Expulsive Contractions: Stages, Tips & Care
Expulsive contractions are the powerful uterine contractions during the second stage of labour that push the baby through the birth canal toward delivery.
Things worth knowing about "Expulsive contractions"
Expulsive contractions are the powerful uterine contractions during the second stage of labour that push the baby through the birth canal toward delivery.
What are expulsive contractions?
Expulsive contractions, also called pushing contractions or bearing-down contractions, are the intense uterine contractions that occur during the second stage of labour (the expulsive or pushing phase). This stage begins once the cervix is fully dilated (10 cm) and ends with the birth of the baby. These contractions are typically the strongest of the entire labour process and serve to propel the baby through the birth canal.
Characteristics and Pattern
During expulsive contractions, the birthing person experiences an overwhelming, involuntary urge to push, similar to the sensation of a bowel movement. The contractions are characterised by the following features:
- Duration of each contraction: 60–90 seconds
- Frequency: every 2–4 minutes
- Intensity: greater than that of earlier (first-stage) contractions
- Accompanied by an involuntary bearing-down urge
Difference from First-Stage Contractions
While first-stage contractions (latent and active phase contractions) are responsible for dilating the cervix, expulsive contractions serve the distinct purpose of actively moving the baby downward through the birth canal. They are generally longer, stronger, and more closely spaced than earlier contractions.
Active Pushing
Midwives and obstetric professionals guide the birthing person to work with the involuntary pushing urge through controlled breathing techniques and optimal positioning. Active pushing at the peak of each contraction can help shorten the duration of the second stage. Various birth positions, including squatting, hands-and-knees, or semi-reclined, may influence the effectiveness of expulsive contractions.
Breathing Techniques During Pushing
- Deep inhalation at the onset of the contraction
- Breath-holding and bearing down (Valsalva manoeuvre) during the contraction peak
- Slow exhalation after the contraction subsides
Medical Monitoring
During the second stage of labour, both mother and baby are closely monitored. The baby's heart rate is tracked using cardiotocography (CTG) to ensure adequate oxygenation. If concerns arise, the obstetric team may intervene with an emergency caesarean section or an assisted delivery using vacuum (ventouse) or forceps.
Possible Complications
In some cases, complications may arise during the expulsive phase that require medical intervention:
- Prolonged second stage: When pushing lasts longer than recommended thresholds (over 2 hours in first-time mothers, over 1 hour in multiparous women)
- Fetal heart rate abnormalities: Detected on CTG, potentially indicating oxygen insufficiency
- Shoulder dystocia: Difficulty delivering the baby's shoulders following delivery of the head
Pain Relief Options
Expulsive contractions are typically very painful. Several pain management options are available:
- Epidural analgesia (EDA): Regional anaesthesia that significantly reduces labour pain
- Nitrous oxide (laughing gas): Inhaled analgesic offering partial pain relief
- Water birth: Warm water immersion may ease discomfort and promote relaxation
- Massage and counter-pressure: Supportive techniques applied by birth partners or midwives
References
- World Health Organization (WHO) (2018). WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: WHO Press.
- Cunningham, F. G. et al. (2022). Williams Obstetrics, 26th edition. McGraw-Hill Education.
- Beckmann, M. M., Stock, O. M. (2013). Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews, Issue 4.
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