I sit here and ponder Why childbirth education is important?. I am an educator because I think it can be a vital piece to the preparation puzzle prior to welcoming a baby.  I use the word “can” versus “is” due to the fact that all educational offerings are not created equally.

It is known that only a percentage of expecting mothers attend a childbirth class series. Perhaps they believe the staff will explain everything when they get to the hospital, they really have a deep trust in the process and are reading up on everything, or since they are having a home birth that additional education is unneeded. Whatever the reason, women are not getting the foundational information that can be incredibly helpful toward confidence, ability, decision making and mothering far beyond the birth itself.

A good childbirth class series (or rather perinatal class) is well worth the monetary and time investment for most first time mothers and can benefit those who have already birthed.  My post on choosing a childbirth class is a good jumping off point to figuring out what type of course suits the individual expecting mother (her partner or labor support).

A class series worth the time and effort will be comprehensive in nature, not just covering labor and birth. What does that look like? A class that covers midway third trimester pregnancy through 4-8 weeks postpartum. It is content that is deep and is applicable to real life.

A sample of course content:

• Pregnancy Basics
• Common Terminology
• Normal Physiologic Changes and “helps”
• Exercise
• Nutrition
• Prenatal Testing
• Birth Plans
• Informed Consent
• Communication and Self-Advocacy Skill Building
• Overview of spontaneous Labor and Birth
• Labor milestones with Comfort and Positioning Strategies
• Overview of all Options in Labor, Birth and Postpartum
• Labor Partner Role
• Immediate Postpartum
• Navigating first weeks Postpartum
• Overview of Infant Feeding and Norms
• Bonding
• Medications and Interventions
• Cesarean and VBAC
• Unexpected Events
• Role-playing Scenarios
• Relaxation and Visualization Practice
• Local/Online Resources

How the educator reaches her class is fundamental to the learning process and take away of participants.  I encourage women to interview the potential educator. Finding the right fit in a class is no different that in provider, doula or birth location.

Even if a woman knows she wants an epidural, TAKING A GOOD CLASS is vital because she will be having a natural birth the epidural is on board and her Plan B could very well be a natural birth. Being prepared will only serve her well in the fluid process known as labor and delivery.

Gaining knowledge that will help a woman to partner with her provider, address her own needs fully and help her to define her own birth philosophy gives her a leg up on being responsible and in charge in her own health care and even outcomes.

The vast scope of what a solid class series can offer an expecting mother (her partner or support person) is incredibly valuable and can not be understated. A class that provides for encouragement, comfort, safety, respect, connection, structure, evidence-based information and real life application can plant seeds and prosper skills that will carry a woman well into her mothering years. These skills are for life, not just for labor and birth. I am stunned often by how birthing knowledge carries me in daily ability with my own family.

Here’s to happy and deep learning!

Being a childbirth (perinatal) educator is a position that affords great opportunity to positively influence women in the childbearing year and far beyond.  It is also a great responsibility that ought include: self-assessment, continuing education, evidence-based curriculum, the ability inform with discernment and the willingness not to teach a good patient course.

With all of this in mind, it is important that pregnant women choose their childbirth class wisely. There is not any one-size-fits-all class.

How does one go about choosing a childbirth class? I encourage you to go about choosing a class series in the same way you would choose a provider or birth location. Do some investigating and even interview the educator.

Off to a good search:

• Get referrals from women who have had or wanted the type of birth you are desiring.
• Check out your local birth groups and get referrals.
• Ask your provider for a referral.
• Do a web search for classes in your area. You may be surprised that there are many offerings method and philosophy based outside and within the hospital setting.
• If thinking about a hospital sponsored course, find out if it is a comprehensive series or a what happens to women once they get to our hospital class? This is otherwise known as a good patient class.
• Check out the course website then call or email the instructor to get a feel for her style and philosophy. Even a hospital based educator should be able to call you back or email you.

