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 my doula clients having a subsequent baby, because for many of the ladies who attend, it is the time where things went wrong for them, and they want to talk about it!
I love this subject because it is very important for ALL pregnant women to understand that the 2nd stage of labour, is a very delicate and crucial stage in the birthing process.
Unfortunately 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 the pushing stage doesn’t go well.
When this happens, what I typically witness is the midwife stepping in and making recommendations. In some cases, encouraging them using words, or even analysing what is happening, by asking questions like – what are you feeling? Occasionally the midwife wants to explain exactly how to do it, and where to feel it. They might even go as far as to place a 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, the woman may end up with assistance via forceps, ventouse or in some cases a caesarean section.
What about 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 pushing phase of labour immediately after the end of the dilation phase 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
Image by:- www.littlebeanies.co.uk