29- Preparing for Pushing
Transcript:
This is episode 29.
And today we’re going to dive in a little deeper to talk about Lamaze international’s healthy Birth Practice # 5: Avoid giving birth on your back and follow your body's urges to push.
Ok, this is the part of labor that I personally felt the least prepared for when I had my babies. I was a little more ready for number 3 but still not where I wanted to be so as I’ve delved more deeply into childbirth education, I’ve learned a lot since then and hopefully can help you be more prepared than I was.
The pushing part of labor is also known as the second stage. It starts around the time mama’s cervix has dilated to 10 cm. Baby’s head is still descending through the pelvis and will soon be seen crowning at the vaginal opening, if it’s not already there.
Many women experience a passive phase when they initially reach the second stage of labor. That just means there may be a bit of a rest period when the contractions slow down or seem to stop. It doesn’t happen for everyone but it’s perfectly normal and if it happens for you, be thankful for the break and take a rest. Sometimes mama can even sleep. It’s ok, you won’t miss any action. When the contractions pick back up you’ll be fully alert again and better able to push for the last stretch. It’s also important to note that during this passive phase the baby is still descending and rotating into just the right place for pushing.
Once baby is low enough and really putting pressure on the pelvic floor, mama will feel a distinct urge to push with each contraction. The top of baby’s head will be visible at this point. Now there are generally 2 types of pushing that a mama can do: spontaneous pushing and directed pushing. The better option is usually spontaneous pushing because mama can feel what’s going on in her body and work with it best this way. That’s not to say that a little direction from a trained doula or midwife couldn’t be helpful. It certainly can be! And if you’ve had an epidural, you will likely need some direction, tho’ ideally you will still be able to feel the baby putting pressure on the pelvic floor and can respond to that. The type of directed pushing you want to avoid is the “hold your breath and push as hard as you can for a count of 10.” This is often referred to as purple pushing because mama’s face sometimes turns purple from holding her breath & the lack of oxygen. That kind of directed pushing can potentially get baby out quicker but it also often leads to tears of the perineum (that’s the skin around the vaginal opening). It’s also harder on baby & mama. Just as mama has less oxygen, so does baby, coupled with a more forceful exit for baby and exhaustion for mama.
I recently heard someone talking about the second stage of labor as working with your body to let the baby out. This is such a good way to think about it – as opposed to our typical mindset of “we’ve got to get this baby out?” – as if it’s all up to you and the doctor. Remember ladies, God designed your bodies to grow and birth a baby. That means, He designed your body to let that baby out. To the extent that you can work with His design, the more smoothly things will go. Now, in a fallen, broken world, we know that sometimes things don’t work the way they were designed to work and there are unforeseen complications. Thankfully, the Lord has gifted many men and women through the years and there are maneuvers and technologies that can help overcome many difficulties that we might face.
I’ll share one example from my first birth. Remember, I told you I was not very prepared for this part of labor so I’m super thankful for the labor and delivery nurse who was providentially with me for the birth of my first baby. I ended up pushing for a good 2 hours. This nurse encouraged me to move into so many different positions during that time and both I and my husband were very thankful for her direction. But it turns out that baby had her hand up by her head which made her exit a little more difficult. Try as we might, we just couldn’t get my body to stretch enough to let both her head and hand out together. We finally ended up using an episiotomy (that means cutting my skin to make more room) to let her out. It’s not what I wanted but after being well supported and trying everything we knew to do to work with my body, it seemed to be the best option and I was satisfied with it.
I want to spend the rest of our time today talking about ways that you can work with your body to help let your baby out and we’ll come back to talk more about spontaneous pushing in a bit. If you’ve had an epidural, your options of different pushing positions will be limited but depending on the strength and type of epidural, with a good support team, you may still be able to move around some, if you want to. Otherwise, there are a few main guidelines when it comes to finding the optimal position for pushing. First, work with gravity, or in other words, use an upright position. Some ideas for this: use a birthing stool; pull up the back of your hospital bed or use the back of a couch if you’re at home, and turn around to kneel and lean over on it; squatting is a particularly good position for opening the pelvis as wide as possible but it’s not comfortable for everybody. If you think you might like to try squatting in labor, I encourage you to practice lots of squatting options throughout your pregnancy. Standing and leaning against a wall or your partner is another option or better yet pulling against a rope that is attached to something overhead. All of these fully upright positions are especially helpful if your baby is coming slowly and needs a bit of extra help. Or for example with a big baby that needs all the room he can get to come out. If baby is coming fast, it may be good to slow things down just a bit to help prevent any perineal tears. If that’s the case, you could try lying on your side with your knees bent and someone helping support the upper leg. Being on your hands and knees can also be a good position to slow things down some. The benefit to these positions over lying flat on your back is that the tailbone is not constricted and can still push back to allow more room for baby to come through but because you’re still horizontal rather than upright, it slows baby’s exit just a little to give your perineum time to stretch. As baby’s head is crowning, with each push, a little more of the head becomes visible, then when mama relaxes between contractions, it goes backward a little bit. This back and forth, however, is an important part of the process because it works to soften and stretch mama’s skin to let baby out. A really hot, steamy compress also works wonders at this point to relax mama’s skin and help the process along.
