The second stage of labour begins when the cervix is fully dilated, and ends with the birth of your baby. The stage lasts anything from a few minutes to a couple of hours.

You'll know you're at second stage when you feel a very powerful need to push downwards. If you've had an epidural, you may not feel this as powerfully, or even at all. This pushing is called 'bearing down'. The midwife will help you know what to do if you don't feel it.

You may feel you need to hold your breath to bear down; don't hold it too long. Listen to the midwife, and follow her guidance. She may even tell you not to push - maybe because a small 'lip' of cervix is still tucked in. When the lip dilates, you're ready to go! Or, she may see your perineum - the skin between your vagina and anus - is very stretched, and want to prevent a tear. You might be asked to 'breathe the baby out' with light, gentle breaths.

Some women just don't feel the urge to bear down, even if they don't have an epidural. The baby just slides out. This is only likely to happen if you have already had a few children.

First sight of your baby

When the head becomes completely visible at the vulva, it's said to be 'crowning'. You or your birth partner can hold a mirror up if you want to, so you can see this moment. With the next contraction or two, your baby's head emerges first, and then the rest of him follows.

Your midwife will gently lift your baby and place him in your arms or on to your tummy, so you can see him properly, and greet him.

What's the best position to be in?

Anything that allows you to feel as comfortable as possible between contractions, and lets your baby emerge safely.

A supported standing squat allows your pelvis to open wide, and your baby to be born with the help of the force of gravity. You need support for your upper body to help you stay balanced. If your partner's strong enough, he can hold you from behind, under your arms. Your knees shouldn't be higher than your hips (this would strain your joints).
A stool or chair supports you, in a sort of semi-squatting position. You may also need to be held.
All-fours allows you to take a rest by leaning forward between contractions.
Lying flat doesn't really help the birth. There's some compression of your pelvis, and your baby has to travel 'uphill' against gravity. Sitting up in the bed, supported by plenty of pillows and perhaps your partner, is a bit better.
On your side, with your upper leg raised, is restful if you are tired and can't be more upright.

The moment of birth Your baby's head usually emerges facing towards your back. The midwife may check the baby's umbilical cord, to make sure it's not round the neck. The shoulders then turn so the body is sideways on, and the head, now outside of you, turns to the side as well.

Qs & As:

Q: Why do some babies need helping out with forceps or a ventouse?
A: Forceps are a set of linked spoons that grasp the baby's head to help it along. A ventouse uses a vacuum pump to help the baby make these last important inches on the journey. A baby might need either of these to be born more quickly, for example:

If he's distressed' - shown in a slowing heart rate, or if the baby passes meconium (the contents of the baby's rectum) which will stain the liquor (amniotic fluid), or shown in a blood sample taken from the baby's scalp.
If his way out is difficult, because he is in a poor position, or because the mother's pelvis isn't able to open wide enough.
If your contractions have weakened, or you're exhausted.
If the baby is pre-term, which means his soft skull bones need more protection.

Q: Will I need stitches after the birth?
A: Sometimes, the perineum tears while stretching over the baby's head. Or, the midwife may ask if she can cut the perineum because she feels you are about to tear badly or the baby needs to be born quickly. You will be cut if you have forceps. This cut is known as an episiotomy. Large tears and episiotomies need stitching up afterwards. You will be given a local anaesthetic while this is done. The stitches should dissolve by themselves; you don't usually need to have them taken out.