In this blog I want to specifically address stage 2 of labor, pushing your baby out. There are many strategies you can implement when you are pushing your baby out that help you push smarter not harder. With these techniques and tips I hope to decrease the amount of time this stage takes for you, help you conserve energy, show you how to work with your body and decrease your chances of vaginal tearing or the need for an episiotomy.
Best pushing practices. Let’s dive in!
Stage 2 of labor. You are told you have reached full dilation of 10cm! You have come so far in your journey of labor and now it is time to push your baby into the world. You’re ready & eager to start pushing and focus on anything else besides your contractions. It’s important to remain patient and relaxed from mouth to toes between your contractions. This stage takes mamas an average of 30 minutes to 3 hours to get through. Don’t try to rush this process. Here is how you can push in the most effective way, using the least amount of your energy?
Pushing is most effective when done at the same time you are having a contraction. Work with your uterus and wait for that urge before you begin each push. Short and frequent pushes ( 2 to 3 pushes for 5 to 10 seconds each per contraction) will spare your energy and be most effective. If you are unable to feel your contractions due to having an epidural, your birth team will instruct you on when to begin each set of pushes.
Remember mama, it is not helpful or necessary to strain with all your might when pushing. Use the least amount of effort that gives you good progress. If it’s possible to be in an upright position or side lying position during the pushing process this will allow gravity to help bring your baby down, decrease pressure on your perineum and allow your coccyx bone to flex to accomodate for the baby moving through the birth canal. Bearing down with all your might over and over again will not only lead you to exhaustion but can decrease the oxygen you are breathing in for your baby.
Have your birth partner remind you to relax between contractions. Let them know to massage away any tension they see in your face, neck, shoulders and arms. When your baby’s head is almost through the birth canal you may feel a burning sensation (the ring of fire), even if you do have an epidural. At this moment, expect to be directed not to push any more. You should breathe through the pain (resist pushing) to allow your baby’s head to emerge gradually in hopes of decreasing the risk of perineal tears.
Be aware of the premature urge to push in transition. It is common when you have almost reached complete dilation that you have the urge to push or bear down. Your baby’s head will be so low that you feel an overwhelming sense of needing to bear down (many mamas say they feel like they need to poop). You might notice you start to grunt or resist your breaths. When this happens, if your caregiver has not confirmed by vaginal exam that your dilation is complete, it is important not to push yet. This is the premature urge to push. It is likely this won’t last longer than just a few minutes but it is important to note because it is not good to push against a cervix that is not fully dilated. Try blowing your breaths out or panting through the urges focusing on keeping your perineum relaxed.
For many mamas, when they are able to start pushing, they feel a sense of relief. Pushing allows you to place your focus and energy into an action and often mamas report decreased pain as well. I can say for me personally this was true to how I felt during both of my births. I was happy to be able to go from trying to get through my next contraction, breathing and swaying, to being able to actively push.
Be aware of holding back during your baby’s descent through your pelvis. You might unconsciously begin to tense up your pelvic muscles during the pushing stage of labor. Be aware of this as you begin to feel more pressure in your vaginal canal from your baby’s head, if you feel uncomfortable with your birth team members seeing your perineum or if you are worried you might poop during your birth. In each of these scenarios you might react (consciously or unconsciously) by holding in & tightening your pelvic floor muscles. This is the opposite of what I want to encourage you to do. Try to recognize when and if you begin to hold tension and focus on releasing that tension to allow your baby to more easily descend.
Use different positions while pushing. As long as you and your baby are doing well you can use different positions to push. Try positions that feel most comfortable to you and be open to positions suggested by your birth team. Your birth team may know what positions could aid in your baby’s proper positioning in the pelvis for descent. If your stage 2 is progressing rapidly, use side lying positions rather than positions that allow more gravity assistance. If your stage 2 is progressing slowly then change positions often (every 20 minutes or so) and use those upright positions that use gravity assistance.
My recommended breathing techniques for pushing. As your contraction is starting, breath in and out slowly, letting the intensity and urge to push build up. Visualize your baby’s head moving down and out of your pelvis for about 5-10 seconds. When the urge to push overcomes you, bear down. While you are bearing down you can either hold your breath in, not allowing any air to be exhaled. Or you can allow some breath to be exhaled in the form of moaning out loud or grunting. Do what feels right for you! Exhale completely when you need a new breath or when the urge to push decreases. Begin again with the urges until the contraction passes. Then relax, lie back, sit or position however best you can to grab rest until the next contraction and urges to push. This style of pushing has worked for me in both of my births without an epidural. It is important to note that you don’t start pushing until the urge really builds up. As well as don’t continue pushing if the urge to push has passed. Work with your uterus, not against it.
I chose not to use the typical directed pushing. This consists of taking in a breath, then bearing down for 6-10 seconds, then completely exhaling and repeating twice for a total of 3 bearing down, breath hold cycles per contraction. Exhales between pushes are quick. After your 3 pushing cycles you will relax, lie back, sit or position however best you can to grab rest until the next contraction and urge to push begins. This may work well for you if you prefer to have someone helping to direct your pushing or if you cannot feel your urges due to having an epidural. This is the technique used routinely in the hospital setting. It is more patterned and forceful than the spontaneous pushing style I first discussed. Both techniques can be effective.
To wrap this up I’ll leave you with this. I encourage you to listen to your body. Be aware of the premature urge to push. Tune into and feel your urges. Wait for the intensity to build up with each contraction before you begin to push. Listen to the directions from your birth team. Keep using the breathing technique that is working for you and progressing your baby’s descent. Don’t be afraid to use different positions. Using these techniques will decrease the amount of time this stage takes for you, help you conserve energy, show you how to work with your body and decrease your chances of vaginal tearing or the need for an episiotomy.