Before registering for a class series:

• How long is the series? A minimum of 12 hours is needed to be a comprehensive series. At least 2 different class sessions over two different weeks, but  preferably a minimum of 4 class sessions. You may find classes up to 12 sessions. Be wary of condensed one or two day classes as there is not enough time to process information and retain it well. It IS worth the investment of time.
• When is the class? Day of week and time of day needs to fit into your lifestyle. Again, I encourage your investment over a period of time versus a one-day class.
• Where is the class held? Classes may be held in like-minded businesses, in home, care provider office or hospital.
• What organization is the instructor trained and certified with? Though certification is not required, it can be very important the training and background an educator has.  Check out the organization to make sure you agree with it.
• What does the instructor’s experience involve?
• What is the instructor’s philosophy and style?
  
• What is the cost of the course? Classes can cost anywhere from free through a hospital to a few hundred dollars. It really can be a wide range. Find your comfort level. Though expect to invest in a good class. Free or low cost for everyone is often not comprehensive in nature.
• What is the course content? A comprehensive class should include a variety of topics, such as, pregnancy basics,  common terminology, normal physiologic changes, exercise, nutrition, prenatal testing, birth plans, informed consent, communication skill building, overview of spontaneous labor and birth, labor milestones with comfort and position strategies, overview of all options in labor and birth, labor partner role,  immediate postpartum, navigating first weeks postpartum, overview of infant feeding, infant norms, medications and interventions, cesarean, unexpected events, role-playing scenarios, relaxation practice and local/online resources. It is usual to expect homework on top of class time as well.
• What are the birth outcome statistics for class participants? It may be difficult though to get true data whether a philosophy-based or method-based class.
• What is expected of me as a class participant?
• What do I need to bring?
• Who may come with me?
• Is there a lending library?

I hope you find this list helpful and are able to find the just right fit. I look forward to your feedback.

I invite you to participate in Preparing For Birth’s upcoming Blog Carnival set to appear on Thanksgiving morning.

Topic: “Why I am grateful for my birth experiences.” This is your point of view. I encourage you to be open about expectations, what it was really like and how it impacted you as a woman, mother, etc.

When Due: Entries need to be received by November 23, 2010 to email desirre@prepforbirth.com

What to include: Blog copy and link to your blog along with name, website, and contact information for attribution.

I look forward to hearing from many of you.

There is such a deep chasm and fracture within the doula community regarding in-hospital and out-of-hospital birth. On the one hand there are those who say anything goes in supporting women and their choices. On the other, there are those who say no doula should support a woman in the hospital environment because it is a “bad and dangerous” place to birth,  or at the very least should get kicked out if she is doing her job “right”.

Who is right? This is where it gets tricky to be sure.

With upwards of 98% of the birthing women going to the hospital in the United States, are WE really within the general doula scope of practice by taking such a hard stance of ignoring those women in need? Who is benefiting here? It is well known, that I am all for a doula deciding her practice style, what scenarios she is best suited to support within, and knowing who she is best able to support.  But to abjectly say, no doula should ever support a woman in a hospital birth, is to me akin to very interventive practitioners who believe that birth is inherently dangerous and a trauma waiting to happen. Thus, viewing every women and baby through high-risk lenses and subjecting them to high-risk protocols where there is no medical need encourages more intervention and higher-risk scenarios to actually occur.

Who does this serve taking such a hard line? Perhaps those speaking it, thinking they are pressing for the greater good. Definitely not the mothers who need the support and assistance navigating a sometimes difficult and stressful system. The mothers and babies are caught then between a rock and a hard place. Then they are effectively forced to go without support and help. The truth is women having hospital births NEED DOULA SUPPORT MORE than women choosing an out-of-hospital option.

Bottom line: I make no claim that it is an easy task to doula within the hospital environment. It is not. It can be brutal. Imagine for a moment, really, close your eyes and think of what happens, what you witness as a doula when you are there — then think of all the women who have no doula present — what happens to them? What do those women experience? What do those babies experience? Now, open your eyes and breathe for a moment. It is not pretty is it?

Right there is what keeps me taking hospital birthing clients. It requires very open communication and immense work prior to labor during prenatals running through scenarios, detailing needs and desires, making certain informed consent and refusal is understood for a variety of procedures, medications, and cesarean. A mother needs to be well-versed in how to use her self-advocacy voice as does her husband, partner or other main support person.

Looking at the flip-side now.

