The Art of Pushing – Guiding your baby out instinctively

Pushing your baby out through your vagina, with an overwhelming natural urge that comes from deep within you, was once again the subject of discussion this week at my pregnancy yoga class!

This topic comes up regularly during classes, and also with our doula clients, because for many of the ladies who attend the classes who are having a second or third baby, it is the time where things went wrong for them, and they want to talk about it!

It is however important for ALL pregnant women to understand that the 2nd stage of labour, is a very delicate and crucial stage in the birthing process, and for many it can be the time when much meddling can take place.

Imagine how disappointed women feel, when they have done all the hard work of dilating to 10 cms, commonly over many many hours, and then they cant seem to get the pushing stage right.

Their midwife might be beside them, encouraging them beautifully, and often explaining exactly how to do it, and where to feel it.  In some cases the midwife might go as far as to place her hand inside the woman’s vagina, and ask her to push against their hand, so that the woman can feel where the right place to push is!

And even after all that hard work, some women may end up with assistance via forceps, ventouse or in some cases a caesarean section.

And then there are the women who never get the “urge to push”. These women can be left with the feeling that their bodies are faulty, and not working correctly.  The midwife perhaps explaining to them afterwards, that it’s ok, “some women simply never ever get that urge”!

So what does that mean?  How come some women do get an urge, and some women don’t??

Why are some women roaring their babies down and out in no time, and others unable to feel when to push, and need the level of guidance that it takes for a midwife to literally explain how to do it and where to feel it?

Are their bodies malfunctioning?

Or is there another reason???

Well simply put, the answer is YES there is another reason!  It is called “failure to be patient”, “failure to wait”, or “failure to give a woman the chance to rest and recuperate before the amazing job of guiding her baby through her pelvis begins”.

Some women just need TIME!

Their bodies are smart, and they know more than we give them credit for.  It’s a shame, that the practice of expecting a woman to go straight into the 2nd stage of labour immediately after the end of the 1st stage has become the norm.  Once full dilation has been established, the woman is encouraged to get on with the job of pushing out her baby, and is shown how to tuck in her chin, catch her breath and push, push, push in to her bottom.

Unfortunately, this kind of encouragement has become a bit of a bad habit, despite the fact that there is plenty of evidence out there, which shows that it is not good practice, and is unnecessary for unmedicated women.

Current guidance from the Royal College of Midwives states:-

There is no evidence to suggest that women need to be taught when and how to push (NICE 2007; Bloom et al. 2005; Sleep 1990). The practice of sustained breath holding in directed pushing may be harmful (Prins et al. 2011; Cooke 2010; Yildirim and Beji 2008; Thomson 1993). Women should be given confidence in following their own urge to push.

However this particular habit is proving a hard one to break, as many women in units across the country, are still being encouraged to push before they are ready.   As a consequence, they are not working with a natural urge, and are then having to be coached in methods of how to do it effectively, because they are unable to feel instinctively for themselves.  The end result of course being that the mother becomes exhausted, and the baby needs help to be born.

You can read the current RCM guidelines on the 2nd stage of labour here:-  https://www.rcm.org.uk/sites/default/files/Second%20Stage%20of%20Labour.pdf

It doesn’t help, that women themselves say they are unsure of how to push!!  I don’t know why though, as no one ever needed to tell us all how to poop, did they?  No one ever shoved a hand up our bums and directed us as to how to do it!  Each and every one of us expelled poop instinctively from the moment we were born, and it was our job as we grew to learn how to control our anal sphincter in order to wait until we were in the right place before we felt it was safe to go.

As adults, we are able to control our bowel movements so well, that if we do not feel safe, the need to poop goes away, and does not return until later that day or the next, when our circumstances have changed, and we are able to relax.

When we do finally go, under no circumstances do we require someone to tell us when and where to push.  Our body does it all by itself, and guides our poop out into the toilet, and helps us to move and breath and push whenever and however is necessary, each and every time.  Because after all, each time we poop, our body requires us to do something different!

And of course the idea of being made to poop, when we have no need or desire to do so, would result in alot of effort, with very little end result.

Well of course, the same can be said for giving birth!

Women should be following their instincts.  They should trust themselves and their bodies implicitly, removing the need for anyone standing beside them, coaching them in the art of pushing.

Instead, they could be resting and relaxing and allowing their bodies to come round to the idea of this delicate stage of labour, all by themselves.  Whenever the time is right, and in an unhurried manner.

Important things to know about the “pushing” stage of labour:-

  • Not all women get an urge to push at the same time as their cervix has reached full dilation.  This could be because the baby still has a little work to do in getting into the right position, and it’s head has yet to trigger the reflex, that will give them the urge.
  • Some women will find that their contractions slow down or stop completely.  This is often referred to as “The rest and be thankful stage”.  This is a normal physiological stage which indicates the body needs to spend a bit of time preparing for the eventual descent of the baby, and the signs that the baby is ready, will soon be apparent.  You can read more about this here:-http://www.midwiferytoday.com/articles/gettingpushy.asp
  • Women need to believe in their bodies, and do what it tells them to do, rather than what they are being encouraged to do, by well meaning spectators.  If the circumstances allow, some women will even experience the “foetus ejection reflex”, as described by Obstetrician Michel Odent here:-  http://www.wombecology.com/?pg=fetusejection

One of my favourite articles on the subject of pushing, is “pushing for primips” written by Gloria Lemay.  We suggest to many of our clients that they read this in preparation for birth, no matter how many babies they have had.

