Hi everyone my name is ILO and I'm a registered Midwife and childbirth instructor I work in a very large Urban setting in Canada and I have two small children at home so I know what this experience is like as a parent for the second time around in addition to my clinical practice I love educating families about the prenatal period their pregnancies birth and the postpartum today we're going to talk about pushing your baby and your baby's birth so let's get started in the second stage of Labor you will experience pushing and the birth of your baby physically what's happening at this stage the contractions are very frequent very intense and each one brings baby's head further and further further and further down into the birth canal in labor generally the muscles of the uterus are pulling up and pulling the cervix thin and tight across baby's head and eventually completely melting that cervix away so all that's left is baby's head down low in the birth canal when it comes time for pushing you start to feel those contractions much lower down deep into the vagina and even into the rectum at this stage you can feel a tremendous amount of pressure in the rectum and sometimes it's an overwhelming pressure to the point where you just start spontaneously pushing at this point we encourage you to go with that urge to really bear down with each of those surges and to help that baby's head come down underneath the pubic bone around and onto the perineum if it's your first baby the pushing stage can take anywhere from an hour to two hours sometimes even three if you have an epidural don't be discouraged it's a deceptively long journey to go around and under the pubic bone I tell my patients to think about it as they're getting a car unstuck from a snowbank in the dead of winter you rock back and forth slowly back and forth building up momentum and eventually that baby will come around underneath the pubic bone and stay on the perineum it's really important at this stage to listen to your doctor or Midwife they will Coach you on when to push how hard to push how effective those pushes are and encourage you along the way at some point that baby's head is going to be staying on the perineum even in between pushes and we want to listen to our coaches Our Midwives our doctors they will tell you to stop pushing at one point and just breathe at that stage there's a tremendous amount of stretching intense burning and stinging on the perineum and this helps the tissues stretch out become nice and elastic and pass behind baby's head and we want you to really take your time as that baby's head is crowning to limit the amount of tearing that takes place on the perineum so really listen closely to what your Midwife and doctor is saying at this stage once baby's head is born we wait for the next contraction for that head to rotate and line up with the shoulders and then with the next contraction another push usually delivers the shoulders and baby is born and placed skin to skin if we can directly on Mom now that I've described the process for you why don't I show you what it looks like throughout the course of your active labor that baby's head will descend through the pelvis coming lower and lower and lower eventually as we start pushing a little bit of that baby's head will peek out in between the labia and eventually stay on the perenium once baby's head is born we wait for that head to rotate to the side and then with the next contraction we get you to push down and we deliver baby's shoulders and then baby comes on skin to skin ideally if we can directly on mummy we like to give babies a little bit of a dry a little bit of a rub and to give them their first cry as they transition from Life in udero to the outside world every once in a while babies need a little bit of extra attention in that case baby will go to the warmer where a team is waiting and they can use suction to clear the mouth and nose sometimes a little bit of oxygen sometimes a more extensive resuscitation if baby needs as soon as baby is ready they'll be taken back to Mom and placed skin to skin and ideally we want to keep baby there for at least an hour having baby skin to skin helps regulate their blood pressure their breathing their temperature their blood blood sugar and also kickstarts those really important hormones to help with breastfeeding after baby is born it's becoming common practice to wait up to a minute until the cord stops pulsing before we clamp and cut once that happens we'll turn baby around place two clamps on the umbilical cord and give the support person the opportunity to cut in between at this stage it can be helpful to latch baby on because it helps contract and cinch down the uterus and separate the placenta from the uterine lining at this point we move into the third stage of Labor which is the birth of the placenta in Canada it's common practice to give an injection of oxytocin to help expel the placenta and to prevent significant bleeding afterwards you may feel some tightenings and cramping mild contractions and see a gush of fresh red bleeding that signals it's time to birth the placenta your doctor or Midwife will often apply a little bit of traction onto the cord and encourage you to Bear down and push to deliver the placenta there's no bones in this one much easier to push out than a baby's head and it feels like such relief to have that placenta born once the placenta is delivered we very closely monitor your bleeding and we'll give your tummy a little bit of a rub to check and make sure that that uterus is well contracted is firm and is underneath the belly button at this stage we put the placenta out of the way on the delivery t table and you have the option of taking it home with you or having the hospital dispose of it don't be shy ask for a placenta tour if you're interested they're such neat organs and it can be an amazing thing just to have a look around and see where your baby was for 9 months right after baby's born we're monitoring very closely their heart rate their breathing their color their tone but we're also going to be checking in at routine intervals throughout the postpartum period additionally to that we do the newborn exam and we check on Mom's vital signs at routine times as well part of the newborn exam is the administration of two medications the first is Vitamin K which is very strongly recommended to help prevent clotting disorders and bleeding internally that we might not see in good time the second optional medication is an antibiotic eye ointment called reasin which is used to prevent eye infections in undiagnosed chlamidia and gonorrhea infections that the mom may have in the postpartum period we'll also take a look at your perineum and assess for any tears if you do need to have stitches put in the epidural is still running at this stage age and you can give yourself a little boost if you don't have an epidural your doctor Midwife will inject local anesthetic into the perum just like you do at the dentist so you will not feel the stitches going in place we'll give you instructions on how to take care of them and they dissolve on their own so there's no need to have them taken out we'll be carefully monitoring your bleeding and it can be quite heavy right after baby's born it should however start to taper off and particularly as you go home and get settled in it should be lighter and lighter each day if you're ever concerned about the amount of bleeding please always check in with your care provider a lot of people also experience some cramping afterwards your uterus is such a smart organ and it cinches down Contracting nicely to help prevent you from having significant bleeding but that can bring about some discomfort so some acetaminophen and ibuprofen can be really helpful in those first few days to help with the after pains as you progress through these amazing stages of labor the contractions pushing your baby out the birth of your wonderful new baby the placenta the after portion it's so wonderful to have our support people with us and our partners have a really important job too they provide emotional support coaching us cheering us on they provide Hands-on Physical support in the labor changing positions getting up to use the toilet repeating affirmations but they also give us information support they're are second set of ears so when we are working our way through these intense contractions and not always taking in what's being said in the room our care team and our labor support folks are there to ask those questions to advocate for us and to relay our birth preferences that brings us to our birth preference list if you're making one ahead of time make sure that your partner is looped in as well so they can advocate for you and give those preferences to your healthc care team when they ask that brings us to the end of this video I hope you found it informative and please be sure to check out the others in our series take care and we'll see you soon