(See "Continuous labor support by a doula" and 'Pushing' below.) In the second stage, pushing (contraction of voluntary striated muscles of the diaphragm and abdominal wall) is partly a response to stimulation of the pelvic floor by the descending presenting part and partly a voluntary effort that is self-initiated and/or directed by a birth attendant, such as a doula or other labor support person. These benefits begin in the first stage and continue through the second and third stages of labor. ![]() Parity and use of neuraxial anesthesia ( table 1).ĬONTINUOUS SUPPORT - Continuous labor support, particularly by a doula, has psychological and obstetric benefits, as shown in the table ( table 2).(See "Labor: Overview of normal and abnormal progression", section on 'Fetal and pelvic factors'.) Maternal expulsive efforts, although active maternal effort is not essential unconscious patients and those with complete spinal cord injury can give birth without obvious active expulsive efforts.(See 'Maternal position while pushing and giving birth' below.) (See "Labor: Overview of normal and abnormal progression", section on 'Uterine factors'.) Uterine contraction strength and frequency.Android pelvic shapes are associated with more occipitoposterior positions during labor. The course of the second stage is affected by several maternal and fetal factors, including : ![]() These movements are necessary to avoid presenting diameters of the nonspherical head that are larger than the diameters of the bony pelvis through which the head must traverse and because the pelvic outlet is at a 90-degree angle to the pelvic inlet. (See "COVID-19: Intrapartum and postpartum issues", section on 'Approach to infection control'.)ĬOURSE - During labor, the fetus in vertex presentation undergoes a series of movements (called cardinal movements) that facilitate passage through the pelvis and soft tissues of the birth canal: engagement of the biparietal diameter at the pelvic inlet (fetal head enters pelvis transversely or obliquely) -> descent into the pelvic cavity -> flexion of the neck due to pressure by maternal soft tissues -> internal head rotation (usually to an occiput anterior position) -> further descent leading to extension of the neck from upward pressure on the head by the maternal soft tissues -> head expulsion -> rotation of the shoulders to the anteroposterior diameter and external rotation of the head (restitution) to realign with the shoulders -> expulsion of the rest of the body. Management of labor and delivery during the coronavirus disease 2019 (COVID-19) pandemic is reviewed separately. ![]()
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