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The second stage and when to push
As you enter the second stage of labor, you will probably experience an overwhelming desire to bear down. Once your doctor has established that you are fully dilated and are ready to start pushing, you may start to feel more in control of your labor since your pushing helps move your baby farther down into the pelvis.
The second stage of labor starts when your cervix is completely open, at about 10 cm, and ends with the birth of your baby. This stage usually lasts for around 45 minutes to two hours during a first labor and from 15 to 45 minutes in subsequent deliveries. The second stage is intense and during this time your contractions will become stronger, but may occur less frequently, occurring around every two to five minutes. At this point you may feel a sensation of fullness in your vagina or bowel and have a strong urge to push. Many women find labor pains more bearable in the second stage since they can now actively work with the contractions and push their baby out. Other women find this a particularly hard part of labor because they start to feel exhausted from the effort of prolonged pushing.
Your baby will start to rotate his or her head and shoulders to enable these to descend through your pelvis to be born, and you will feel the urge to bear down and push as this is happening. Your doctor will help you focus and encourage you to push when you feel the urge, which will come naturally with a contraction. With each contraction, you will need to concentrate on pushing down deep into the pelvic area and bottom. It can help to put your chin on your chest and to bear down for as long as possible during a contraction, during which time you may need to take several steady breaths. You may feel like grunting and making noises when bearing down, or you may prefer to breathe deeply and quietly; you should do whatever you find helpful and works best. You will need to work with your body's instincts and adopt the position you find most comfortable and easy to give birth in. Pushing your baby out into the world takes a huge amount of effort and energy, but you have the ability and are very capable of doing this.
Your doctor and birth partner will encourage and support you throughout this stage and help you to believe in your ability to give birth.