So the other ideal, er rather idea, is that a doula should support anyone and anything because she is a doula poses other issues in my mind.  I do not see anywhere in the job description that this is what a doula ought do.  Any one doula cannot be the right doula for every mother or scenario. This way of thinking can fall into  a cookie-cutter way of practicing, thinking one can be all to everyone. Doulas are people too. Each has individual abilities, biases that need to be addressed, history and points of view.

I think it has been mistaken that a good doula is one that has no say in how she practices or who she is best to serve.  I believe there is a doula for every type of scenario and mother. It is a very individual pursuit and fit.

I know some amazing niche doulas out there who support only high-risk mothers, multiples, same-sex couples, in-hospital birthers, planned cesareans….. The list could go on.

Honestly, I will say there are some amazing doulas who can work under this very open practice style effortlessly and with excellence.  I applaud those doulas, though I think that is the minority and most are not able to keep it up without finding a comfort zone long haul.

Childbirth is such a deeply intimate and intense process with so many variables, being the right fit all the way around is necessary in my humble opinion.  I have seen doulas deeply wounded and traumatized by what happens in the birth room. Sometimes that is unavoidable, but through years of interaction with many doulas, the running thread is that the doula had misgivings even during the interview that this was probably not a good fit but chose not to refer the mother out to someone she knew was better suited for whatever the reason.

Are women and babies really being served best under this model of practice? This is for you to go ahead and answer for yourself.

Bottom Line: Women and babies need individual care whether from a doula, nurse, or care provider. Can a doula be all things to all mothers? Some, I am sure. Overall I believe not. For the health of a doula and the health of her ability to practice and support well, finding the “comfort zone” can make the difference for the mother, baby and doula. Why? Because doula work is such an intense giving of oneself (emotionally, physically, even spiritually). A continual self-assessment needs to be done just where her true and honest “comfort zone” is. By doing this, a doula is caring not only for herself by avoiding burnout, but also for her future clients and her ability to care for others with excellence and utmost professionalism.

There has been much ado surrounding the language of breastfeeding being normal and usual versus the best for baby and mother in great thanks to Diane Weissinger. It is so valuable to recognize that while we all desire to be the best, we often hit the normal everyday averages in life. We are comfortable reaching a goal that seems more attainable. Best or better can feel so far out of reach where average and usual seem quite in reach most of the time. None of us generally want to be below the average or usual. Thus the language of the risks of NOT breastfeeding is so vital.

I would like to see the same type of language revolving around pregnancy and birth as well.

In the overall picture here is the usual occurrence: Ovulation leads to heightened sexual desire, which leads to sexual activity, which leads to pregnancy, which leads to labor, which leads to birth, which leads to breastfeeding…..

So how do we look at language as an important part of our social fabric and belief systems surrounding this process?

Let us look at contrasting statements of what is often heard and how a positive point of view can be adapted.

Pregnancy is: a burden, an illness, an affliction, a mistake, something to be tolerated……

Pregnancy is: a gift, wonderful, amazing, part of the design, someone to grow…..

Labor is: scary, worth fearing, the unknown, unpredictable, painful, to be avoided, to be numbed from, to be medicated, to be induced, out of control, unfeminine…..

Labor is: what happens at the end of pregnancy, hard work but worth it, manageable by our own endorphins and oxytocin, an adventure, not bigger than the woman creating it, to be worked with, worth be present for, is what baby expects……..

Pushing and Birth are: terrifying, physically too difficult, only works for women who are not too small, short, skinny, big, fat, young or old, responsible for pelvic floor problems, out of control, horrible……..

Pushing and Birth are: what happens after dilation completes, to help baby prepare for breathing, bonding and feeding, sometimes pleasurable, sometimes fast, sometimes slow, able to occur in water, standing, laying down, squatting, on hands and knees, often most effective when a woman is given the opportunity to spontaneously work with her baby and body, not always responsible for pelvic floor issues, amazing, hard work, worthwhile, sets the finals hormonal shifts in motion for mother and baby……

Is it really BETTER? I say no. It is usual and normal.

• Spontaneous labor is not better – it is the expected usual occurrence at the end of pregnancy.
• Unmedicated labor and birth is not better – it is what the body mechanisms and baby expect to perform at normal levels.
• Unrestricted access to movement, support and safety in response to labor progression is not better – it is the usual expectation to facilitate a normal process.
• Spontaneous physiologic pushing is not better – it is what a woman will just do, in her way.
• Spontaneous birth is not better – it is what a mother and baby do.
• Keeping mother and baby together without separation is not better – it is what both the mother and baby are expecting to facilitate bonding, breastfeeding, and normal newborn health.

