Monday, 09 February 2009
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There is an Art and Science to Pushing Out a Baby...
There is an art and science to pushing a baby out. Two hours into pushing with a patient the other day, she said in exhaustion and frustration, “Why did no one tell me about this pushing thing?” It may seem like pushing should be an instinct, and while that is true, there a few reasons why the instinct might lead you astray and a bit of Pushing 411 becomes helpful.
If you have a natural delivery, without an epidural, you will unmistakably feel the urge to push as the baby descends and more pressure is exerted by the head against the rectum. It feels like you are beyond constipated (and pregnant women know constipation!) and ready to have the biggest bowel movement you have ever had. It does not conjure up a very attractive image, but it is definitely the best way to describe the sensation.
So how does instinct interfere when the majority of women know exactly when to push? Often the baby’s head will be very low, creating that need-to-push urgency. However, this can happen when the cervix is not yet completely dilated. Contrary to what some people may tell you, listening to your body and pushing when you still have cervix is a very bad idea. The continuous pressure of the baby’s head against the cervix will cause it to swell and turn what should have been a normal vaginal delivery into a C-section. You should not push until the cervix is fully dilated. While it may be difficult to go against what your body is telling you to do, this is the time to regain focus and breathe through contractions instead of bearing down against the pressure.
Another common scenario is when women have an epidural that is working very well (too well, you could say). Even though their cervix is completely dilated and the baby’s head is very low, they have no sensation at all. Using the muscles to push then becomes similar to trying to move your lip after you have had lidocaine at the dentist’s office. You try…you think something might be happening… but you aren’t really sure. The baby, however, does not know that you have no sensation to push and it may respond as many babies do when they are getting squeezed by contractions just before delivery—by having drops in the heart rate. While this can vary in significance and outcome for the baby, this is when coached pushing becomes important. Women need to be told when and how long to push because they have no natural urge.
To follow later…pushing positions and techniques to cut down on pushing time. How long did you push with your deliveries? Did you have the urge at the appropriate time?
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About the Author
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- From: NurseJenna
- Name: NurseJenna
- About Me: Hi Everyone, I'm a Registered Nurse in labor and delivery and also a Family Nurse Practitioner. I'm here to offer any advice or answer questions about pregancy, labor and delivery, or your newborn. I hope your find my suggestions helpful whether you are awaiting your little one, or trying to get a good night's sleep after coming home. Please feel free to ask me any questions and I will do my best to get you the answer, or at least let you know where to find it.
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Comments (29)
I had an epidural but I could still feel the pressure of the baby's head, yet I felt no pain. It was great. I pushed three times and out shot the baby. The doctor was surprised and was not expecting it. She came out FAST.
It was a great experience and I'm SO glad I got the epidural.
I had the epidural. I knew it was time to push when I wanted more epidural. Of course, they had to check me before they would give me more and wouldn't you know, I was dialated to 10. 14 minutes later my son was born.
I think it should be clarified that pushing as your body tells you to, is important. However, there are a few things to remember. For a first time mom, it IS important to wait for pushing until full dilation has occured for the reasons mentioned in the post. And it IS important that caregivers do check to make sure a lip isn't there. A woman should be told that her body's natural urge to push may still happen, and her body may still to do, even without her help. That's when, of course, positions like the knee-chest are important to take some pressure off the cervix. But for multips, gentlepushing against a bit of lip of cervix can be beneficial. Having worked with midwives for quite a few years, I've seen them allow multip moms to push gently when they start feeling the urge, and they actually push some of that cervix away and go on to have wonderful births. I've also seen moms push against a 9 1/2 cm cervix, have it swell up a bit, and then have her breathe through an hour or so of contractions and go on to have a normal vaginal delivery instead of a c-section. Not all of those situations end in c-sections.
The epidural thing is true of course. What I always recommend - both to students and doula clients who choose to have epidurals, that the best way to handle second stage - is to allow baby's head to descend a ways before actively pushing. The uterus is still having powerful contractions and can push a baby out. By allowing an hour or two of uterus pushing to do some of the work, your pushing stage won't be as long either. Penny Simkin, CD, PT, is well known for her research in this area.
