The second stage of active labor is the actual birth, when the baby is pushed out by the tightening uterine muscles (contractions). During the second stage:

• Uterine contractions will feel different. Though they are usually regular, they may slow down to every 2 to 5 minutes, lasting 60 to 90 seconds. If your labor stalls, changing positions may help. If not, your health professional may recommend using medication to stimulate (augment) uterine contractions.
• You may have a strong urge to push or bear down with each contraction.
• The baby's head is likely to create great pressure on your rectum.
• You may need to change position several times to find the right birthing position for you.
• You can have a mirror positioned so you can watch your baby crown and emerge from the birth canal.
• When the baby's head passes through the vagina (crowns), you will feel a burning pain. The head is the largest part of the baby and the hardest part to deliver. If this is happening quickly, your health professional may advise you not to push every time, which may give the perineum, or area between the vulva and the anus, a chance to stretch without tearing. Or he or she may make an incision in the perineum (episiotomy). This depends on clinical judgement and/or your preference.

Should I plan to have an episiotomy?

This pushing stage can be as short as a few minutes or last for several hours. You are more likely to have a fast labor if you have given birth before.