Denying the norms and adding in unnecessary interventions, medications and separation is creating a risky environment for mothers and babies. Thus increasing fear, worry,and even a desire to be fixed at all costs.

Perhaps even worse, an atmosphere has been created where the abnormal has become the expected norm and the normal has become the problem to be eradicated.

Bottom line, our language matters and will help shape for the positive or negative the future of birth.

Women and babies are not made with a pop out button like some Thanksgiving turkeys indicating being done. That pesky due date becomes such great topic of debate. It can lead to unnecessary interventions (such as induction, provider change because of regulations or cesarean), emotional unease (I am broken, this baby is never coming, I am LATE one minute past 40 weeks), physical distress by way of decreased pregnancy change tolerance, and mess with a woman’s work schedule (when to start maternity leave or return to work date).

Prior to home pregnancy tests and ultrasound dating, the due date was much more of a due month. Now it seems everyone has bought into this mysterious due date being something very hard fact and unfailing.

Henci Goer wrote a tremendously helpful article called “When is that baby due? ” several years back that sheds light on this very issue. She states: “When it comes to determining your due date, “things,” as the Gilbert and Sullivan ditty goes, “are seldom what they seem.” The methods of calculation are far from exact, common assumptions about the average length of pregnancy are wrong and calling it a “due date” is misleading. Understanding these uncertainties may help to curb your natural impatience to know exactly when labor will begin.”

The most common way women are finding out the due date of their baby is by using an online calculator such as this:

However, this even from the federal website does not take into consideration ovulation, only length of cycle (which is an improvement over straight up LMP dating).

So how do women handle this notion of a due date? I asked the question and here are some responses.

• KZ -    “Last time, I told everyone my due date, and when E had other plans, I got the, “Have you had that baby, YET?? How long are they gonna make you go?” *cringe* This time, I’m wising up and saying Spring. That’s it. Spring.”
• SL – “I used a “due season”. I told my three year old that the leaves would change on the tree and we would probably have Thanksgiving dinner and she would be here sometime after that. ”
• KMC-M -”I love the Ish… december-ish”
• CLM -”I always give very generic answers to avoid the annoying “aren’t you due yet???” comments. I’ve also written on Christmas cards … “baby #3, due Spring 20??”. Once I was due at the very end of July. My well meaning neighbor was asking … “are you STILL pregnant?” on July 4th. Ugh.”
• LE – “Whenever someone asked my due date I always said, “he’ll come when he’s ready” or “when God decides he’s ready”
• SC – “Mid to late month was the closest I’d get.”

Seems these particular women either have previously gotten bitten by the pesky due date or learned in the first pregnancy not to put too much stock in an arbitrarily determined date. I say good for them!

As a midwife assistant, I now participate in the baby assessments. Some of these post birth assessments gestationally date baby. Often the dates are different than the due date assumption. Some earlier and some later.  This happens even with women who knew exactly when the last menstrual period, ovulation, and conception occurred along with cycle length.

Only the baby (and God according to my belief) knows the due date aka when he or she will press start.

Early is not one day prior to 40 weeks EDD just as late is not 40 weeks and 1 day over EDD. Full term pregnancy is defined as 37 weeks-42 weeks gestation.

I think it is high time “we” layoff pressuring mamas and their babies. “We” must stop trying to evict them earlier than they desire without a true medical reason. One day to any adult is nothing, but even a day to an unborn baby coming earthside can mean the difference between alive and thriving.

In the past months I have become very aware of the deep notion in our birth culture, and yes even in the natural birth circles, that there are so many do it this way and don’t do it this way put upon women or she is wrong or not quite right.

The truth is, women do a variety of things in labor and birth. They do not all need the same education, need the same type of support, need to birth in the same type of location, or look the same during the process.

