Towards the end of the active pushing phase the burning feeling can intensify as the baby moves further down the woman's vagina stretching her perineum further. This can also be a time when the woman 'holds back', due the pain being experienced, or possibly because of concerns about the birth. When your bottom is pulled in it also tightens the pelvic floor muscles and perineal tissues. The crown of your baby's head can be held back by a tense perineum, making it more difficult for the tissues to 'fan out' slowly, stretching to allow the baby's head to completely emerge.
It is at this time that your caregiver would be watching the perineum to determine how it is stretching and if a surgical cut (or incision) is required through the perineal tissues to enlarge the vaginal opening. The medical term for this is an 'episiotomy' and in most cases is an unnecessary intervention. You may wish to read more about how and when these are performed in
episiotomy and tearing.
Gradually, the baby's head can be seen clearly with each contraction. The first glimpse of your baby's head often looks similar to a 'wrinkled walnut' in your vagina. This is because the bones of the baby's skull are overlapping and the skin is being 'bunched up' in the process. At this stage of the labour your caregiver would refer to the baby as being 'on view'.
Often you are unaware that the baby is able to be seen (it all feels the same at this point!), but your partner and caregiver will notice, and the sound of their excitement can be a reassuring response. You may wish to ask for a mirror to see your baby for yourself, or feel your baby's head with your hand during each contraction, as it appears at the vaginal opening.
With the combined work of the uterus (and you pushing your baby down), the size of what can be seen of the baby's head gradually increases with each contraction, disappearing (or retreating back) when the contraction and pushing stops.