From Robin Elise Weiss, LCCE,
Your Guide to Pregnancy & Childbirth.
FREE Newsletter. Sign Up Now!

If you've been to a birth in the last ten years or even watched one on Baby Story, chances are you've seen the coach like yelling match that begins once the laboring mom begins to push. "PUSH!" Everyone in the room begins to instruct the mother on how to push her baby out.

During pregnancy a woman takes a childbirth class that probably prepares her for this description of labor though she she should also be taught about spontaneous bearing down, allowing her body to tell her when to push. Spontaneous bearing down is a bit more difficult with the rise of the epidural anesthesia rates. This has lead to the concept of laboring down, allowing the body to naturally push the baby down gently rather than the coached pushing.

Studies indicated that mothers who had coached pushing in the second, or pushing, stage of labor may shave a couple of minutes at best off of the time in pushing. But they risked a higher incidence of meconium stained amniotic fluid, which often leads to greater intervention for potential fetal distress. A different study also indicated that bladder problems might be more frequent in women with coached pushing.

If there is no anesthesia and no fetal distress, allowing a woman to push to her comfort, spontaneous bearing down, is an effective way to allow the baby to progress through the birth canal. In women with epidural anesthesia, the laboring down technique works very effectively. Even though the woman is anesthetized, her body will continue to labor or work, though many times with the use of Pitocin.

Prior to labor you should discuss with your doctor or midwife what their normal routine is for labor. If they tend to use coached pushing or rely on the nurses in the labor and delivery unit to lead the pushing efforts discuss your preferences with them. They may be willing to let you try either spontaneous bearing down or laboring down, even if they are unfamiliar with these techniques.

Tips for pushing:

• Wait until you feel the urge to begin pushing.

• Do not hold your breathe for more than 10 seconds at a time.

• Use upright positioning to allow gravity to make pushing more effective and less work.

• Request that there are no time limits placed on your pushing efforts as long as both you and baby are doing well.

• Consider using a doula to help you explore many of the techniques and options for the second stage of labor.

Additional Resources:

Bloom et al, "A randomized trial of coached versus uncoached maternal pushing during the second stage of labor," American Journal of Obstetrics and Gynecology, January 2006

Schaffer et al, "A randomized trial of coached versus uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function," American Journal of Obstetrics and Gynecology, May 2005

MCN Am J Matern Child Nurs. 2000 May-Jun;25(3):165.

Caring for women with epidurals using the "laboring down" technique. MCN Am J Matern Child Nurs. 1998 Sep-Oct;23(5):274.

1/3/06