Women sometimes prefer:

• Touch and movement
• Solitude
• Sound
• Quiet
• Bright light
• Dim light or darkness
• Smells
• Lack of smell
• To eat
• To drink orally
• Deep connection with those around her
• To have direction and encouragement
• To do it her own way with no outside input
• To vocalize
• To be inward
• To have clinical assessment
• To have no clinical input
• To have a care provider
• To be her own care provider
• To catch her own baby
• To have another person catch her baby
• To be coached through labor and pushing
• To physiologically push and deliver her baby
• To have a doula present
• To be totally alone
• To have a crowd around her
• To have it be very intimate
• Birthing at home
• Birthing at a birth center
• Birthing at the hospital
• and many, many things

It breaks my heart to see women beating up other women under the guise of being helpful.  Women are not plug in play in need of a prescription to make her do labor and birth right. We need to trust that women will do what is most beneficial in labor and birth when the space and opportunity is given to do so.

Bottom line: We need to stop making women feel badly for just doing what they want to do. We need to encourage women to trust their instincts. We need to continue to give women information on healthy birth. We need to not make it about US and let go of other women’s choices.

With the majority of women heading to the hospital to birth their babies, planning for the impending birth has become an important aspect of preparation in the United States (though the percentage of out of hospital births is rising).  Standardized, highly medicalized, non-individualized perinatal and postpartum care has really led the way to this being a need. Sadly for most women, attaining evidence-based and individualized patient care going into the hospital environment is not often simple or accessible even with a well thought out, communicated, and researched plan.

In light of the care women are likely to come across for themselves and their babies, below is a list of the common information that needs to be addressed during pregnancy for labor and birth  (for a comprehensive pdf, please email me at desirre@prepforbirth.com):

• What level of care is needed – low-risk (the most common) or high risk
• Eating and Drinking Orally
• Saline-Lock, running IV or Neither
• Fetal Monitoring – continuous or intermittent
• Pain Management Options
• In the event of Labor Induction
• In the event of Labor Augmentation
• Pushing and Delivery Options
• Cord Clamping Options
• Immediate Postpartum Baby Care, Assessments, Interventions & Treatments
• Immediate Postpartum Mother Care, Assessments, Interventions & Treatments
• In the event of a Cesarean
• Infant Feeding Options
• In the event of Mother/Baby Separation or NICU Stay

Once the information is gathered women are often urged to write it all down in document format.  The most recognizable term is Birth Plan. The very word plan though can be a stumbling block for both mothers and staffers alike.  It can come across hard line and lacking flexibility. Unfortunately, this can be construed by a staffer or care provider that a woman is telling them how to do their jobs or that she has very set even unrealistic expectations. Don’t kill the messenger here, that is really how it can be looked at and thought of by the medical professionals receiving it. I am not saying it is the “right” thinking.

The idea that the term “Birth Plan” may very well be outdated is intriguing to me.  Upon research, I have indeed found so many other ways to name this document.  I highly encourage a pregnant woman to try many different titles on for size to see what best suits her communication style and personality.

A birth plan by any other name list (please send me any other titles to add that are missing):

• Birth Preferences
• Birth Map
• Birth Dreams
• Birth Vision
• Birth Wishes
• Birth Needs
• Birth Desires
• Birth Wants

Be aware that whatever the document is called, it should be no more than a single page that speaks to the current practice culture in any given area. For example, if Cytotec (misoprostol) is never used for ripening, then saying it isn’t to be used is moot and can negate the other portions of the document to the reader because the reader may think the writer is out of touch with what goes on. Do the research on the birth location practices and protocols along with the care providers standing orders so the details are up-to-date.

By no means though should cookie-cutter care be what defines a woman’s options, desires or needs for her written “Birth Plan”.  Always discuss with care provider ahead of time. If a provider uses responses like, “You can try that but…”, “Just get the epidural because….”, “Why would you want to do that?”, “Having a natural birth doesn’t make you a hero.”, or anything similar, these are giant red flags. This could be the first insight that a woman and her provider do not share the same philosophy or idea of expected care. Red flag responses may very well be leading to a serious compromise to the provider’s desires no matter what is agreed to. Well crafted and designed lip service is how I see it. Please listen intently to the answers to questions.

Writing a “Birth Plan” is a valuable and pretty necessary undertaking when birthing in the hospital in my opinion and experience.

As a last thought, a “Birth Plan” document is not legal, but rather a communication tool and values clarification vehicle for a woman, her provider and the staff she will come in contact with.

