The first stage begins with crampy abdominal or back pains that last around half a minute and occur every ten to thirty minutes. The crampy pains become stronger and closer together over time.[10] During the second stage pushing with contractions may occur. In the third stage delayed clamping of the umbilical cord is generally recommended. A number of methods can help with pain such as relaxation techniques, opioids, and spinal blocks. While making a cut to the opening of the vagina, known as an episiotomy, is common it is generally not needed. In 2012, about 23 million deliveries occurred by a surgical procedure known as Caesarean section. Caesarean sections may be recommended for twins, signs of distress in the baby, or breech position. This method of delivery can take longer to heal.Most babies are born head first; however about 4% are born feet or buttock first, known as breech. During labour a women can generally eat and move around as she likes, pushing is not recommended during the first stage or during delivery of the head, and enemas are not recommended.