Operational Obstetrics & Gynecology

Labor and Delivery

Watch a Video Showing a Normal Delivery or Cesarean Section

Labor	Contractions	Electronic Fetal Monitors
Latent Phase Labor	Fetal Heart Rate	Pain Relief
Active Phase Labor	Urine	Second Stage Labor
Progress of Labor	Estimated Fetal Weight	Preparing for Delivery
Delivery of the Baby	Dilatation and Effacement	Managing the Delivery
Delivery of the Placenta	Fetal Orientation	Episiotomy
Managing Labor and Delivery	Leopold's Maneuvers	Anesthesia
Initial Evaluation	Fetal Membranes	Clamp the Cord
History	Blood Count	The Placenta
Risk Factors	Early Labor	Uterine Massage
Vital Signs	Monitor the Fetal Heart	Post Partum Care

Second Stage Labor

On reaching complete cervical dilatation, the woman has entered the second stage of labor. The second stage lasts until the delivery of the baby. During the second stage, try to measure the fetal heart rate every 5 minutes.

During the second stage of labor, the woman will feel the uncontrollable urge to bear down. This Valsalva has the effect of increasing the expulsive forces and speeding the delivery process.

For most women, the most effective way to push is in the semi-recumbent position. With the onset of a contraction, she takes several, rapid, deep breaths. Then she holds her breath and tightens her stomach muscles, as though she were trying to move her bowels. She pushes for 10 seconds, relaxes, takes another breath, and pushes for another 10 seconds. Most women can get three or four pushes into a single contraction. She will usually push more effectively if her knees are pulled back towards her shoulders.

Some women find they are not comfortable in the semi-reclining position and they may push while tilted toward one side or the other.
Some women prefer to deliver on their side, with one knee drawn up and the other leg straightened (the Sims position).
Some women prefer to deliver in the sitting or squatting position.

Duration of the second stage is typically an hour or two for a woman having her first baby. For a woman having a subsequent baby, the second stage is usually shorter, less than an hour.

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Operational Obstetrics & Gynecology - 2nd Edition
The Health Care of Women in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMEDPUB 6300-2C
January 1, 2000

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

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