I am looking for some short video clips or pictures of pairs (couples or labor support pairing) to use in my in progress on-line childbirth class series.

General, activities or positions needed:

• Birth ball use
• Knee-chest
• Squatting
• Hands and knees (modified and traditional)
• Belly lift
• Rebozo use
• Slow dancing
• Labor walking
• Swaying
• Leaning
• Birth stool
• Side-lying
• Advanced sims
• Hip squeeze
• Sacral pressure
• Knee press
• Tailor sitting
• Pressure massage
• The dangle
• Laboring outside
• Laboring in tub, shower or birthing pool
• Variety of pushing positions
• Crowning or birth
• Delayed cord clamping
• Cutting the cord
• Assessments on mom
• With IV
• Being monitored either electronically, handheld doppler or fetascope

Please email to desirre@prepforbirth.com by April 30th for a release form and item(s) to submit including name, date of labor and birth and any other pertinent information.

Thank you so much for participating,

Desirre Andrews

Women often ask me what does pushing feel like. As an educator and doula it is probably one of the more challenging concepts to address.

Some of the imagery can be quite vulgar.  “Push like you are pooping.” Do women REALLY want the image of pooping out their babies?! Or the imagery puts pushing in a neat box. “The urge will overwhelm you and you cannot help it.” “You will just know.” Those do not adequately speak to what can occur. Some women get no urge to bear down until the baby is very low and engages the nerves. Others will have the urge when baby is high and dilation isn’t complete. Still other women do not get an intense urge at all regardless of pain management or natural birth.

For that matter, great rectal pressure may be felt, intensely abdominal use, incredible pelvic pressure may be experienced,  or frankly not much at all can be felt.

I believe whatever a woman’s body does is right for her birth and her baby.

Below are many quotes that others openly offered to help women everywhere have a deeper understanding of what pushing is like.

Quotes from real women

“My babies #1-4 practically fell out. #5 I was in what looked like early labor for 4 days. Midwife assistant came over, checked me, I was at 7 cm but ‘not in active labor’. I got into it quickly! Long story short I pushed, painfully, for 3.5 hours, baby had 11″ cord with a true knot. She needed to be pinked up but is almost 3 and is doing well.”

“When I was coached to push (w/ no 3..first natural birth) I was in agony. When I was left alone and did not push (w/ no 4), life was good.”

“I feel like if I can just get to the pushing phase, it will be a breeze from there.” (and it was. The whole “surrender/dilate” phase is much more challenging to me than the whole “take control/pushing” phase.)”

“Pushing was fantastic with my 2nd baby and awful with my 3rd! It was really surprising because after my 2nd birth I thought “Okay so pushing is the really fun and satisfying part! That’s when it gets EASY.” Then my third birth totally shocked me. Pushing was the most painful and difficult part of the birth. I had stayed so calm and collected… until then. Every pregnancy and birth is so different!”

“I love the way it feels to have a baby move through me and into my waiting hands.”

“The mirror really gave me focus and helped me push very effectively when I inspired by seeing a peek of baby head.”

“I *loved* pushing. I didn’t do it for very long (two contractions), but it was so great to finally get there. I was told to purple push (not in those terms – the nurse told me to hold my breath), and intellectually I knew I shouldn’t, but I tried it and it really did feel like I was more productive that way. I felt like a warrior. It was awesome.”

“Before anyone hates me for only pushing through two contractions, you should know that I’d been in labor for three days – so it all comes out in the wash ”

“Pushing with my 2nd was horrible. 3+ hours of the worst pain I had experienced at that point in my life. Turns out her little fist was up by her cheek (um ouch) and her head did not mold much. My 3rd I did not push because she was precipitous and we were trying to get to the hospital. I felt like all the energy in the world was gathering and swirling at my fundus and then suddenly flowed through me carrying her with it. It was the best physical experience of my life.”

“I have heard some say that pushing feels good.. um, I personally have not experienced that and I have had clients remark the same … :p”

“Hmm…Definitely the best part of labor and delivery. For me though – never had any “urge” to push but still had baby out in 20 mins…I think I was feeling determined being a VBAC mom…still, would have been easier if I felt the need to and not just contractions. “

“Heard lots of clients say it feels good after hours of labor”

“Difficult. I had an urge to push “early” every time. Once I got to the “ring of fire” it was awesome though.  I knew I almost was there.”

