When Push Comes to Shove

This post was most recently updated on August 20th, 2017

At some point when contemplating how this baby is going to actually come out, most of us naturally turn our minds to labour and how we might cope with the contractions. Few of us think about the second stage of labour – after all, isn’t it as simple as the instruction on the door above? Once labour has unlocked the door, it’s as simple as pushing the the baby through the door, right? The midwife or doctor tells us when and how to do it, don’t they?

After all, almost every depiction of birth we see on TV seems to be showing us clearly that women need help, together with an awful lot of elbow grease, to push their babies out. The midwife gives instruction:

Take a deep breath, put your chin on your chest.

Push down into your bottom, like you’re doing a poo

Now take a quick breath and push again.

Push, push, push. That’s it, push hard.

Sometimes, when at a birth I also see and hear:

Get angry with your baby

Or:

Push my fingers out of you. Get angry with me.

It is not surprising that many people call this “purple pushing”. Mothers usually get very red in the face, their eyes bulge and sometimes even break blood vessels in their eyes. This technique for second stage (called ‘valsalva’ pushing in the textbooks) is firmly embedded in our cultural consciousness.

But is it the healthiest, easiest option for the mother or the baby?

If a mother and baby are healthy and un-medicated, it’s not a great leap to understand that purple pushing might not be their best option. If a women holds her breath while pushing, she is not allowing that oxygen to get to her baby. Sometimes, this results in the baby getting distressed and birth needing to be hastened.

Sometimes, the mother pushes and pushes at the behest of the midwife or doctor for quite some time. The baby doesn’t seem to be making any progress down the birth canal and the mother begins to run out of energy and lose heart. This can result in the the baby being born with the help of a ventouse (suction cap) or forceps – or even caesarean section.

I sometimes wonder, when I see the fear and anxiety of this kind of situation, how the baby must be feeling, too. We know that the emotions a mother is feeling have an effect on the baby so it seems logical to ask ourselves if the minutes before birth are high stress for the mother, that the baby may feel the effects, too.

Does it have to be this way? Surely the urge to expel the baby is a reflex? Telling us how and when to push our babies out feels as bizarre to me as trying to tell me how and when to sneeze.

Pushing is a reflex, like sneezing

What actually happens is that most women begin to feel a growing bearing down urge. Sometimes it starts well before full dilation – this seems not to be a problem; the mother is just making small adjustments to her baby’s position, not trying to expel her baby.

As she comes up to full dilation, the urge to bear down, to expel, to push, may grow and grow, until it becomes overwhelming and undeniable. Just like the urge to sneeze builds and builds until nothing can hold it back.

Many women find that this part of labour is liberating. It can feel a huge release to be actually doing something with the contractions. Sometimes women say that the contractions become less painful or even pleasant. Others find this part of labour very challenging, both physically and emotionally. The important thing is that you have people around you supporting you, making sure you have the physical energy by offering you drinks and snacks, are warm and comfortable enough and feel as private and safe as you need.

Sometimes, a mother can reach full dilation but her body and mind need a while to re-group, her baby needs time to descend and stimulate the nerve endings that create that pushing urge. World famous midwife Ina May Gaskin calls this the ‘rest and be thankful’ phase of labour. I’ve seen this phase last up to an hour and I’ve heard tell of longer. The contractions can space out of even stop for a while and the mother can rest or even fall asleep.

As the urge to bear down builds, the sensations tell the mother what to do; what postures to adopt, when to bear down, how to breathe. There seems as little point telling her what to do as there would directing the sneezer or, for that matter, someone on the toilet doing a poo!

There are lots of opinions about pushing. Some think the only way to gently birth is to ‘breathe the baby out’ and that this means denying the urge to push and to just keep breathing slowly and deeply. I think this is a misunderstanding of the techniques, like hypnobirthing, that many woman practice. It is not about trying not to push but merely about allowing your body to show you the way – moving, breathing, pushing as your body dictates. This is usually, in a woman who is undisturbed and un-self-conscious, a ‘breathing down’, a grunting push, a low moan or even a silent bearing down. A woman may find she needs to push, and push hard, to birth her baby. Someone else may find her baby slipping out with hardly a grunt. Each birth is different and perfect in its own way. My only suggestion is another one from Ina May – try to keep your vocalisations low and your jaw and lips loose. There is a direct connection between your throat and jaw and your pelvic floor and vagina. Any singing teacher can tell you about this connection.

birthing is as natural as going to the loo

Sheela-na-gig says, “Look how big you can get?!”

So do you have a choice in the way your baby enters the world? Well I believe that under normal circumstances then, yes; yes you do. Consider finding your position of choice as your body dictates. This might be kneeling, squatting, all fours, ‘the running start’, sitting on the loo (put a towel under the seat so you’re not worried about birthing the baby down the toilet!) or sit on your partner’s parted knees or ask your support people to help you into a supported squat. Or use the buoyancy of the water in the birthing tub to help you into any position you need. Ask that you are not hurried and coached. Ask that your birth supporters trust you. Trust yourself and trust your baby – you both know what to do.

I love your comments so please tell me what you think – if you’re a midwife or doula, what are your favourite pearls of wisdom about the 2nd stage of labour? As a mother, what helped you when pushing your baby out? If you’re pregnant for the first time, what intrigues, scares or interests you most about this very special part of labour? If you’re a midwife or doula, please share your thoughts on the ‘down and out’ phase of labour.