Pushing in Labor
Ah, push it…push it real good! While Salt-n-Pepa’s epic hit may get us into the groove, the act of pushing in labor can be filled with anxiety, fear, and achievement. At the end of the tunnel, there will be a baby! How will I know when to push? How does pushing work? What does pushing entail? What happens if xyz occurs due to pushing?
The second stage of labor is the pushing stage. This stage of labor sees the cervix dilated to 10cm, the bag of waters may have ruptured, and there is the feeling of pressure in the pelvic area. The baby can be situated in the pelvis ready to be labored down further or ready to be born.
Common Fears During the Pushing Stage
During the pushing stage, anxieties can heighten. The mental picture of the cervix opening to the size of a bagel. The feeling of the baby passing through the birth canal into the cervix, and experiencing the “ring of fire” can physically tighten up the body to inhibit progress. Some common fears in this stage of labor are: tearing, pooping during labor, feeling pain, baby being stuck, not being able to feel the body pushing.
Tearing is a big fear in the pushing stage as the body can tear naturally, or an episiotomy may be administered. There are different degrees of tears that may affect recovery in the postpartum phase. Shit happens! Pooping during labor occurs due to the fact that the same muscles to have a bowel movement are the same muscles used to have a baby. Pain in childbirth is a thing. It IS painful to fit a small watermelon through a bage, AND pain is also subjective to the individual. There are holistic and medical interventions that can help with the idea of pain, and can be tailored to the birthing person’s wishes.
In most cases, providers will allow a birthing person to push for up to 3-hours. In instances where a baby may be engaged into the birth canal for a prolonged time, the mental, physical, and emotional drain can create a narrative of “is this baby ever going to come out?”, “get this baby out of me!”or maternal exhaustion setting in; possibly leading into a cesarean section. For some, pushing while under the anesthesia of an epidural leaves them feeling like “what if I can feel my body to push?”. Because epidurals are a nerve narcotic, this is a high possibility. Allowing the body to come down from the epidural can allow the birthing individual to feel.
Options for Pushing Positions
Pushing options are plentiful. Side-lying, squatting, lunging, hands and knees, standing, and on the back are some positions commonly used in pushing. Side-lying is a comfortable position as it allows the birthing person to rest in-between pushing. Squatting and lunging positions allow for the assisting of gravity during pushing. Hands and knees positions are popular in the homebirth realm. Being on the hands and knees provides a foundation and a grounding sense in pushing. Standing often is utilised with squatting and lunging. In between pushes standing to gain traction, and going into a squat/lunge. On-the-back is the most pushing position utilized in hospital settings. This position is also most commonly known as the norm. Unfortunately the on-the-back position for pushing is one of the most restrictive.
Differences in Coached Pushing and Passive Descent
When it comes to the actual process of pushing, there are coached methods and passive descent. Coached pushing is when the birthing individual is coached through the pushing process. Typically this is a 3 sets of 10 second pushing sessions. This form is most common in the hospital setting. The provider, nurse, doula or partner leads the sessions that begin at the onset of a contraction. The birthing person takes a big deep breath and bears down in a push as their birth team begins the count series. In-between each set there is a rapid rest of new breath and back into the hold. Benefits to coached pushing are: the ability to be guided with an epidural, feeling confident in pushing, knowing the timeline of events unfolding.
In passive descent, the birthing individual pushes when the urge to push occurs. This form of pushing can be timed, untimed, instinctual, or navigated. The benefits to baby passively descending are: reduction to perineal tearing, less physical strain on the birthing individual, decrease in fetal distress.
There’s a medium between the two processes that marries both methods together. This allows for support from the birth team, while also listening to what the body (and baby) are naturally doing. Coached and passive can be a benefit for some individuals that gravitate to a both natural and scientific approach to birth.
What is Laboring Down
When the flow of contractions, the breathing, the movements, and the positioning of the body is part of laboring down. Laboring down is allowing the baby to descend into the birth canal in an instictural way. Giving in to the baby’s seven cardinal movements in labor. The more that one allows gravity to assist in the birthing process the more beneficial to the birthing person and the baby. In vocalization, breathing baby down is one form of laboring down. In movement, standing, squatting, and leaning over are ways to allow the body to labor down.
Pushing is the second stage of labor. This stage can be intense, and understanding how the body and the baby works together to descend baby into the birth canal and ultimately earth-side. This phase can last 30 minutes to 3-hours, and can be labor intensive. Utilizing different positions will aid in a progressive laboring process. Knowing when to push and how to push will provide confidence when the moment arises.