Labor Stage 2: Normal and Abnormal Labor

00:01 Now let's discuss the second stage of labor.

00:06 First, let's review all of our stages of labor.

00:09 Stage 1 starts with the onset of labor until 10 centimeters dilated.

00:14 Stage 2 starts with 10 centimeters dilated and it ends with the delivery of the fetus.

00:19 And then stage 3 starts with the delivery of the fetus and ends with the delivery of the placenta.

00:26 So it's important to know that during stage 2, the fetus is entering the pelvis through the cardinal movements of labor which begin in stage 1 and are completed in stage 2.

00:38 Now let's review the cardinal movements of labor.

00:41 First there is engagement, that's when the head enters the pelvis.

00:45 Then there's descent, that is as the fetus starts to descend into the pelvis.

00:50 Then there is flexion.

00:52 Because of the pelvis the fetal chin will go against the chest to have the fetal vertex enter into the pelvis.

00:58 Then there is internal rotation as the head starts to turn.

01:04 Then there's extension as the head goes underneath the mom's pubic symphysis.

01:08 And then there is external rotation where the head will go back to the original rotation.

01:13 And then expulsion, and the fetus is delivered.

01:16 Now if you have a little trouble, remembering all of these maneuvers, here's another metaphor that may help you.

01:22 So you may think of it like a wedding.

01:25 First you get engaged.

01:27 Then you descend down the aisle.

01:29 Then you flex your head to pray.

01:31 Then you turn towards your spouse.

01:33 You lift your head back up.

01:35 You kiss each other.

01:37 Then you externally rotate or turn towards the congregation.

01:41 And then you walk down on the aisle.

01:43 And that's the expulsion.

01:44 I hope that helps you remember these steps.

01:48 Now for stage 2, what are parameters for normal labor? In our primiparous patient with an epidural, we expect that baby to be pushed out within 3 hours.

01:58 For multiparous mom 2 hours.

02:01 Without an epidural for primiparous mom, the baby should be pushed within 2 hours.

02:06 And for our multiparous mom without an epidural, we expect the baby to come out within 1 hour.

02:12 A stage 2 progresses but takes longer than the expected parameters we have listed here.

02:18 This is considered a protracted second stage.

02:20 If there is no descent for more than 2 hours, this is considered an arrest of the second stage of labor.

02:27 So abnormal labor in the second stage is considered an arrest.

02:34 When that occurs, an operative delivery must happen.

02:37 If the fetus is less than +2 station, meaning the head is higher than +2 station then you would proceed with a cesarean delivery.

02:46 If the head is below +2 station and all the other parameters are met an operative vaginal delivery can happen.

02:54 That's discussed in another lecture.