The cervix is completely dilated, and baby’s head has rotated and descended through the birth canal. The feeling of wanting to push will gradually increase. It is time to push when the baby’s head has descended and is situated against the pelvis. This is done with the help of the fetal ejection reflex. Pressure on the rectum results in a feeling of “I have to push”. The midwife is there to guide you throughout the process.
For first-time mothers, it is considered normal that it takes two hours from when the cervix is completely dilated until baby’s head is pressing on the pelvis. From then, it normally takes one hour to expel the baby. If the woman has given birth before, the process goes considerably quicker. Baby number one has paved the way for his or her siblings, so to speak.
In this stage, you will need help focusing on the breaks between contractions and resting, even though these breaks last only one or a few minutes. At this point, it’s common for women to say things like, “This is never going work. I want to go home”. You need to believe that things will be fine and that your baby is almost here. When the expulsion contractions increase and pressure on the rectum is at its greatest, many women are convinced that they will have a bowel movement and that their entire genital area will rupture. Many women are concerned that they will have severe vaginal tears, which is fully understandable. It might be good to know that one of the midwife’s primary tasks is to do everything to ensure that the tear is as little as possible.
At this point, when the baby arrives, communication and trust between you and your midwife is important. The midwife will guide you through your baby’s delivery so this is not something you need to concern yourself with in advance. Your partner may be feeling “out of the loop” but from an emotional perspective, your partner’s presence is important in making you feeling safe.
Sources: - Abascal, G., & Huss, M. S. (2018). Att föda. Bonnier Fakta.