labour second stage management

During the second stage of labor, which begins with complete cervical dilation and ends with delivery, skilled attendants should encourage the woman to push when she feels the urge, monitor fetal well-being, and be prepared for potential complications, including instrumental vaginal delivery or cesarean section.
Here's a more detailed look at the management of the second stage of labor:

Key Aspects of Care:

☆Positioning:
Allow the woman to deliver in a position of her choice, including upright positions, as long as it's safe and comfortable.
☆Pushing:
Encourage the woman to push when she feels the urge to bear down.
Avoid directing pushing unless necessary, as spontaneous pushing is often more effective.
Remind the mother to urinate so her bladder doesn't interfere with her progress.
☆Monitoring:
Continuously monitor the fetal heart rate (every 5 minutes).
Check maternal vital signs, especially if there are pre-existing conditions like hypertension or cardiac disease.
Observe progressive descent and rotation of the presenting part.
☆Pain Relief:
Discuss pain relief options with the woman before labor and offer them according to her wishes.
Perineal Care:
Perineal massage with lubricants and warm compresses may soften and stretch the perineum, reducing the risk of tears.
Consider perineal protection devices.
☆Avoid routine episiotomy.
☆Assisted Vaginal Delivery (AVD):
Be prepared to undertake instrumental vaginal delivery (vacuum or forceps) where indicated for fetal bradycardia or non-advance of the presenting part.
☆☆☆Second Stage Arrest:
Second-stage arrest is typically defined as at least 3 hours of pushing in nulliparous women or at least 2 hours in multiparous women.
If progress is suboptimal, seek obstetric review and consider interventions.
Cesarean Section:
Consider second-stage cesarean birth if AVD is not safely feasible.
Postpartum Care:
Following delivery, the infant should be dried and stimulated as appropriate, and transferred to the mother for skin-to-skin contact.