Read it here:-  http://www.glorialemay.com/blog/?p=72

Or listen to it here:-  http://www.blogtalkradio.com/waterbirthinwoman/2010/05/28/pushing-for-first-time-moms-with-gloria-lemay

 

Image by:- www.littlebeanies.co.uk

9 Comments
  • Rachael Evans

    12th April 2015 at 1:59 pm Reply

    This is really interesting, I don’t even remember “pushing” my son, he just came out after one long labour, I don’t even recall stages or any need to push, my body just got him out ?!?! Love this blog, wish I’d read it before my labour x

  • Janie Al Alawi

    12th April 2015 at 6:35 pm Reply

    As an Independent Midwife I think this is a fabulous piece of writing – and so true. It’s the systems’ ‘failure to wait’ and the imposition of time limits in the hospital setting that sets up assisted birth many times. Sitting patiently, watching and listening should be the norm for all midwives.

  • Natasha Stringer

    12th April 2015 at 7:40 pm Reply

    Really enjoyed reading this article. The author is able to define that full dilatation and the expulsive part of the second stage of labour very often do not happen at the same time. A refreshing insight.

  • Emma Whapples

    12th April 2015 at 8:28 pm Reply

    If only the concept of time was removed from labour. Normal birth is difficult to define yet abnormal birth the basis of all obstetric policy. That notion has always baffled me.

  • Catherine Gulati

    12th April 2015 at 10:36 pm Reply

    It’s refreshing to read this and I hope it helps lots of women. If I had read this before giving birth, I would have felt more relaxed about it, and would have asked my husband to insist that the hospital didn’t make us feel hurried. In fact the hospital gave us a time limit and people kept coming in to see if the baby would be born within the time limit! That was very intrusive and probably prolonged things as it made me feel anxious.

  • Nicky Grace

    13th April 2015 at 12:20 am Reply

    I totally agree with the article and thank you. It’s all about the timing isn’t it? If the baby emerges within a fairly short space of time no one has any issues. Unfortunately we (midwives and doctors) have yet to learn the difference between those women whose body simply requires a ‘rest and be thankful’ phase (which naturally makes things take longer but is not problematic for mother or baby), and those (probably relatively rare cases) who really have got problematic delay at this stage requiring assistance. I’m not sure how the professionals in general are ever going to acquire this knowledge as any practitioner who uses clinical judgement to step outside guidelines or usual practice will be hung out to dry if there is a poor outcome – including independent midwives. And some longer second stages do need assistance as either baby or mother can sustain injury if this stage is genuinely prolonged .. So what do we do to increase our knowledge while doing our best to practice safely? As an independent midwife the best way I have found is to limit vaginal exams – it is only after a diagnosis of ‘fully dilated’ that 2nd stage is diagnosed – if you don’t interfere by doing a VE no one is under a time pressure for ‘progress’. Obviously there are some occasions when a VE is warranted, but taking routine VEs out if the equation can help the mother to birth as physiologically as possible.

  • Allison Hamilton

    13th April 2015 at 1:40 am Reply

    I found this article quite insulting to hospital midwives who are constrained by time limits imposed by hospital protocols. Most of the constraints I encounter are caused by the choices many women make for themselves; epidural anaesthesia for instance or those who push for early inductions which is becoming more common or those who just want to sit on a bed and do nothing to help labour progress naturally or those who are obese and grossly unhealthy. Myself and the midwives I know support women in labour everyday with patience and respect but women need to take responsibility for the decisions they make including lifestyle choices. We are such easy scapegoats!!!

    • Sallyann Beresford

      13th April 2015 at 11:22 pm Reply

      Allison, I’m truly sorry to hear that this article has upset you. The point you make concerning hospital protocols is an extremely important and valid one, and is in fact one of the reasons that many of our doula clients approach us for support. I agree it is important that women take responsibility for their decisions and birth preferences – through this blog I hope we can share some of our knowledge relating to the options that women have – and indeed informed choice has always been at the heart of what Sarah and I believe in.

  • Yvonne P

    13th April 2015 at 8:43 pm Reply

    Expectant mums out there – this is a MUST to read and understand!

    I so relate to this article. During my first child’s labour after dilation I had no desire AT THAT GIVEN MOMENT to push yet the midwife then began to tell me that I should push. Needless to say, an otherwise normal birth went off course as I wasn’t allowed the time and space for my body to naturally tell me when was right.

    During my following labours, my body did the talking, NOT the midwife and the pushing stage worked fine!

    Note to Previous commentator – midwives are the professionals not the scapegoats but my experience showed me a baby’s journey of birth does not follow a set time pattern so professional midwives shouldn’t dictate delivery by the clock!

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