Understanding the second stage of labor: what happens after full cervical dilation and how EMTs monitor the delivery

Which phase of labor occurs after full dilation of the cervix?

• A. First
• B. Second
• C. Third
• D. Fourth

Answer: (B)

The second phase of labor, which follows the full dilation of the cervix, involves the actual delivery of the baby. During this phase, the mother's body works to push the baby through the birth canal. This phase begins once the cervix is fully dilated to 10 centimeters and continues until the baby is born. Understanding this phase is crucial for EMTs and healthcare providers as it represents a critical time when monitoring the mother and fetus is essential. Key signs of the second phase include increased contractions and the mother’s urges to push. This stage can vary in duration from just a few minutes to several hours, depending on various factors such as whether the mother has given birth before. The subsequent phases—such as the third phase, which involves the delivery of the placenta—occur after the second phase concludes with the baby's birth.

If you’ve ever watched a delivery unfold—even on a TV show—you’ve probably heard the phrase “the second stage.” For EMTs and other frontline responders, this is the moment everything has been building toward: the actual birth. It’s the phase that begins after the cervix has fully dilated to 10 centimeters and ends when the baby is born. Let’s unpack what that means in real-world terms, so you’re not just memorizing a fact but understanding what to expect when time is critical and the scene is unfolding fast.

A quick refresher, so we’re all on the same page

• First stage: Cervix dilates from closed to 10 centimeters. Contractions are building in intensity and frequency.

• Second stage: The baby is delivered. Contractions may continue, but the emphasis shifts to pushing and guiding the birth.

• Third stage: Delivery of the placenta. This follows the birth and is a separate, shorter phase for most deliveries.

• Fourth stage: The early postpartum period, with stabilization and assessment of both mother and newborn.

You’ll notice the second stage is often the most dramatic for everyone involved. The body’s built-in urge to push, the crowds of muscles, and the changing rhythms of contractions all collide in a surprisingly human moment—one that demands calm, coordination, and clear communication from whoever is at the head of the scene.

What happens during the second stage

Think of the second phase as the point where the birth canal becomes the main stage. The cervix is fully open, so the body’s pushing reflexes take over. Contractions remain a driving force, but now the mother’s body uses those contractions to propel the baby downward and out.

There are some telltale signs you’ll see and hear:

• A strong, persistent urge to push, sometimes described as feeling the need to “bear down.”

• Crowning, when the widest part of the baby’s head becomes visible at the vaginal opening.

• Increased intensity and endurance of contractions as the baby moves through the birth canal.

• The mother’s breathing pattern often shifts to a slower, focused push during contractions, with careful breathing in between.

If you’ve ever held a marathon in your own body, you’ll recognize the mix of effort and grace when the finish line comes into view. The second stage is that finish line for the baby’s journey through the birth canal—the moment the baby transitions from inside to outside, with the new family beginning to bond in real time.

What EMTs and other responders focus on in this phase

On scene, the second stage is where you switch gears from monitoring to active support. You’re still assessing the mother and fetus, but now you’re coaching, positioning, and protecting the space around the birth. Here are the core priorities you’ll be balancing:

• Positioning and comfort: Help the mother assume and maintain positions that aid delivery—often sitting up or on the side with support, whichever feels more natural for her and keeps the airway clear. A pillow, blanket, or improvised support can make a big difference.

• Breathing and pushing guidance: Encourage controlled breathing and effective pushing with each contraction. You don’t want to stifle effort, but you also want to avoid fatigue that could compromise both mom and baby.

• Monitoring: Keep an eye on the mother’s vital signs and the baby’s condition. If the umbilical cord is visible, note its color and tension. If the cord presents early or there are signs of distress, you’ll adjust the plan and call for additional help.

• Safety and space: Maintain a clean, calm space around the patient. Minimize unnecessary noise and movement, and keep others clear so the mother can focus and the baby can emerge safely.

• Readiness for the unexpected: Sometimes a birth doesn’t unfold as smoothly as the textbook version. Be prepared to adapt—have towels handy, keep the patient warm, and know when to pause and reassess if something doesn’t feel right.

