The descent phase of labor
Now the baby is low in your body, moving into the birth canal, usually with the head down toward the open cervix. You will feel your uterus contract to help the baby make its way out into the world. The time to push is when you feel that contraction. Try to listen to your own urges. Waiting for your body's signal to push will make the delivery easier. (If you have an epidural to reduce your pain, the urge to push may be diminished.)

Pushing is hard work—your face will get red and you will be wet with perspiration. With each contraction, each push, more of the baby's head will appear in the vaginal opening. Baby's head may slip back between contractions, but will soon appear again. At this stage, contractions may be coming every 1 to 3 minutes, with only a short time to "relax" in between.

The appearance of the full top of the head is called crowning. Once crowning occurs, the birth will take place within the next few contractions and pushes. The baby is born head first in 19 of 20 births. Most of the other births occur with the buttocks first (breech birth).

The delivery
At the beginning of the delivery, a stinging or burning sensation signals that the baby is stretching the outlet of the birth canal. When you feel that, stop pushing, pant, and let the contractions of the uterus push the baby out. This sensation will last for a short time, and then you will experience numbness as the baby's head stretches the vaginal opening so thin that the nerves are blocked.

At this point, the medical staff will check to see if the umbilical cord is clear of the baby's neck. If they think your vaginal tissues are going to tear, they may suggest an episiotomy—a surgical cut to avoid the tear. You should remember, however, that the vagina is very elastic, very able to stretch for this task, so an episiotomy is usually unnecessary for an uncomplicated delivery.

If episiotomy is necessary, you will be given local pain control, and then a small cut will be made between your rectum and your vagina to enlarge the opening for birth. After the birth, this area will be sewn back together. Midwives, by the way, are trained to perform episiotomies if necessary.

Baby's head will turn from side to side to make the passage easier. When the whole head appears, the neck will straighten and the head will turn to align with the position of the shoulders. Baby's body will continue to turn, moving first one shoulder and then the other to continue through the birth canal. The rest of the body quickly follows, and the baby is born!

Complications
Fetal distress is the term used if a problem involves the baby. Your baby needs to be born within a certain amount of time after your amniotic membrane ruptures. Your health care professional can measure fetal distress by monitoring the baby's heartbeat. If the baby's heartbeat doesn't improve quickly, your health care professional will need to disregard your planned mode of delivery and move to the quickest method. A cesarean section, an episiotomy, or the use of forceps may be needed to ensure safe delivery of your baby.

Problems that will endanger the mother can occur during labor and delivery, but they are uncommon where modern facilities are available. You will be monitored for any indication of complications throughout the labor and delivery.

The last stage of delivery
The delivery is not complete until the placenta is expelled. For most women, this takes place within 5 to 45 minutes of the baby's birth. The walls of the uterus contract several times to loosen the placenta. These contractions may hurt, but they will be mild compared with those that pushed the baby into the world. There is a rush of blood from the vagina, the umbilical cord lengthens, the uterus and your stomach rise as the placenta passes from the uterus into the vagina, and finally, your uterus becomes firm.