Nursing Care during the Second Stage of Labor
Key Points
- Second-stage care prioritizes coordinated pushing support, fetal surveillance, and maternal safety.
- Maternal assessments include frequent vital signs, contraction trend, descent progress, and fatigue.
- Fetal heart rate monitoring must rapidly identify compromise and trigger escalation.
Pathophysiology
The second stage begins at complete cervical dilation and ends with birth of the newborn. During this stage, uterine contractions and maternal bearing-down efforts combine to move the fetus through the pelvis while fetal oxygen reserve is repeatedly challenged by contraction stress.
Nursing support influences both physiologic efficiency and safety. Position changes, breathing guidance, and targeted coaching can optimize descent mechanics and reduce unnecessary maternal exhaustion while preserving fetal tolerance.
Classification
- Maternal-support domain: Positioning, rest-push balance, comfort measures, and emotional coaching.
- Fetal-monitoring domain: Continuous or intermittent surveillance for distress patterns.
- Preparation domain: Delivery setup, newborn warmer readiness, and team coordination.
- Complication domain: Slow descent, excessive bleeding, shoulder dystocia risk, and maternal fatigue.
Nursing Assessment
NCLEX Focus
Priority questions ask which finding in second stage requires immediate provider notification and which support action should be implemented first.
- Monitor maternal vital signs at least every 30 minutes and contraction pattern about every 15 minutes.
- Assess pushing effectiveness, energy conservation, and signs of physical or emotional exhaustion.
- Track fetal station progression, crowning, and fetal heart rate response to contractions and pushing.
- Identify complication cues such as abnormal fetal tracing, prolonged second stage, excessive bleeding, or dystocia concern.
Nursing Interventions
- Coach pushing with stage-appropriate breathing and individualized strategy (open or closed glottis).
- Promote position changes that support descent and comfort while maintaining monitoring quality.
- Apply comfort measures such as warm compresses, massage, and cool-cloth support.
- Prepare sterile birth field and newborn resuscitation readiness while maintaining continuous bedside communication.
Fetal Distress and Dystocia Risk
Abnormal fetal heart patterns or signs of shoulder dystocia require immediate escalation and coordinated emergency response.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| labor-analgesics | Epidural and non-epidural options | Analgesia choice affects pushing sensation, coaching strategy, and movement support. |
| uterotonics | Oxytocin labor context | Contraction pattern and fetal response must be monitored closely during use. |
Clinical Judgment Application
Clinical Scenario
A patient with complete dilation has prolonged pushing, rising fatigue, and intermittent nonreassuring fetal heart changes.
Recognize Cues: Decreasing push effectiveness, slower descent, and fetal stress indicators. Analyze Cues: Maternal exhaustion and contraction stress may be reducing safe progression. Prioritize Hypotheses: Immediate priority is fetal safety while restoring effective maternal effort. Generate Solutions: Adjust position, refine coaching, optimize rest between contractions, and update provider. Take Action: Implement support bundle and increase surveillance frequency. Evaluate Outcomes: Descent progresses and tracing stabilizes, or expedited operative plan is activated.
Related Concepts
- stages-of-labor - Defines transition points and expected second-stage progression.
- fetal-heart-rate-and-contraction-patterns - Pattern interpretation directs urgent decisions.
- nonpharmacological-pain-management - Comfort strategies improve coping and pushing efficiency.
- intrauterine-resuscitation - Needed when second-stage fetal oxygenation becomes compromised.
- labor-dystocia - Slow progression framework informs escalation thresholds.
Self-Check
- Which second-stage findings indicate progression versus arrest of labor?
- How do open and closed glottis pushing strategies influence coaching?
- Which cues require immediate escalation for possible shoulder dystocia or fetal compromise?