And finally - I think primips should be told that pushing is hard work, and can, and does take on average 2 hours! We need to prepare them for the work of 2nd stage - sure, some push their babies out in a few pushes, but the vast majority of primips take much longer than an hour. In the classes I teach, we tell moms that 2nd stage can last from 20 minutes - 4 hours. As long as mom and baby are tolerating everything well 2nd stage should not be rushed or timed.
I labored for 26 hours (about 18 hours active labor) before I was fully dilated. At the very end, my midwife checked me and said that I had a very small interior lip and I could give little pushes if I wanted and we would see if that would move it out of the way. Well, I put a little oomph behind my breathing, if that makes any sense, and about 30 seconds later I had a real pushing contraction. I honestly can't tell you how many times I pushed, but he was born 8 minutes later, so I'm thinking it was something like 4 or 5 pushes. I really didn't need coaching- it felt so good and the pressure down there was so intense! The midwives just let me push as I felt the need to, which may sound like a good way to get a tear, but I was fine.
BTW, this was an unmedicated homebirth, so obviously I didn't have an epidural to numb things and create the need for coaching. So I can't say anything about trying to push with the epi.
How long did I push for? Baby #1 with an epidural - 45 minutes, (2nd degree tear) baby #2 with an epidural - 15 minutes, (3rd degree tear) baby #3 without an epidural - 8 minutes, (2nd degree tear) and baby #4 without an epidural (home water birth) - 20 minutes (because I let the baby come down on his own first, and I breathed him out instead of pushing like crazy) - NO tearing because of the gentleness!!
this was very informative and definitely something I could have used or had clarified for me. We had birthing classes and they basically told us you push when we say push and not before (sounds of a crackin whip). I guess because nobody asked why they didn't tell us why. The nurses were actually very informative. I guess none of knew the right question to ask.
I kind of wish that I could give birth vaginally, but I won't be able to b/c I had a vertical incision b/c of my emergency cesarean. Even if I thought that there was a doctor that would let me do it, I wouldn't want to because I couldn't ask for a better OBGYN.
The contractions ARE the pushing.. sorta like if you try pushing while wanting a 'poo' it is alot harder but if you WAIT then the whole thing will happen of its own accord. Your bowels will contract and do the pushing & out it comes! You know what I mean? I had an epidural through my first childs birth- kept the use of my legs so was able to stand through most of the labour then when she crowned I hopped up on bed & kneeled & she came out . The contractions ARE the uterus pushing in the END... More importantly (for me) - our uterus will open up (expand) up tp 30% more if we are leaning FORWARD than if lying on your back! Queen Victoria was one of the first to this 'trend' of lying down while giving birth... Almost every culture up to then & since then continues to either kneel or stand thru delivery. Try lying down for a poo....
I had an epidural and couldn't feel a thing (no pressure, no pain, nothing) so I was worried that I wouldn't know how to push! But when it came time, the nurses told me to just push like I would if I needed to make a bowel movement. I tried and they said, "you're doing it perfectly, don't stop!" And three pushes later, out popped my daughter! Of course, she was tiny, so that might have helped some.
Baby # 1 with epidural,I was so numb down there i had to be told when a contraction was coming and when to push.---pushed 2hrs and 20 min.
Baby # 2 with epidural,able to feel the urge to push and she popped out after only 3 or 4 pushes.
Baby #3 due in 3 weeks,-- hope to go naturally as much as is possible, so I really hope you get that pushing positions and techniques written A.S.A.P!!!
thanks for a very helpful and informative post!
Baby #1- 12 hr. labor with epidural, I had no contraction pain, but extreme pressure, so I knew when to push, but couldn't tell if I was doing it properly. I pushed 2 1/2 hrs!
Baby #2- 5 hr. labor. only 3 hrs of "painful" labor, went from 3 cm to delivery in 38 minutes!! so of course, no epidural (or any pain meds) that time!! I wanted to push at 6 cm, but of course breathed thru ctx. Several minutes my water broke and I was an anterior rim, and my body was pushing even tho I tried not to. Baby was born 4 or 5 pushes later, before the Dr. got there!! The nurse did a great job of delivering baby boy!