Practical tips you can carry into field practice

• Communication is medicine: Speak with the mother and any accompanying partner or family in a calm, reassuring voice. Explain what you’re seeing and what you’re doing, even if the situation changes in a heartbeat.

• Gentle guidance over force: The push is real, but your job is to facilitate—not choreograph every move. Let the mother guide the pace, with support and cues from you.

• Cord considerations: If the umbilical cord is around the neck or appears tight, don’t panic. Gently slip the cord over the baby’s head if possible, or loosen around the neck if it’s safe to do so, then resume delivery. Don’t tug on the cord.

• Immediate baby care: As soon as the head is delivered, check for breathing and color. If the infant isn’t breathing well, initiate ventilation with a newborn mask or bag-valve mask as appropriate, following your local protocols. A skin-to-skin pause with breathing support can help stabilize both baby and mom during this critical moment.

• Prepare for the next moments: Once the body is delivered, expect the placenta to follow within a few minutes. Keep the mother warm, assess for heavy bleeding, and monitor the newborn for any signs that require quick intervention.

A few practical scenarios—and how to stay steady

• Normal progression: Baby crowns, you guide the head with a supportive stance, and the body follows with a few more pushes. The baby’s first cry brings instant relief and relief becomes shared with a relieved sigh from the room.

• Cord around the neck: It happens more often than you’d think. If you can slip the cord over the head without pulling on the baby, do so. If not, you pause to reassess and seek additional help. The key is to keep the line clear between life and quiet stillness.

• Prolonged second stage: Sometimes the mother has given birth before, so the pace might be quicker; other times, it’s longer and more labor-intensive. Your role is to stay present, offer breaks between contractions, and coordinate with the team to ensure a safe outcome for both mother and baby.

The bridge to the next phase

The second stage ends with the baby’s birth, which is a milestone worth celebrating—and it also marks a transition. The third stage—delivery of the placenta—begins right after the baby is born. This phase is typically shorter, but still critical because it helps prevent postpartum complications like heavy bleeding. For EMTs, recognizing the boundaries between stages is a practical map that keeps everyone safe and focused.

Why this matters for EMTs and healthcare providers

This moment is more than a medical milestone. It’s a test of your situational awareness, your ability to stay calm under pressure, and your skill at guiding a process that’s both physical and emotional. The second stage is when teamwork matters most: clear instructions, coordinated movements, and a shared sense of purpose can make a life-altering difference in seconds.

If you’re studying the EMT National Registry content, you’ll see why this phase is emphasized. It’s a clear example of how obstetric care blends bedside assessment with hands-on skills in a rapidly evolving environment. You’re not just checking boxes; you’re helping a family welcome a new member into the world. That human element—breath, tone, touch, and timing—matters as much as any clinical detail.

A few reflective notes to keep in mind

• The rhythm of labor is personal. No two births are identical, and that variety keeps the work honest and urgent at the same time.

• You’ll benefit from practice in a real-world sense: repetition helps you recognize the signals and respond with the right balance of action and restraint.

• Emotional cues aren’t decorative. A reassuring voice, a gentle touch, and confident leadership can ease fear and support the mother’s best efforts.

• Technology aids, but it doesn’t replace presence. Monitoring devices, oxygen, and suction help, but the human connection often carries the day.

A final thought

If you’re preparing to work in environments where you’ll encounter childbirth, the second stage is a vivid reminder of why your role matters. It’s a window into human resilience—the body’s ability to transform stress into a life miracle. You’ll move between clinical know-how and compassionate leadership in the same breath, guiding a family through one of life’s most remarkable moments.

In short, the phase that comes after full dilation is the second phase—the push-filled stretch where the baby makes its entrance. It’s not merely a clinical milestone; it’s a shared moment of arrival, a rhythm you’ll match with expertise and care. And when that baby emerges, you’ll be ready to help with the next steps—safe delivery, warm hands, and a calm voice that says, with quiet confidence, you did well.