How to push properly in labor
We tend to think of labor as one long event that ends with the birth of your baby but in fact it is divided into three stages. The first stage of labor is when contractions work to thin and dilate your cervix so your baby can pass through it, and the third is the delivery of the placenta. The stage in between – the second stage of labor – is the pushing stage, and it usually lasts one and a half to two hours in first-time moms-to-be. If it continues any longer, or your baby is in distress at any time, he made need help to be delivered. The pushing stage is more likely to be long if your baby isn’t in a good position for birth – for example, if he’s posterior (with his back to yours).
How will I know when it’s time to push?
One thing that will cross your mind more and more as your due date nears is how you’ll know when it’s time to push. This really depends on what pain relief you are using in labor.
If you have had an epidural, which numbs you from the waist down, you may not feel the urge to push at all unless it wears off sufficiently by the time you are fully dilated and ready to push. But most women (not all) who have given birth naturally report an overwhelming urge to bear down and push.
This likely occurs as your baby’s head moves along the birth canal and presses on your rectum, as this results in the rectal nerves sending a message to your brain to empty your bowels. It’s possible you may pass a bowel movement while you push, but this is perfectly natural and nothing to be embarrassed about – your caregivers will have seen it happen many times and will clear it away with no fuss. Most women who report this urge say that it is impossible to resist – but it’s important that you push properly, as this can help you birth your baby faster and help prevent tearing as your baby’s head crowns (emerges from the vagina).
Pushing stage phases
The pushing stage is divided into three phases:
- Latent In this phase, contractions ease off and you may not feel much urge to push at all. Take the opportunity to rest until your contractions start to intensify again, as pushing during this phase doesn’t actually accomplish much. If this phase lasts more than 20 or 30 minutes, get into a more upright position or ask your caregivers to help you do so, as this can help encourage the urge to push.
- Active/Descent In this phase, contractions are strong and come frequently and it’s now you will be most likely to feel the strong urge to push.
- Transition/Perineal This is the phase where your baby’s head crowns. You’ll feel a burning sensation and may be advised to resist the urge to push (try to pant through it) so your baby’s head can stretch the tissues gradually, thus lessening the risk of tearing.
Which positions are best for pushing?
If you are having an epidural your caregivers will likely help you into a semi-sitting position, with your upper body propped up by pillows, and may also encourage you to wrap your hands around your knees to pull them up towards your shoulder. This gives your caregivers a good view of your baby’s head as it crowns.
If you are able to keep mobile,
upright positions are best for pushing as they mean gravity can step in and lend a hand. Your birth partner can support you under your shoulders for you to push while standing, or you can kneel while holding onto the bed frame or drape yourself over a birthing ball. Squatting positions are especially good as they fully open the pelvic outlet for your baby’s head to pass through.
How to push
If you are having a natural birth and feel the urge to push, you’ll likely be advised to go with it – this is called spontaneous pushing. You may be able to do three to five pushes, each lasting around six seconds, during each contraction. Push through your bottom as if passing bowel movement – don’t hold back for fearing that you will pass one, as this will affect your pushing. If you feel the urge to vocalize by grunting or groaning, don’t feel embarrassed about doing so.
As your baby’s head begins to crown your caregiver may ask you to try to stop pushing and to pant. This is so your baby’s head can pass slowly through the vagina without (hopefully) tearing you.
What if I don’t get the urge to push?
Not every woman experiences the urge to push, and you won’t be able to feel it if you have had an epidural. In these cases you may have what’s called directed pushing, where your caregivers tells you when to push (if you have an epidural and can’t feel your contractions, your labor will be monitored and a screen will show you when your contractions are peaking and you’ll be directed to push then).
An alternative option to this directed pushing is ‘laboring down’, where you don’t push but instead allow the contractions of the uterus to move your baby along the birth canal until his head is crowning, at which point you’ll be asked to push. Laboring down means a longer second stage but it’s much less tiring for you and there is evidence it results in fewer forceps and vacuum extraction deliveries than directed pushing.
What happens after I push out my baby?
After an initial cuddle she’ll be checked and assessed before being given back to you. You’ll then go through the third and final stage of labor, delivery of the placenta.
The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.
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Last Modified: 24/07/2009
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