Baby #3--due in July. Epidural--who knows???? :)
I had no epidurals, so I definitely felt the urge to push! With my first, I pushed for about 30 minutes, my second, it was through 3 contractions, and with my 3rd, the baby was out in one big push. With the first, I did feel the urge a little early, because I remember the nurse telling me I still had a little ridge left, and I couldn't push yet, but I was upset because I felt like I couldn't help it and wanted to push so badly. But with the next two, when I felt the urge, it was time. However with my 3rd, I had to wait because the doctor wasn't there. That was hard!!
I have had no pain meds with all 3 of my babies so far.
With the first one, it took me 15 minutes to push him out. He was 7lbs 14 oz. No tearing.
With the second, the doctor said "Bet you can't push this one out as fast as you pushed out the first one" and I pushed him out in 14 minutes. He was 8lbs 7oz. No tearing.
With the third, the whole labor process only lasted 6 hours. It took me about 10 minutes to push him out and the doctor slid in just in time to catch him. He was 8lbs 4oz. Again, no tearing.
I just followed my body with all of them. I do remember with one of them (don't remember which one though) the doctor saying that I had a bit of a lip left so she stretched it while I gently pushed once and that took care of it. I also did a water birth with my second one.
With the baby currently in the oven, I plan to do things pretty much the same ... other than that my dr retired :( I would really like to do a waterbirth again.
Thanks for the info, and taking time to make it available to those of us who are most likely to benefit from it. I would like to point out that not all women have an urge to push. After 6 babies, only two of which were delivered with any drugs at all, I can honestly say that I've only once had an urge to push. That lack of the "urge" nearly caused me and my 2nd son some real problems. I knew I needed to be pushing, and I was trying, but was not terribly effective because I didn't feel an urge and that makes it hard to push effectively. Only when I realized that intervention was imminent did I get frightened enough that the adrenaline rush gave me just enough strength to give two more HUGE pushes -- and out popped Duncan. He weighed 10 pounds and 6 ounces and his (watermelon) head and (barrel) chest were the same robust 15 inches around
. The official word, after delivery, was shoulder dystocia (boy we barely dodged that bullet). So, while it is true that the urge to push is natural and highly beneficial to most women, there are an unfortunate few of us who "just don't get it."
Oh, and I never pushed more that 45 minutes. The first baby took 4 pushes, the second took 2, the third took about 40 minutes, the fourth and fifth (that was the watermelon head) were so intense that I lost all track of time, but it wasn't long -- and with the last, because I never had the urge, I didn't start pushing until the nurses started saying "don't push, wait for the doctor -- where is the doctor?" At that point I realized that I was fully dilated and wasn't about to suffer any longer because the doctor was dawdling. There was another dr. in the room, who just happened to wander in to see what all the commotion was, so I said "let him catch her" and started pushing. Once again, only two pushes!
I got an epidural pretty late in the game, so I could still feel the urge to push. The nurses told me not to push yet, so I didn't. Without the epidural though, I would have definitely pushed too early. When I got the go-ahead to start pushing, I only pushed for about 15 minutes. I was surprised by how fast it went!
Somehow with my first I ended up with too much epidural, however that happens. One of the nurses later said I had enough for a C-section. Anyway, I was pushing with my son for 3 hours because I could not feel a thing. Once the epidural wore off ALOT I finally was able to push him out.
With my daughter I had a natural (no drugs) birth and I was pushing for less than 10 minutes.
@sidewayslife@xanga - I did a waterbirth with my second - it's so fabulous. That's what I plan to do next time too.
@nicolevw@xanga - Yes, forgot to mention that part - I had a 3rd degree tear with my first, after pushing for 3 hours, lost so much blood that I needed a blood transfusion. With my second, a home waterbirth, no tearing at all.
@MlleBaroque@xanga - That sounds exactly like my birth experience! SOO much easier than I expected.