“Ahhh, I’m not so fond of the pushing. Did it for 2 1/2 hours with my daughter (LOA) and though it was only about 20 minutes with my boys, they were both OP. That was, shall we say, unpleasant. I cannot relate to those who’ve told me it was such a relief!”

“My labor was surprisingly short, only 6 hours and she’s my first baby so far. I woke up in active labor and at 4 cm and I wanted to push THE WHOLE TIME! It was horrible having the nurse say I couldn’t push yet when I wanted to so badly, but once I did get to push, oh my goodness, it felt incredible. So much control and power, it felt so good to finally work to end. 3 big pushes and there she was. ”

“Sheer, immeasurable power. Unbelievable!”

“Babies actually come out of your butt. Don’t let anyone tell you otherwise.” One of my clients recently said that. ”

“Birth is shockingly rectal” – Gretchen Humphries. She was totally right.”

“Pushing with my first felt like I was satisfying an urge, an uncontrollable urge. It felt almost desperate I couldn’t stop it. (kinda like having that rectal urge when you REALLY have to poop). Pushing with my second was no big deal, I followed my urges again and pushed 3x and out she came in her 10# glory. It was extremely satisfying and powerful I felt like I had just finished exercising. Amazing!”

“The ring of fire OH MY it is indeed! Though as soon as the burn started the whole are went numb almost like too hot or too cold numb and the power of the urge to push my son out was almost beyond description.  Pushing was never easy for me as I have an unusual pelvic shape.  But my last son WOW no molding and quite a large head to birth him was incredible really.  No tearing, just some abrasion.  Recovery was a snap.”

“I had at the point of delivery what was the best orgasm of my life!”

“Pushing was totally primal.  I had an incredible urge and it took over.”

“The pressure of the baby entering deep into my pelvis and vagina was wild and almost overwhelming.”

“Feeling my baby when he was partially inside and partially outside of my body was a euphoric and surreal moment. The hour of pushing was well worth it.”

Bottom line – you and your baby are unique. You work together during all parts of labor including pushing through to delivery. Be confident. Use your intuition. Follow what your body desires to do.

Questions and Answers

1. I have had a previous episiotomy, do I need another one automatically? No you don’t.  Depending on how your scar has set and the position you push in the scar can re-open or it adhesions in the scar will need to be broken up.  I would suggest perineal massage prenatally if there are any adhesions to break them up and soften the area prior and to choose a pushing position that doesn’t put all the tension on that exact area.
2. Is is wrong to push when I am not fully dilated? Not necessarily.  Now I think grunty smaller pushes with those contractions can be effective to complete dilation if you are in transition.  Prior to that change the position you are laboring in to change where baby is placing pressure.  Knee chest can be very effective to abate very early pushing desire.
3. What if I poop during pushing? Some women will pass some stool and some won’t.  An open bottom is vital to pushing, so it is a normal but not always occurence.  A fantastic nurse, MW or doc will not actually wipe it away but simply cover as to not cause constriction of the sphincter muscles which can disturb the pushing progress. If it is possible to discard the stool without disrupting you, it will be done very quietly, quickly and discreetly.
4. I am very modest, do I have to have all my “glory” showing? Absolutely not.  You can maintain good modesty all the way up to delivery.  Even then you do not need to be fully exposed.  Truthfully a home birth or birth center birth with a midwife if likely going to help you have your modesty concerns respected and honored. Really no one needs to put hands in you during pushing, needs to stretch anything, or needs to see everything either.  A midwife is trained to see by taking a quick peek or simply to know when she needs to have hands ready to receive baby and to offer external positive pressure if mom wants.
5. Is there a “right” position to push in? There IS a right position for you, your baby and your pelvis. The only way to know is to try a variety of positions, pushing spontaneously and listening to your body.  Generally the lithotomy or semi-reclined position disallows the tail bone to move up and out to create more space. Side-lying, squatting, leaning in a mild squat, hands and knees, hands and knees with a lunge, and even McRoberts can be excellent to open a pelvis to a large degree. Pay attention and go for what feels right.