May 21, 2014
Volume 16, Issue 11
Midwifery Today E-News
“Second Stage”
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Get second stage advice in e-book format!

Download Second Stage: The Pushing Phase of Labor, a collection of 10 articles from Midwifery Today magazine. Articles include “Understanding Stages of Labour after the Paradigm Shift” by Michel Odent, “Midwifing Second Stage” by Sister MorningStar, “Supporting Motherbaby in Second Stage Waterbirth” by Cornelia Enning and “Getting to Second Stage” by Carol Gautschi.

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In This Week’s Issue

Join us in the UK

UK conferenceAttend our conference in Bury St. Edmunds, UK, 26–30 May 2014. You’ll be able to choose from a wide selection of classes, including Prolonged Labor, Breech Skills, Comfort Measures and Rebozo Techniques and Practice. Planned teachers include Robbie Davis-Floyd, Eneyda Spradlin-Ramos, Jane Evans and Elena Piantino. Only walk-in registrations are now being accepted.

Learn more about the Bury St. Edmunds, UK, conference.

AU conferenceLearn about midwifery skills from around the world

Come to our conference in Byron Bay, Australia this November. You’ll be able to choose from classes such as Rebozo Techniques from Mexico with Angelina Martinez Miranda (pictured), Spinning Babies with Gail Tully, Prolonged Pregnancy with Gail Hart and Placenta as Medicine with Jodi Selander. Plan now to attend.

Learn more about the Byron Bay, Australia, conference.

Quote of the Week

The moment of birth is an eclipse of all the work, struggle, pain, waiting, fear, anticipation, exhaustion and mystery that has led up to it.

Sister MorningStar

Midwifery Today E-News is just the beginning.

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The Art of Midwifery

The most important thing for the midwife during the pushing phase of labor is to refrain from engaging the mother’s thinking brain. Stay sensual with her. If you feel she needs to slow her breathing down or to breathe more deeply, sit nearby and do that. Breathe the way you want her to breathe. She will do exactly what you do.

Sister MorningStar
Excerpted from “Midwifing Second Stage,” in Second Stage: The Pushing Phase of Labor, a Midwifery Today e-book
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Editor’s Corner

Birth Refugees

Midwifery Today magazine is going to do a tribute to Marsden Wagner—the world lost him at 84 years old on Sunday, April 27, 2014, to pneumonia. He was a great advocate for midwives and birthing women and was Regional Officer for Maternal and Child Health in the European Regional office of the World Health Organization for 15 years. He also spoke at many Midwifery Today conferences and often wrote articles for the magazine. About 15 years ago, I asked Marsden, “What is the most important issue facing midwives today?” He answered, “Autonomy.” I believe this was a prophetic statement. In California, a law was recently passed. Because midwives were working to get out from under doctor supervision, they gave up the legal right to help mothers with breeches, twins and VBACs, effectively paving the way for more cesareans and other interventions. California Bill AB1308 takes away the basic human right of choice from women most in need of choosing where and with whom they give birth. It makes them even more vulnerable in a largely profit-oriented birth industry.

Birth is a human rights issue, but where is the human right for motherbaby or for midwives? Midwives are being pressured into giving up their autonomy to serve women in order to be licensed and approved. Women the world over are searching for safe places to have their babies. A woman from Kazakhstan asked a midwife friend of mine to help with her birth. This woman was able to get a visa, but unfortunately two other women from Russia, who also asked my friend for help, were denied visas. Many women understand the trauma and abuse that can happen within the medical system and, sadly, too many have already experienced it.

The Global Midwifery Council (GMC) is attempting to help those whom we are calling “birth refugees.” We are making a list of existing safe places to have optimal births around the world. These are places where moms can come a few weeks to a few months prior to the birth and where they can have a lovely prenatal and birth experience. If you know of any places like this or are a midwife who offers this, please e-mail me at or Deborah Allen at There need to be places all over the world for these birth refugees to find rest, relaxation, good food and the best birth possibilities.

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Featured Article

Getting to Second Stage

I am enamored with the students I have with me at births that are eager and anxious about being there. There are certain parts of birth that bring them greater satisfaction than others do. One fascination they seem to have is with second stage.

As a woman “gives to birth,” the crescendo becomes evident as she moves into her deeper work. Soon she discovers what is expected of her. This is when she often conquers her fears and begins to move into an altered state—shaking, passing gas, burping, “leaving the planet”—all indications of “Ah-ha—she is almost there!”

Most often, quiet sacred obscurity is my place at this junction in time as I savor the sense of being present for her. Depending on the situation or family, I may quickly sketch her or intuitively sing soft melodies in the background. For some women, primitive instruments like the didgeridoo, drums, flutes or even soft “hmmms” can bring her there. It’s intuitive.

Pretty soon you’ll hear a gentle catch in her throat—a subtle, almost unidentifiable sound that she may not even notice. Looking at her full, firm belly, you’re soon to see a fuller, softer and yielding bottom. As she opens to this truth, she opens to birth. Her soul becomes fully engaged in this rite of passage. This is a vulnerable time for many women. You may hear, “How do I…?” “Can I…?” “Help me!” and “I forgot…”

Before birth, I sometimes have a woman or her partner gently push into her vagina as though there is a head moving down. This gives them a sense that yes, this is an okay sensation to feel, especially if the woman has suffered sexual traumas or has a surgical birth memory that she wants to overcome. Many midwives believe this helps get a woman’s head connected to the sensation of the expulsion, keeps her from pulling away and helps her stay loose. Ina May Gaskin’s adage of “loose lips, loose vagina” really helps yield a woman’s mind/body connection. Conflicting mind games are dismissed when she obtains full surrender and each invisible step brings her closer to the finish. So much of what happens in birth is the invisible workings of the mind and heart.

