Let's talk about pushing

[vegasgrl]

I'm sure the length of the pushing phase varies, but I'm curious as to why it varies, and why it varies SO MUCH. My cousin (intervention-laden epidural hospital birth) pushed for FIVE AND A HALF HOURS. She's completely terrified of ever having another baby. A friend of mine recently had a hospital birth with an epidural that they turned off for her pushing stage. She pushed for an hour and a half and was not at all prepared for the pain.

When I read homebirth stories, I almost never hear of pushing lasting this long. Is it that the interventions/epidurals are making the pushing phase longer? Has anyone ever pushed for five hours during a natural birth? It seems like if I wait for my body to want to push, there's no way it should take so long. But I've also read about women here who never have the "urge" so they just have to bear down and go for it.

So do tell...how long did you push? And what do you think influences the length of the pushing phase?

[ashleedio]

With my 1st, I pushed for about 10 minutes and through 3 contractions... I remember saying to the nurse, "I'm ready to push now." They got the dr in the room within a minute or so, she did some perenial massage on me as she talked me through how to push, and what to expect (probably about 10 minutes after I said I wanted to push). She asked to let her know when I was ready to start, but the massage felt so good and relaxed the pressure away so much that I waited another couple of contractions before deciding that I was ready to go. DD was born with very little strain and just a few pushes (I think 3 pushes per contraction, times 3 contractions).

I don't know that it's necessarily true, but my belief is that I had a very short push time because *I* chose when I was ready to push, it wasn't told to me that I was "ready." Like I said, I don't know that it's the reason, but it makes sense to me.

[Bromache]

Hmmmm.... Well, I would definitely think the epidurals had a negative effect on the two women you've mentioned. That being said, I have no real idea what else makes a difference. I mean, I guess fear of the pain or of tearing would make you "tighter" and that would slow the process down, and probably make it more painful. Also, coached pushing instead of following your own instincts...

However, for my first birth, I pushed for a whole hour! And didn't have fear OR coached pushing, and certainly no epidural (it was a homebirth). The only thing that seemed to ME to be a factor was that my darn contractions slowed right down during that stage. For a whole hour BEFORE that, I had an urgent desire to push and had to work through that with a lot of help form my midwife because I wasn't fully dialated. That was awful. And then to have the contractions slow down when I was finally ready? Ugh! Not my favorite parts of labor. I just hope it's a lot faster this time around, but I guess we'll see...

[CherryBomb]

I pushed for 2 hours with my VBA2C. No epidural. No one told me when to start pushing. or "coached" pushing.

Yet I know someone who had an epdiural, was told when to start pushing, and was "coached" and pushed for a whopping 15 minutes.

I think there are probably a lot of factors.

[Astraia]

I do think that pushing because you hit that "magic 10" is a big factor.

If you wait a bit past full dilation (usually) the baby will move down on it's own, epidural or otherwise, and pushing will be a lot more successful. If the baby is high up you can push for awhile to move the baby down, which would have happened eventually if you'd been patient.

The only difference I can think of is that SOME babies have trouble getting past the pubic bone (ie, posterior babies) and need some significant maternal effort and/or dr/mw help, and then come flying out.

Again- generalizations, everyone is different. I do think that the WHEN you start pushing, as well as baby's position when you start pushing, is a huge factor.

ETA: I pushed for 1 hr 43 min with my first, but it was coached. I had no urge for a LONG time, but once she was far enough down (the last 40 min maybe?) I couldn't not push with contractions. So if it had been just me, it would've taken 40 min of pushing.

[Nikki74]

I pushed for half an hour with my first labor. It was my second child, but I'd had a caesarian with my first, so this was my first labor. I was so happy it didn't take too long, especially as I heard that often it can take 1.5 - 2 hours the first time around!

I think what made it quick was that I was homebirthing, and so much more relaxed than if I was in hospital. I was kneeling at the foot of our stairs, with my elbows a couple of steps higher, propping me up...so I was fairly upright with my pelvis as open as it could be, I guess. I also sat back on my heels in between contractions, so that the head would stay put and not lose progress by moving back up in between contractions.

I think it would have taken much longer on my back with my knees up by my chin, the way they like it to be done in the hospitals...

Also, my pushing was not coached. I pushed when my body told me to, and stopped when I ran out of energy...I didn't have anyone there counting to 10 while I was pushing...my midwife just let me do what felt right at the time.

