Second Stage of Labor: What Happens After Water Breaks

The second stage begins at full cervical dilation (10 cm) and ends with baby's birth. Rupture of membranes often occurs during first stage or early second stage.

Physiology

• Contractions: Stronger, longer (60–90 sec), closer (2–5 min apart).
• Fetal descent: Head engages, flexes, internally rotates, extends, externally rotates, restitutes.
• Maternal urge to push: Ferguson reflex (stretch receptors in vagina/perineum).

What to Expect

• Intense rectal pressure, urge to bear down
• Burning/stinging as crown stretches perineum ("ring of fire")
• Crowning → head delivery → shoulder rotation → body delivery

Duration

• Nulliparas: 1–3 hours (longer with epidural)
• Multiparas: Often <1 hour

Coping Strategies

• Upright positions (squat, hands-knees, birth stool) use gravity.
• Open-glottis pushing (exhale while bearing down) vs. closed-glottis (Valsalva).
• Breathing, visualization, hydrotherapy.
• Partner/doula support; follow provider guidance.

Complications

Prolonged second stage (>3h nullipara, >2h multipara with epidural) may need operative vaginal delivery (vacuum/forceps) or cesarean.