After the cervix has fully dilated, the second stage of birth, the expulsion of the fetus, begins. Contractions are somewhat less intense, lasting about 60 seconds and spaced at 1- to 3-minute intervals.

Toward the end of this stage of labor, the doctor may perform an episiotomy (ee – pee-zee-AH-tuh-mee) to reduce the risk of a tearing of the tissue between the vaginal opening and anus as the fetus emerges. Today episiotomies are very controversial, and the debate centers around several issues. Those who support the practice argue that it can speed up labor, prevent tearing during a delivery, protect against future inconti­nence, and promote quicker healing. Those who argue against the practice claim that it increases infection, pain, and healing times, and may increase discomfort when inter­course is resumed (Hartmann et al., 2005).

Although the use of routine episiotomy is gradually decreasing, it is estimated that episiotomies are done in over 40% of U. S. births (Allen & Hanson, 2005; Scott, 2005).

Other Western nations do far fewer, with seemingly few problems. Racial differences in episiotomy rates have found that overall, white women undergo episiotomies more fre­quently than black women (Goldberg et al., 2002).

As the woman pushes during contractions, the top of the head of the baby soon ap­pears at the vagina, which is known as crowning. Once the face emerges, the mucus and fluid in the mouth and nostrils are removed by suction. The baby emerges and, after the first breath, usually lets out a cry. After the baby’s first breath, the umbilical cord, which supplies the fetus with oxygen, is cut; this is painless for the mother and child. Eye drops are put into the baby’s eyes to prevent bacterial infection.

Directly following birth, many physicians and midwives place the newborn directly on the mother’s chest to begin the bonding process. However, sometimes the father may be the first to hold the child, or the nurses will perform an Apgar test (Finster & Wood, 2005). A newborn with a low Apgar score may require intensive care after delivery.