So, many women want to know which is the best position for pushing and the answer to that is it’s up to you! What works best for one baby & mama may not work best for the next one. It really depends on your preferences and baby’s position. You may find that you cycle through a number of different positions during the pushing stage, in fact, I recommend it. Whether you realize it or not, changing positions often helps baby wiggle around to the position she needs to be in to make her grand entrance into the world.
Now, let’s go back to spontaneous pushing and breathing for this stage. It’s good for mama to make a noise as she pushes. Lower tones are better. Making a noise ensures that there’s a little bit of breath escaping as opposed to the hold your breath and push method. The lower tones focus the effort low and tend to make it more effective. When left to herself, mama will usually push for 5-7 seconds at a time several times through the course of each contraction. I always encourage mamas to take a deep cleansing breath (breathe) at the beginning and end of every contraction. This can help to steady mama and gives baby a boost of oxygen. When pushing, tucking the chin and grunting or groaning can be helpful. If baby is coming fast and you want to slow things down so your skin has time to stretch without tearing, quick puffs or breaths out can help do the trick. Remember to rest between contractions and be patient.
Allowing mama to have a calm unrushed environment for pushing has many advantages. Baby gets more oxygen through the placenta, mama is less likely to become physically exhausted and the perineum and pelvic floor muscles are less likely to be damaged. It also leads to a more satisfying overall experience for mama and that’s important.
Mamas, it’s really helpful to have a good support team around you, encouraging you and helping you to get into whatever different positions you want to try, or if you’re not sure, suggesting different positions that you can try every 15 minutes or so – like my labor and delivery nurse did for me. Trying out different pushing positions with your husband or other support person before you go into labor can be so helpful. This allows you to talk through the ways that they may be able to support you to get into a position or to help you sustain it. It’s also less strange to use it in labor if you’ve tried it before. Unfortunately, many people have in their heads that you have to be lying on your back on a bed when it comes time to push baby out so it’s important that you talk about other options ahead of time if you think you might want to use them. Talk with your doctor or midwife. Ask if they have any recommendations or requirements for the second stage of labor. If they’re not open to you trying different positions during the pushing stage, & that’s something you want to do, you might consider looking for another care provider. Another question you could ask is if the hospital has birthing stools, a birthing bar or other aids for mamas to use while pushing. Talk with your husband or other support person about your desires and why upright forward leaning positions can be so helpful. Remember there are pros and cons to any position you decide to use, including lying on your back. Being ready to try different positions for pushing may be the difference between a stalled labor which would require a vacuum or forceps delivery or even a c-section and a successful vaginal delivery.
We’ve talked a lot about preparing your body for pushing and letting your baby out during birth but before we end today I also want to take a minute to talk about preparing your soul or your heart. The bible uses words like heart, soul, mind and spirit to refer to the immaterial part of humans. That’s what I’m talking about here. We know from scripture that humans are embodied souls and the two (body and soul) affect each other in complex ways. For example, undealt with fear or anxiety about having a baby often causes excess pain during labor and could cause you to involuntarily hold back during the pushing stage. Having a caring and encouraging support team goes a long way to help alleviate some fears and anxieties. Listening to a playlist of scripture filled praise and worship songs during your labor can also be reassuring & relaxing.
Sometimes the fear may be related to modesty issues – not wanting people to be staring at your private parts or you may be concerned about pooping while you push. For the first, it’s important to remember that those looking are watching the progress of your baby but you can ask to be covered as much as possible. Upright positions may also lend to a little more modesty in that regard. As for pooping, you should know that it’s normal to pass a small amount of stool when you push. This is actually a good sign and lets your birth attendants know that your pushing is effective. Nurses are trained to remove the stool discreetly. You might find it helpful to sit on the toilet for a few contractions to help you open up and get past that fear.
If you have been sexually abused in your past you may consciously or unconsciously fear being reminded of that abuse by the sensations of labor or the lack of control you might feel. Not all survivors of sexual abuse react in the same way but it is not uncommon for them to struggle with certain aspects of pregnancy and childbirth. Again, a caring and encouraging support team during birth can go a long way to help minimize the struggle.
Regardless of where the fear or anxiety stems from, I would encourage you to take time before you go into labor, to talk through your fears and concerns with your husband and take them to the Lord together. It may also be beneficial to talk with a trusted older woman in your church or even a trained biblical counselor – someone who will listen well and point you towards Christ for hope and help.
By the time you get to the pushing stage of labor, it is my prayer that you will be able to let go and relax your body trusting the Lord to carry you through.
Alright, we’ve covered a lot and there’s still a lot more that could be said. I hope this has been helpful to get you started thinking in the right direction. And remember my suggestion to talk about your preferences with your spouse and your care provider. Oh, and practice! Don’t forget to try out some different positions to see how they might feel ahead of time. I’ll link to an article with pictures in the show notes that can help you with that.
Show notes:
In this episode we’ll talk about Lamaze international’s healthy Birth Practice # 5: Avoid giving birth on your back and follow your body's urges to push. We’ll discuss the difference in spontaneous and directed pushing, talk about what position is best, and touch on the link between the body and soul when it comes to fears and pushing during labor.
Resources:
Lamaze Article on Healthy Birth Practice 5
short video put out by Lamaze on HBP5:
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