I.

Increase Uterine contraction

The character of the contraction in the 2nd stage of
labor is different from those in the 1st stage with the
full dilatation of the cervix, the membranes usually
rupture and there is escape of good amount of liquor
amni. The volume of uterine cavity their by reduced.
Simultaneously, uterine contraction and retraction
become stronger and longer but may be less frequent
occurred, every 2-3 minutes and last for 60-70 sec.
allowing both mother and fetus regular recovery
periods. The consequent drainage of liquor allows the
hard, round fetal head to be directly applied to the
vaginal tissues..

This pressure aids distention. Fetal axis pressure increases

flexion of head, which results in smaller presenting diameters,
more rapid progress and less trauma to both mother and fetus.
If mother is upright during this time, these processes are
optimized
The contraction become expulsive as the fetus descends
further in to the vagina. Pressure from the presenting part
stimulates nerve receptors in the pelvic floor (this is termed
the Ferguson reflex) and the women experiences the need to
push. This reflex may initially be controlled to a limited extent
but becomes increasingly compulsive, overwhelming and
involuntary during each contraction.

II. Abdominal pressure

This power is produced by the contraction of abdominal and thoracic muscles
and diaphragm. This power is also called voluntary power or maternal effort.
The expulsive force of uterine contractions is added by voluntary contraction
of the abdominal muscles called bearing down. When second stage is
reached, the woman is compelled to bear down or push. As she holds her
breath to push, the diaphragm is lowered and the abdominal muscle contract.
III. Soft tissue displacement
Normally, at the onset of labor with the non-engaged head, the pelvic
structure anterior to the vagina are urethra and bladder and posterior to the
vagina are:
The pouch of Douglas with coils of intestine,
Rectum,

 Anal canal,
Perineum and
Anococcygeal raphe (body)
As labor advances, the body of the uterus, the cervix and the vagina
together to form a uniformly curved canal that is called birth canal. The
fetus is gradually expelled from the uterus against the resistance effort by
pelvis floor. As the fetal head descends, the soft tissues of the pelvis
become displaced. Anteriorly, the bladder is pushed upwards into the
abdomen where it is at less risk of injury during fetal decent. This results
in the stretching and thinning of the urethra so that its lumen is reduced.
Posteriorly, the rectum becomes flattened in to the sacral curve and the
pressure of the advancing head expels any residual faecal matter. The
levator ani muscles dilate, thin out and are displaced laterally, and the
perineal body is flattened, stretched and thinned.

IV. Expulsion of the fetus:

The fetal head becomes visible at vulva, advancing with
each contraction and receding between contractions until
crowning takes place. The head is then born. The
shoulder and body follow with the next contraction,
accompanied by a gush of amniotic fluid and some times
of blood The second stage culminates with the birth of
the baby.