Pushing for Birth – another look

“Pushing felt good.” “The urge to push was unstoppable.” “I loved when I got the urge to push!”. “I felt like I was going to split apart.” “It hurt so much more than I thought it would.” “I didn’t want to push.” “Why did I have to hold my breath and tuck my chin?” “I grunted and threw back my chin.” “Why were people yelling at me?” “All I wanted to do was breathe and not push.” “What is the deal? I was told I couldn’t get a baby out on my side, squatting, hand and knees or when I arched my back and threw my head back.” “It felt so good to put support at the top of vagina.” “If I would have pushed in another position would I have torn so much?” “Why did the nurse and doc keep putting their hands in me while I pushed?” “Would I have avoided a cesarean pushing in another position?”

The myths surrounding pushing in our culture are widespread. Over and over women are told unless they push in the “C-position” or reclined position with tucking chin and holding breath “purple pushing” there is no way they can effectively push out a baby. Women are told that spontaneous or limited bearing down will take much longer. When in fact that is untrue.

Interestingly, when not coached, women spontaneously know how to push, how to breathe properly and how to help baby descend. As a matter of fact, most women choose to squat, stand and lean or use a variation on hand and knees to deliver their babies and even nap in between pushing cycles.

By the comments above pushing can be wonderful, challenging, or even both.  Outside influence can hinder or encourage a woman. She is very vulnerable and usually tired, but then the second wind comes.  She knows her baby will be here soon.  She knows that after the hours of getting out of her own way and letting her body do the job it was designed for, she can now DO something. Second stage can last minutes or hours, though it is like early and active labor more rest than work. Women may even sleep in between contractions.

So why are women continually told there is only one way to effectively deliver a baby and expected only to do that?

Here are a few thoughts to chew on:

  • 98% of babies in USA are born in the hospital versus at home  with or without a midwife or at birth center with midwives in attendance.
  • Most OB’s are not trained to receive a baby in any other position. They are trained to see with their eyes for one orientation and have not learned to “see” with their hands.
  • Most OB’s are trained to sit in front of the mother on a stool like a catcher.
  • Staff and OB’s want something to do when really the woman pushing is the only one who needs to be doing anything.
  • In hospitals, nearly ALL women – in some areas close to 100% are medicated with narcotics or more likely with epidural anesthesia disallowing freedom of mobility and body presence.
  • Beds are used virtually 100% for hospital deliveries versus a birth chair, birth stool, toileting, squat bar, standing or leaning.
  • Women are programmed to be in one particular position because it is virtually all we hear about from others and see in the media.
  • Women are not taught to trust their instincts and to listen to their body and baby during birth so instead they look outside to gain understanding of what to do.
  • Nurses are trained only is “pushing” women in the new classic C position with vigorous perineal and vaginal “massage”.
  • Women are limited to a specific pushing time and often in the one position before a cesarean is performed even when mom and baby are doing well.

When a woman chooses a variety of positions for pushing without hindrance (this can include the C position) it can:

  • Reduce trauma to the perineum, labia, clitoris, and urethra
  • Shorten pushing time
  • Allow for movement of the tail bone thus opening the pelvis more
  • Can lessen stress on the baby
  • Give mom more sense of control over the birth
  • Changes the pelvic shape to aide baby in molding and adjusting
  • Allow for fetal ejection reflex to occur
  • Allow for a euphoric and natural state to occur

Using alternative breathing techniques other than holding the breath as in directed pushing to a count of ten or more can allow for baby to get more adequate oxygenation as well as,  be a more gentle process for both parties. A laboring woman may breathe in several different ways during pushing.

She may:

  • throw her head back and open her neck with an open mouth while breathing to comfort and pushing
  • spontaneously push while breathing non-specifically
  • she may grunt and growl
  • she may hold her breath for a moment and then exhale several times during a pushing episode
  • she may do a slow-exhalation with mouth relaxed and slightly open (open-glottis) while pushing
  • breathe slowly/rhythmically and not push actively allowing for passive descent of baby through contractions

Most un-medicated or lightly medicated women will choose a position and breathing style that works for her body allowing for the natural progress to occur, usually culminating in the fetal ejection reflex at the very end.  Instead of forcing a woman into a cookie cutter type position, she needs to be given the opportunity to trust her body, trust the process, feel the process and feel supported. Otherwise, we don’t really need to do anything.

I urge you to have deeper conversations about pushing and delivery with your care provider BEFORE you go into labor. The answers to the questions may be a green or red flag for you. Pay careful attention that your questions are really answered to your satisfaction.  It is your provider’s job to prove to you why he/she practices the way he/she does.

  • Ask your provider what his or her philosophy about pushing and delivery is.
  • Ask provider to describe what pushing normally looks like with his/her patients.
  • Ask how many hands off deliveries your care provider has done.
  • Find out what positions your provider is comfortable or willing to GENTLY receive your baby in.
  • Ask if provider performs perineal massage? If so, have it described to you. GENTLENESS is the key here. No one needs to tug, pull and yank your vagina, labia, and perineum.
  • Ask your provider if spontaneous pushing and delivery are supported.
  • Tell your provider you will agree to coached pushing after you have tried everything you want to do
  • Ask about percentage of women under provider care “require” an episiotomy
  • Ask how long pushing will be tolerated before wanting you to have a cesarean or instrumental delivery.
  • Ask for evidence to support practices. Actual studies not just verbal.
  • If you are having a hospital or birth center birth upon arrival and admittance speak clearly to your nurse about what you plan on doing for pushing.

Here’s to pushing with confidence, using your instincts and following your body!  Here’s to finding the provider with a normal outlook on pushing and delivery.