Two Step Birth or One Step Birth? An Important Question for your Careprovider.
That moment when your careprovider tells you “we can see baby’s head” is music to your ears. (Although you might not believe them if it’s been a longer than expected labor!).
What happens in the next few moments can change your birth experience and your baby’s significantly. Come back to this link later for more important questions to ask your careprovider - (hopefully you’re discussed these questions already ahead of time).
If you are giving birth in a US hospital this information is particularly relevant to you. Take a look at this template of epidural birth preferences too.
What Is a Two Step Birth?
During my midwifery training this was the part of birth that demanded patience…baby’s head inches forward a tiny bit with the surge…and then slips back…with the next surge the dance repeats…one step forward…two steps back. This is perfect. By letting baby and body set the pace the tissues of the perineum are stretching slowly and gradually…no hurry…just patience. Add a warm compress to the perineum once baby’s head is visible to make those tissues even more pliable and reduce more serious perineal injuries.
Then the most intense part of these final moments before baby is born when the widest part of your baby’s head begins to be born…no hurry…slow and steady. Hands off the perineum…quietly observing…waiting…
Baby’s head moves forward a tiny bit more, he’s facing downwards, we can see his tiny eyebrows, next his eyes emerge…his nose….mouth and a gorgeous little chin - you hear the words "the head is out - almost there” …and we wait for the next surge….sometimes that next surge follows quickly…sometimes there’s a moment or two (or three or four) and we’re all patiently waiting, honoring the wisdom of the body that has done such an incredible job so far - we trust that for most healthy well parents the body knows how to finish it too. What are we waiting for? We’re waiting for something magical to happen inside - we’re waiting for an important part of labor called ‘restitution’ when baby’s head begins to turn on the perineum to face mom’s thigh. Now we know the shoulders inside are aligned with baby’s head and coming through the widest opening of the pelvis.
The process of waiting for baby’s head to turn and the shoulders to line up is known as restitution ( a ‘two step delivery’). With the next surge baby’s shoulders begin to be born and baby slips into your careprovider’s hands as they receive your baby without any pulling or force.
What I just described above are the hallmarks of a two step birth.
Watch this video to see these incredible cardinal movements babies make to be born.
Research is finally catching up on what midwives have been doing forever - waiting for the next surge and NOT pulling on baby’s head is the healthiest and safest option for both you and your baby especially when all has been well throughout your labor.
What’s a One Step Birth?
If you’re giving birth in a US hospital a one step birth is normal practice unless you ask for a two step ‘delivery’. If your OB starts pulling on your baby’s head and neck and doesn’t wait for the uterus to help - that’s a one step delivery (there’s no ‘receiving’ of baby but an anticipatory intentional pulling on baby’s head).
You might be surprised to learn that a two step ‘delivery’ is not common practice in many US hospitals. It’s very likely that your OB was trained NOT to wait for that next surge and to pull on baby’s head immediately (take a listen to the podcast below).
If your careprovider’s usual practice is not to wait for that next surge and start pulling on your baby’s head it can not only cause perineal injury, a shoulder injury to your baby, it may even result in an obstetric emergency - should dystocia.
New research supports waiting - even as long as 4 minutes for that next surge (no need to start running Pitocin immediately either!).
Is this news to you? If so consider asking your OB at your next appointment AND talking to your partner and doula about reminding your careprovider when they say they can see that tiny bit of baby’s head so that it’s fresh in their mind.
*** As some providers aren’t familiar with the term ‘one or two step birth’ instead you can ask if they will wait for restitution (when the shoulders and head line up together).
Learn more in Rebecca Dekker’s latest podcast.
Around 40mins into this great podcast from Evidence Based Birth where OB Dr. Amber Warmsley talks about two step delivery and how OBs are being trained not to wait. Take a listen and talk to your OB.
Resources:
Kotaska, A. & Campbell, K. (2014). Two-step delivery may avoid shoulder dystocia: head-to-body delivery interval is less important than we think. J Obstet Gynaecol Can. 2014 Aug;36(8):716-720.
Zhang, H., Zhao, N., Lu, Y., et al. (2017). Two-step shoulder delivery method reduces the incidence of shoulder dystocia. Clin Exp Obstet Gynecol. 2017;44(3):347-352.