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1. SECOND & THIRD STAGES OF LABOR (10 cm Dilated to Placenta Delivery)

• Maternal Positioning: Promote upright, squatting, or lateral positions to maximize pelvic space and use gravity for fetal descent. Never use supine or dorsal positions, which compress the inferior vena cava, reduce placental perfusion, and prolong labor.
• Active Pushing: Wait until the fetus descends (0 station) and the client actually feels the urge to push (delay up to 2 hours for epidural clients). Encourage open glottis (natural) pushing over closed glottis (Valsalva/breath-holding) to reduce maternal  ...