As previously mentioned, the second stage of labor begins when the cervix is completely effaced and dilated and ends when the infant is born.

a. These signs of the second stage of labor are considered imminent or impending signs.

(1) Imminent signs.

(a) Increased bloody show.

(b) Desire to bear down or have bowel movement (result of the descent of the presenting part).

(c) Bulging of the perineum.

(d) Dilatation of the anal orifice.

(2) Impending signs.

(a) Nausea and retching.

(b) Irritability and uncooperativeness.

(c) Complaints of severe discomfort.

(d) Pleas for relief.

b. Once dilatation and effacement are complete, the patient is instructed to push with each contraction to bring the presenting part down into the pelvis.