When the cervix is completely dilated to 10 centimeters and effaced, it's finally time to push.
This stage of labor can last anywhere from a few minutes to a few hours -- it usually gets shorter with each child because the vaginal canal has gotten more flexible over time. The mother bears down as if she's pushing out a bowel movement and holds it for a count of 10 before releasing. The pushing stage is pretty intense -- she may break a sweat and breathe heavily.
During the course of labor and delivery, women and their partners should expect to see things like blood, mucus and amniotic fluid. But those aren't the only fluids to expect. Drugs and strong contractions can cause laboring women to lose control of their bladders if they haven't been catheterized. Some drugs can also cause women to feel nauseated and vomit. It's common for women to push out some feces when pushing out the baby.
As the baby begins to crown (which is when the head shows at the vaginal opening), the spaces between episodes of pushing become shorter. This is the time that an episiotomy may be performed or the doctor may use a vacuum or forceps if the baby's head seems to be getting stuck. Usually, a few very big pushes are enough to release the head, and the rest of the body tends to follow pretty easily. Getting the head through is the most painful part; some women say that the burning and tearing makes them feel as if they might rip open, but the vagina is very elastic.
If the woman has had an epidural, she shouldn't have much pain, just pressure. Usually the epidural is turned down or off so that she can better feel her contractions. Sometimes the doctor must tell her when to push by monitoring her contractions because she can't feel them well enough. In this case the pushing isn't as effective as it would be if she could still feel everything, but women with epidurals deliver vaginally without intervention all the time. There's an increased risk of needing a vacuum or forceps, however.
The head's out! That's the hard part. Now what?