Surrounding a woman with positive words and thoughts creates a reality that can bring her further into this yielded space. Even having her post words around the room where she labors—words like gratitude, love, truth, peace, surrender, as well as affirmations like, “Yes! I can, I will, I am,” can help her to get there. Midwives often forget that our beliefs in her abilities can alter her accomplishments. It is important to check our hearts and push through any lack of belief that may inhibit her strengths. This may sound silly or ethereal, but I guarantee it can make a difference for a laboring mom and family.

Carol Gautschi
Excerpted from “Getting to Second Stage,” Second Stage: The Pushing Phase of Labor, Midwifery Today e-book
Second Stage: The Pushing Phase of Labor, can be purchased:
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Second Stage Handbook

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If you do, you need Midwifery Today’s Second Stage Handbook. This book explores how to best serve women at this crucial stage. You’ll learn from expert practitioners as they reveal their observations on when to push, what works and choices available for the mother. The Second Stage Handbook is part of the Holistic Clinical Series. Order the book.

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The Belly Mapping Workbook shows how a woman can discover her baby’s position in late pregnancy. This technique can be a fun bonding activity and is often used for proactive childbirth preparation using optimal fetal positioning. The workbook includes 100 drawings and photos that take you through details of head-down and breech babies. At just $14.95, it makes a fine gift for a pregnant friend! To order Belly Mapping Workbook cover

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Learn about the pelvic exam

Maternal Exam for the Student Midwife, Part II, The Pelvic Exam, is a two-disc DVD set packed with information about various aspects of pelvic examination. You will see how to do internal, bimanual, rectal and speculum exams. Also covered are visualization of the external genitalia, palpation of the internal reproductive organs, and the procedure for collecting cultures from the cervix and surrounding tissues. To order

Maternal Exam for the Student Midwife, Part I, is also available.

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Learn about Shoulder Dystocia and Malpresentations with Midwifery Today’s new 4-CD Audio Set
Shoulder Dystocia Audio 4-CD Set When you order this CD set you’ll be able to listen to Gail Hart, Mary Cooper and Ina May Gaskin as they discuss a variety of important topics. Material covered includes how to identify true vs. false shoulder dystocia, how nutrition can be one of the best methods of prevention and how to assist shoulder dystocia when it does happen during birth. Also included is information about malpresentations such as twin, breech and asynclitic births and brow, face and periatel presentations. Order the audio CD set.

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Paths to Becoming a Midwife: Getting an Education is just what any aspiring midwife needs and would be a much appreciated gift. The fourth edition of this book includes several new articles on the various midwifery philosophies, new information on becoming an apprentice, dozens of recently updated articles, and a directory of more than 150 schools, programs and other resources. Order the book.

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Website Update

Read this article excerpt from Midwifery Today magazine, now on our website:

  • Mercy In Action Midwives Form Disaster Response to Deadly Super Typhoon—by Vicki Penwell

    Excerpt: “I think all of the midwives are dead!” This is what a distraught husband told his laboring wife the day after super typhoon Haiyan devastated the coast of Leyte Island in the Philippines. … The midwives aren’t all dead, but the ones who survived saw their equipment washed away, their clinics and birth centers smashed into rubble and their own homes destroyed. In addition, many of them lost loved ones and are struggling with deep grief and emotional shock.

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Birth Q&A

Q: Please tell us about the longest second stage you have experienced. What did you do? What helped?

— Midwifery Today

A: The second stage is technically defined as uterine expulsive contractions—meaning reflexive pushing. It is [very recent history that people have attempted] to redefine it as full dilation.

A long delay before pushing should not be tabulated as “second stage.” The distinction is important when time protocols must be followed.

The longest true second stages I have had in my practice were both in women whose contraction patterns were widely spaced. Their contractions were 10 minutes apart and never became closer, which meant they only pushed about six times an hour. They were very easy, relaxed and comfortable second stages for both mother and baby.

I have heard of a few very long second stages, but usually they were in women with epidural anesthesia. Most of the time when someone says a long second stage, they are counting from full dilation, not from the onset of a reflex pushing. But some babies do take a long time to mold and descend.

The old textbooks say that second stage can be expected to take two to six hours with first-time mothers. We need to remember that Dr. Friedman was only giving averages, not defining normal length.

— Gail Hart

A: The longest true second stage (with strong reflexive pushing with each contraction) I have witnessed was five hours with a VBAC mom.

— Vijaya Krishnan

A: Most of the time, mamababy knows best! It depends on when you count second stage. Since I do not follow a severe medical model, I believe that “complete” isn’t until she has a serious urge to push and, with a primip, when I know her cervix is gone. With multips, I have them push as their body dictates.

— Carol Gautschi

A: My first baby had a six-and-a-half hour second stage of uncontrollable pushing. The contractions were very close together and very painful. I birthed at home and without drugs. It just took a long while to work him out.

— Krystina Thomas

A: My sister-in-law pushed for six hours with a strong pushing urge. My nephew was direct OP and would not rotate. She pushed standing, sitting, squatting, kneeling—you name it, we tried it. He descended ever so slowly and she worked her butt off. With a very patient and wonderful OB checking in once in a while and the most extraordinary nurse, Tyler emerged with the most atrocious looking head I had ever seen, but he was as bright-eyed and perky as can be!

— Roseanne Azarow Ebert

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