Oh, pushing was definitely my favorite part of labor! It was so exciting because I knew it was the end and I'd get to meet my baby soon! I had a natural un-medicated labor, so I felt everything! And pushing when I had the urge, though it hurt, it also felt really good! My body actually started pushing a little bit on its own before I even realized what I was doing. My doula asked me if I was pushing and that was when I realized I was...just little pushes. My moans from the pain became grunting from the rectal pressure, which is how she was able to tell I was pushing. I didn't push hard though until my nurse checked my cervix, and sure enough, it was gone and my daughter's head was about to crown. I pushed for all of 15 minutes. I needed some coaching as to how hard to push, but I listened to my body as to how long to push with each contraction. It was done and overwith so quickly. It was definitely the most rewarding part of labor! And the most work!
Baby #1 was born 6 hours after water broke - started having contractions about an hour after water, went to the hospital about two hours after that, labored with some IV kind of drug, pushed for 10 minutes tops? I definitely wanted to push. What drove me nuts was the nurse telling me "I'm going to count to 10, and push during that time and then stop. Then push again when I tell you." I wanted to push like to 18 or 20, catch my breath longer, and then go again. I couldn't think clearly enough to vocalise that, but it sure bugged me. Tell your nurse in advance if you know you can hold your breath to push longer than average - or whatever may be unique to you - before it hurts enough that it's hard to think clearly. But in the end, all was well. I had an epiesiotomy (sp?), which aggravated me.
Baby #2 was a longer labor because I went in before I needed too - I was freaked out about how quickly the first one went, and figured it would be even faster for #2. I had been examined that morning and had a little pinkish discharge. I thought, "Could it be the mucus plug?" (It was a normal consequence of being examined.) We went in, were checked, and told to go walk for a while. We should have just stayed home until I had contractions. I went back to the hospital and they ended up giving me Pitocin (vile stuff). When at long last it was time (the next day), I wanted to push very badly. The doctor wasn't there, and the nurse told me to try not to push, so I tried to breathe in and not out, and she eased back the remaining lip very gently, and then finally I could push. I think it was two pushes, because I have a very vivid memory of seeing her face after her head came through - solemn as a sleeping judge - and then I don't think it took too long for her body to come out. I did have some tearing, but I also had my baby :)
I was in the epidural worked "too good" range. So, by the time I was ready to push, my doctor had to help me. I thought I was pushing and realized it wasn't working when my doctor said, "You really can't feel anything, can you?"
lol So, my doctor pushed down on my belly making sure my son was making his way out with every push. Needless to say, it worked and my son popped out after 20 minutes of pushing. Whew! 
Although, the labor part of it is another story. lol
PS Baby #1 was 8 pounds, 12 oz. Baby #2 was 9 pounds 2 ounces, and that was at 38 weeks! So maybe it was just as well that we didn't wait for contractions.
How long does typical undrugged labor usually last?
I had an epidural (after the first 30 hours of induced labor). But it was a very well done epidural and I could still feel everything but the pain. I loved it. I remember suddenly getting the urge to push and blew out candles through a few of those urges until the doctor came in to check on me. She had just come on duty and was still in her street clothes. To her suprise I was at 10 cm and the time had finally come to push that baby out. By the time everyone was in place and ready I pushed for no more than 15 minutes before he came flying out. In the doctor's words, "you've had it difficult up to this point so you deserve this fast delivery". The baby coming out felt so good.
At one point I forgot to actually push and just scrunched up my face like I was pushing. She asked me, "are you still pushing?" and I realized I wasn't. We all laughed.
Pushing times I feel are what made a huge difference in my recover times from babies. Both were unmedicated midwife births #1 in a hospital #2 at home. #1 I hit the magic 10 cm and was coached to start pushing, pushed for 3 HOURS but only really felt a need to push for the last 10 min. result a 7 lb 8 oz. baby and about 6 months before I felt like myself again.
#2 I was 10 cm for probably a full hour, my midwife said to start pushing only when I couldn't do anything BUT push,to really save my energy and let the contractions do their work for me, two pushes and 8 lb 3 oz. baby delivered at 3 am and by 8 am I was up and around!