The feeling of lightness in the sides and epigastrium 
 

The onset of a mild colicky pain in the lower abdomen and the waist. 
 

An urge to pass urine and stools frequently and white vaginal discharge "show" is seen. 
 

Feelings of exhaustion and eyes and face of the woman appear slightly sunken.
 

She may be given rice kanji with ghee at this stage. 
 

She may be allowed to move about intermittently during this stage.

Avi, i.e. strong labour pains mark the onset of the second stage. 
 

The amniotic fluid, i.e. "Garbhodaka" is gushed out during this stage. 
 

The pregnant lady should be advised to sit with legs folded on the bed.
 

The relatives and the nurses should reassure her and keep up her spirits. 
 

She should inhale fine powder of kustha, Cardamon, Langali, Vaca, Citraka, Bilva and cavya or smoke of leaves of Bhurja or Simsapa sara.
 

She should bear down during pains and relax in between pains. 
 

Warm medicated oil should be massaged lightly over the waist, back pelvis and hips. 

When the head of the foetus enters the pelvis, intense pains start. 
 

The lady should lie down on the back. 
 

It is important that she should not bear down in between the pains, as it would lead to exhaustion of the mother, foetal distress and abnormal presentation. 
 

The attending nurse should encourage her to bear down at the onset of the pains. 
 

The nurse should chant the following mantra in her ears:
"Let the elements, namely, earth, water, energy, air, space and Gods Visnu, Prajapati and Kartikeya protect you as well as your baby and help you to have a painless delivery. Let your son have a complexion like that of Kartikeya and let Lord Kartikeya protect him."
  

The labour may be obstructed at the level of the head, shoulder or hips of the baby.
 

In such cases, the vagina should be exposed to the medicated smoke of the skin of a snake or Madanaphala and the vagina should be massaged with medicated oil intermittently. 
 

If the baby presents with a buttock, the baby's position should be manipulated by hands so that the head comes out first.
 

For weak pains, 'Samirapannaga rasa' and enemas are helpful.
  

The baby may be pulled out if the labour pains are weak.

The attending nurse should carefully watch the expulsion of the placenta.
 

If the placenta is not expelled naturally, the following procedures should be carried out.
     
     Press on the hypogastrium with the right hand, simultaneously, supporting the spine with the left hand till the placenta is expelled. 

     If all these measures fail, the nurse should introduce a clean hand with clipped nails, lubricated with medicated oil or ghee along with the cord into the uterus and gently separate the placenta and remove it.

Paste of Kasa and Talisa leaves should be administered in
wine, Kulattha soup or decoction of Mandukaparni or Pippali.
 

Powder of Kustha and Langali should be given by mouth with wine 
 

Vagina should be exposed to the medicated smoke of the leaves of Bhurja, Kacamani and the skin of a snake, Patola and Nimba. 
 

A cotton swab soaked in Til oil medicated with Satapuspa
Kustha, Madanaphala and Asafoetida should be inserted in vagina or an enama of Til oil medicated with the same medicines should be given.
  

Evacuation enema with

• Decoction of Madanaphala, Jimuta, lksavaku, Dhamargava, Krtavedhana, 
  Hastipippali or

• Paste of Shalmali stem in decoction of Bruhat panchamula with a small quantity of til oil is useful.
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Palate and throat should be stimulated till the lady coughs.