):CD006173. doi:10.1002/14651858.CD006173.pub2

  61. Hutton EK, Hassan ES (2007) Late vs early clamping of the umbilical cord in full-term neonates: a systematic review and meta-analysis of controlled trials. JAMA 297:1241–1252

    Article  CAS  PubMed  Google Scholar 

  62. McDonald SJ, Middleton P (2008) Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev (2):CD004074. doi:10.1002/14651858.CD004074.pub3

  63. Van Rheenen P, De Moor L, Escbach S et al (2007) Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Trop Med Int Health 12:603–616

    Article  PubMed  Google Scholar 

  64. Dombrowski MP, Bottoms SF, Saleh AA et al (1995) Third stage of labor: analysis of duration and clinical practice. Am J Obstet Gynecol 172:1279–1284

    Article  CAS  PubMed  Google Scholar 

  65. Combs CA, Laros RK (1991) Prolonged third stage of labor: morbidity and risk factors. Obstet Gynecol 77:863–867

    CAS  PubMed  Google Scholar 

  66. Brandt ML (1993) The mechanism and management of the third stage of labour. Am J Obstet Gynecol 25:662–667

    Google Scholar 

  67. LipitzS FJ (1988) Puerperal inversion of the uterus. Eur J Obstet Gynecol Reprod Biol 27:271–274

    Article  Google Scholar 

  68. Miras T, Collet F, Seffert P (2002) Acute puerperal uterine inversion: two cases. J Gynecol Obstet Biol Reprod 31:668–671

    CAS  Google Scholar 

  69. Tandberg A, Albrechtsen S, Iverson DE (1999) Manual removal of placenta. Acta Obstet Gynecol Scand 78:33–36

    Article  CAS  PubMed  Google Scholar 

  70. Fernando R, Sultan AH, Kettle C et al (2006) Methods of repair for obstetric anal sphincter injury. Cochrane Database of Systematic Reviews (3):CD002866. doi:10.1002/14651858.CD002866.pub2

  71. Zetterstrom J, Lopez A, Anzen B et al (1999) Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol 94:21–28

    Article  CAS  PubMed  Google Scholar 

  72. Zetterstrom JP, Lopez A, Anzen B et al (1999) Anal incontinence after vaginal delivery: a prospective study in primiparous women. BJOG 106:324–330

    Article  CAS  Google Scholar 

  73. Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36

    CAS  PubMed  Google Scholar 

  74. American College of Obstetricians and Gynecologists (2006) Episiotomy: clinical management guidelines for obstetrician-gynecologists. ACOG Practice Bulletin No. 71. Washington, DC, ACOG. Obstet Gynecol 107:957–962

    Google Scholar 

  75. Hartmann K, Viswanathan M, Palmieri R et al (2005) Outcomes of routine episiotomy: a systematic review. JAMA 293:2141–2148

    Article  CAS  PubMed  Google Scholar 

  76. Carroli G, Mignini L (2009) Episiotomy for vaginal birth. Cochrane Database Syst Rev (1):CD000081. doi:10.1002/14651858.CD000081.pub2

  77. Walker MP, Farine D, Rolbin SH et al (1991) Epidural anesthesia, episiotomy, and obstetric laceration. Obstet Gynecol 77:668–671

    CAS  PubMed  Google Scholar 

  78. Bikers WM (1970) Epidural analgesia in obstetrics. J Reprod Med 5:41–49

    Google Scholar 

  79. Legino LJ, Woods MP, Rayburn WF et al (1988) Third and fourth degree tears. 50 year’s experience at a university hospital. J Reprod Med 33:423–426

    CAS  PubMed  Google Scholar 

  80. Combs CA, Robertson PA, Laros RK (1990) Risk factors for third-degree and forth-degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol 163:100–104

    Article  CAS  PubMed  Google Scholar 

  81. Albers LL, Migliaccio L, Bedrick EJ et al (2007) Does epidural analgesia affect the rate of spontaneous obstetric lacerations in normal births? J Midwifery Womens Health 5:31–36

    Article  Google Scholar 

  82. MacDougall M, Waugh J, Morland D (2011) Epidural analgesia may be protective against third and fourth degree perineal trauma. Arch Dis Child Fetal Neonatal 96:1. doi:10.1136/archdischild.2011.300162.2

    Article  Google Scholar 

  83. Burrel M, Dilgir S, Patton V et al (2004) Risk factors for obstetric anal sphincter injuries and postpartum anal and urinary incontinence: a case-control trial. Int Urogynecol J. doi:10.1007/s00192-014-2478-7

    Google Scholar 

  84. Murphy DJ, Macleod M, Bahl R et al (2008) A randomized controlled trial of routine versus restrictive use of episiotomy at operative delivery: a multicenter pilot study. BJOG 115:1695–1702

    Article  CAS  PubMed  Google Scholar 

  85. Robinson JN, Norwitz ER, Cohen AP et al (1999) Episiotomy, operative vaginal delivery, and significant perineal trauma in nulliparous women. Am J Obstet Gynecol 181:1180–1184

    Article  CAS  PubMed  Google Scholar 

  86. Bodner-Adler B, Bodner K, Kimberg O et al (2003) Management of the perineum during forceps delivery. Association of episiotomy with the frequency and severity of perineal trauma in women undergoing forceps delivery. J Reprod Med 48:239–241

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michela Camorcia .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Camorcia, M. (2015). The Second and Third Stage of Labor. In: Capogna, G. (eds) Epidural Labor Analgesia. Springer, Cham. https://doi.org/10.1007/978-3-319-13890-9_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13890-9_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13889-3

  • Online ISBN: 978-3-319-13890-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics