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Labor: How Do You Push?

I want to get into this…this is more debated then you even know, because if you have had a child vaginally before, you have most likely experienced coached pushing. This basically means, “Don’t worry, we will tell you what we want you to do.” That takes the worry out a little bit for some people in the moment but afterwards, many women come to me for my Natural Birth Class with the same story…

  • I had NO IDEA what I was doing
  • I couldn’t tell where I was actually pushing
  • I felt like I was hyperventilating
  • I felt like being on my back was the worst possible position to be in

The tricky part to teach and to “doula” in these conversations is to gently explain, it’s not the nurses fault, it’s not the midwife or Dr’s fault and it’s not the doulas…it’s all about how well you prepare, if you never learned how to properly push a baby out, this is one situation where “learning on the job” isn’t always the best fit.

Transition

Let’s start with moving through those last few centimeters and getting over the hump of transition. There is a reason many women get an epidural around 5-6cm. Our bodies have a beautiful way of moving through stages and being prepared for these new phases, sensations and emotions that come with each stage will make a huge difference.

Signs of this phase of labor are shaking uncontrollably, feeling nauseous/puking, feeling a sudden out of control feeling (fight or flight), some women say they feel like they are on drugs and often this can look like you are suddenly unable to walk or move, you are feeling fearful and starting to hint towards meds. The things I often hear are:

  • I can’t do this anymore
  • I want to go home
  • I hate this, I really think I’m going to need meds soon
  • I want to talk about the epidural

In this very fragile time, it is important to eliminate anyone from the room that isn’t full supporting your original goals. If you wanted an epidural, this is the time to get it. If you didn’t want one, you need a team to remind you that:

  • Remember, this phase is going to be quick…you prepared for this, you knew it was coming.
  • This will be a blip, this is a quick moment in your story, remember after this is rest and pushing
  • I know it is intense, can we do this together? One minute at a time, look at me.
  • During contractions it’s getting through them, one minute a time but in between it’s remembering to release…your mouth/jaw, your forehead, your hands and your shoulders

This phase is typically going to be a quick one for mom’s who have had a vaginal birth before, sometimes a bit longer for first time moms but still quick in comparison to their labor up until this point.

Resting

So, don’t believe me? I swear some moms have amnesia about this part…however, as a doula we often see a resting phase. Just after this intensity, this surge of hormones that rushes into our body and creates those shakes, vomit, racing thoughts…those same hormones allow your body to find peace, it settles into your body like a drug. In fact, these beta-endorphines are so special and often aren’t felt under the influence of an epidural:

As labour contractions become more intense, natural pain relief hormones are released. Known as beta-endorphins, they are similar to drugs like morphine and act on the same receptors in the brain. As well as pain relief, they can also induce feelings of elation and happiness in the mother. As birth becomes imminent, the mother’s body releases large amounts of adrenaline and noradrenaline – so-called ‘fight or flight’ hormones. A sudden rush of these hormones just before birth causes a surge of energy in the mother and several very strong contractions which help to deliver the baby.

YourHormones.Info

Pushing

So, here we are. Through this time of rest or maybe at the tail end of transition, you start feeling intense pressure on your tailbone and rectum. Nurses and Midwives/Dr’s maybe start asking about the pressure, When are you feeling it? They want to know if it’s non stop pressure or if it’s coming and going with the contractions.

This lets them know if the contractions are still moving baby down in to position, but then baby is still going back up a bit or if baby is now staying low.

When we hear that it is non-stop, that usually means a head has come down far enough that it is no longer going back up with contractions, it has settled down into the lower part of your pelvis. We often start feeling this pressure along with the urge to push around +1-+3 station (below).

As a doula I often start hearing (sorry but these aren’t the most G rated things, but they are exact quotes):

  • I feel like my butt is going to explode
  • I’m going to poop my pants
  • I can’t walk, my legs feel like they won’t work
  • I really need to use the bathroom
  • ahhh, this baby is coming!
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So, what if you aren’t feeling “the urge”? If you are on an epidural the answer is very simple…we wait! If baby is happy and you can breathe through the pressure and are feeling good, we ask the nurse and Dr. if we can have more time.

One of the best ways to prevent tearing is to not start pushing until your body has done most of the work with contractions. On top of that, it’s understanding what pushing even means.

Here we go, so try (yes, right now) try to blow a pretend candle out in front of you. Do you feel that? Somehow..magically you tenses and released at the same time. We talk about this push and pull a lot in my classes because it’s SO hard to comprehend.

The BEST way to practice this type of muscle release with pressure is by sitting on the toilet and trying the candle trick. It’s the easiest way to get an understanding of where this baby will be coming from and how to work with your body instead of bearing down with all your might and tensing every muscle you have.

Babies come with ease when we create a muscle release around them, this isn’t always easy, if you have already pushed a baby out the traditional way we are coached to do in the hospital, you may be thinking….ugh, yeah right.

I remember a fair amount of bearing down with my daughter and no one was coaching me at all. However, when I think about the places where I made the most progress, it was on the toilet when I was releasing and then waiting for my body to tell me to push and then in the tub where I suddenly couldn’t stop pushing because my Fetal Ejection Reflex kicked in.

If we give space and time for all of these natural processes of our bodies to work with our baby, things happen with ease, but we have to speak up! None of this comes without an understanding of your own body and communication with your birth team.

Sometimes, it can feel like you just want to go with the flow and do what the nurse or “professionals” around you are suggesting. However, if you don’t feel like pushing yet…none of these processes are kicking in yet, this means long pushing phases and it could just mean a simple position change (all 4’s, stand up, work with gravity, or peanut ball) and things trigger right in! Oh, that magic peanut ball does the trick every time =)

So, our quick tips for non-coached pushing are:

  • Labor baby down as long as possible
  • Don’t start pushing until your body is starting to push on it’s own
  • Get upright or on all 4s

I want to also cover how this may be different if you are on an epidural. Often times on an epidural, you still feel that pressure when it is time to push, however, what if you don’t? This is when that candle blowing trick comes into play, you may not be able to feel a thing, but that sensation…that place you have been practicing, is still the same.

While, it may be preferred by Dr/Midwife/Nurses that you stay on your back for pushing and pull your legs back like you are rowing a boat, you can also turn on one side, lean over the back of the bed (if your epidural is good and you can still move your legs) or ask for a squat bar. It feels like this is inconvenient sometimes, but it’s not, everyone in the room is there to help get this baby out, speak up and move in the ways that feel right for your body.

Here’s the thing, there is in fact a time and place where being on your back for pushing works better, we see it with some women where they just feel stronger and more stable that way.

There is also a time and a place for coached pushing, you take a deep breath, you start bearing down like you are pooping and you move that baby down. Some women need these cues and that is totally fine if that’s what is working.

We offer up these options and alternatives because as doulas, we see what can be possible when babies are in a great position and labor is going well (baby is responding well) and mom is prepared and ready to release and settle into bringing a baby down in as relaxed an environment as possible. You won’t know if you don’t try.

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Remember, this is your birth, your body, your baby…you only get this moment once. Speak up! Keep tuning in to your body, if what is going on feels counter intuitive, fight against it and ask for something different.