Pushing in Labor

When we think of labor we often think of only the contractions and the first stage of labor, where the cervix is opening for the baby to descend into the birth canal. Let's talk about second stage, or pushing.

Pushing is characterized by contractions that have are generally occurring less frequently than in the end of first stage, giving mom a bigger break in between the contractions. Where mom has been told her entire labor to "stay out of the way" of her contractions, now she is actively working with the contractions to give birth.

The Urge to Push

Some women will feel what is called an urge to push. This is generally caused by the baby pressed onto the Ferguson Plexus of nerves, creating Ferguson's reflex, the urge to push.

You might have an overwhelming urge to push where you can't do much else. You might have a so-so urge to push where it could go either way for you. And occasionally some women will never feel the urge to push.

This urge is effected by regional anesthesia (epidural, etc.), because the mother is numb and cannot respond to her body's signals.

The Rest and Be Thankful Phase

Once you are completely dilated, you might experience up to an hour of no contractions. This has been fondly named the rest and be thankful phase. Usually this is occurring to allow some rest for the mother or rotation of the baby to a preferable position.

In some hospitals and birth centers moms are required to push during this phase even without the urge to push. This may not always be beneficial to mom or baby.

Positioning

Upright positioning is usually favorable for the second stage, allowing gravity to assist the mother. There are numerous positions available in modern birth beds, including the squat bar, and foot pedals.

Out of bed positions are wonderful and becoming more popular, particularly for women having trouble pushing in the bed. Including:

• Squatting (Opens the pelvic outlet an additional 10%)
• Birth Stools
• Birth Balls
• Water Pools
• Birth Chair
• Dangling
• Toilet

Side lying positions are used to slow down a very rapid labor and are great for protecting the perineum during a rapid birth.

Semi-reclined, or laying on your back with stirrups are still very common in many hospitals, particularly if you have regional anesthesia, or will be having a forceps or vacuum delivery. This position does not use gravity and increases the length of the pushing stage and increases the use of episiotomy, vacuum extraction, and forceps. You can request a different position.

Purple Pushing

When you are asked to hold your breath to a count of ten, numerous times during one contractions, we call this purple pushing. While the picture is not beautiful it is one of a mom turning purple, eyes bulging out, possibly broken blood vessels, not to mention a room full of people screaming, "PUSH!"

Purple pushing came into play as the epidural rates increased and women never got an urge to bear down. We now extend it to nearly everyone having a baby.

The options are:

• Laboring Down: Allowing your body to push the baby out on its own. Not really assisting the pushing efforts of the uterus, unless you have an overwhelming urge to push. This is particularly useful for women with epidurals because then they are not pushing against a baby who is still in a malpresentation.

• Spontaneous Bearing Down: Allowing your body to tell you when to push. When this technique is used we never find mom holding her breath more than about 6 seconds, allowing more oxygen for the baby.

Remember that once you are completely dilated not every women responds the same to second stage. Some have very short pushing stages, while other push for quite awhile. With the use of positioning, bearing down techniques, etc. You can have a comfortable second stage for your body.