Phases of second stage labor: Four descriptive case studies

In recent years, the second stage of labor has become an area of interest to a number of observers who have described divisions or phases with behavioral characteristics. Using a descriptive case study design, four normal nulliparous women in spontaneous second stage labor were videotaped from the occurrence of involuntary bearing-down efforts or the recognition of complete cervical dilation until birth. Analysis of these videotapes, the accompanying narrative transcripts, and uterine monitor tracings provided evidence that some behaviors changed over the progression of the second stage. These changes could be divided into three behavioral phases that the nurse/midwife can identify in order to recognize the typical pattern of progression and possible deviations from normal.