When the cervix has dilated to 10 centimeters, labor usually becomes more intense and contractions
become more frequent. At this point, the baby is usually positioned head-down, facing the mother's back with its chin tucked in and coming out of the uterus with the back of the head first. After the baby has moved into the birth canal, most women need to help the delivery process by pushing during their contractions.
In 19 out of 20 new mothers, the baby is delivered within two hours. Although it can be normal to take longer, many women deliver in one hour or less.
For many women, this stage of labor is the most exhausting because it takes a lot of energy to push. Eventually, the baby's head will begin to come out of the vagina. When the biggest part of the head is coming out of the vagina, this stage of the delivery is called "crowning."
At some time during this stage of your labor and delivery, your doctor may decide that you need an episiotomy. An episiotomy is a small incision, or cut, in the opening of the vagina. It widens the birth canal and helps to control tearing as the baby moves through the vagina. An episiotomy can also be helpful when a forceps or vacuum delivery is necessary. You might want to talk with your doctor ahead of time about what might make an episiotomy necessary and then discuss your individual situation.
After the crowning, your doctor will deliver your baby's head and clear its mouth and nose of fluid. The baby's shoulders will be delivered next. After the shoulders, the rest of the baby's body usually slips more easily through the birth canal. Once the baby is delivered, the doctor will cut the umbilical cord. Birth assistants will begin to clean, dry, and warm up the baby. Sometimes, a pediatrician will also be there to make sure that the baby is doing well.