[kcparker]

Originally Posted by vegasgrl

So do tell...how long did you push? And what do you think influences the length of the pushing phase?

I think it depends on a number of factors:
1. Who is determining when the 'pushing clock' starts - if your HCP says, "You're at 10, start pushing," it's not necessarily an accurate assessment of what your body needs to be doing at that point. For heaven sakes, I took an hour long NAP after I was fully dilated. If you dilate and the baby moves down, it can leave a bit of a 'gap' at the top of the uterus between the fundus and the baby, and the uterus has to 'catch up' with the baby. Pushing at that point is not going to be effective, merely tiring for the mom, and it will add to the total pushing time if you are pushing before your body is really ready for it.
2. Positioning of the baby - an anterior baby will probably descend more efficiently than a posterior baby or a kid with a nuchal hand.
3. Positioning of the mama - if you are on your back, you may have to do more work than if you are squatting or on hands and knees as you're working against gravity.
4. How long it takes mama to 'get the hang' of pushing - some women push like gorillas from the git-go, others are more tentative.
5. If you have an epidural, you will likely labor down until baby is almost on the perineum, so you might have a longer 'passive descent' phase and a shorter 'active pushing' phase.
6. Strength and sense of urgency on the part of the mama. I have seen a first-time mama push out her baby in 20 minutes because of heartrate decels and a lot of encouragement from the medical team to get him out as fast as possible. Conversely, I have seen a totally exhausted mama who was fighting through nerve pain push for 2 hours because she was soooo tired that she hardly had any strength left.
7. Which # baby is this? The first baby is the 'trail-blazer,' and frequently more pushing is required to mold the baby's head and push him through the pelvis - have you looked at an anatomical model of pelvic bones? That's a small space, and a lot of things have to shift and stretch. But after #1, the pushing is generally quicker because that path has been forged.

I pushed for about 2 hours with my son. Nobody coached me, I changed positions as my body dictated, and when I thought, "Why is that taking so long?" the midwife seemed to read my mind and said, "Remember, half of pushing is molding the baby's head. It might feel like nothing is happening, but you are doing a lot of good work with each push." I just pushed to comfort, no breath holding for a count of 10, and the midwife encouraged me to push and hold, push and hold, so that tissues stretched gently instead of just trying to get him down and out as fast as I could. I think the average second stage length for 1st time mamas is about 1 hour, 50 minutes.

[clemrose]

I have a friend who just had her baby at home (with the same midwife I've had both of my babies with) and from the time she first felt the urge to bear down until when her baby was born was five hours. MW thinks it was a deep transverse arrest and was considering transfer. My friend did lunges and other crazy-awesome-birther maneuvers to get him out at home. Obviously, hers is a rare case.

I don't believe that being fully dilated necessarily means that one is ready to push. I've often heard women say they never had the urge to push and wonder if some of those times things would have been different if they had not been told it was time to push.

My hb pushing stage with my daughter was about an hour and forty-five minutes. I began pushing involuntarily and had no coaching. The contractions spaced out during the pushing phase and I was able to rest in between them (I'm guessing this is also beneficial to my dd who got rest from contractions in the birth canal).

My hb pushing stage with my son (born this past Sunday ) lasted maybe 45 minutes from the time my body, once again, began pushing involuntarily. With my son I did no pushing from my abdominal muscles--I just concentrated on relaxing my bottom and literally breathed him out (all 10 lbs 4 oz of him!).

Both of my kiddos were born with a hand curled up under their chins -- less streamlined than most babies are coming through the bc...could have influenced pushing time.

[marrymeflyfree]

I pushed for just under 2 hours with my daughter's unmedicated birth. I think it would have been shorter if her fists hadn't been clenched at her temples! But...it would have been a lot longer if I'd been stuck horizontal in a bed, if I'd not had the birth stool available, if I'd been weak from being unable to eat or drink. Having those freedoms made it possible to get the job done, imo. Who knows what may have happened if the scene had been different..

[Everrgreen]

I pushed for 3 hours at my homebirth (first baby). I did start having what I believe was 'the urge to push' and started pushing when my midwife checked me and I was fully dilated. By the time my baby was crowning I was barely even feeling my contractions anymore, I asked the midwife to tell me when to push because I had no idea. I was exhausted and I believe my contractions were actually slowing down and weakening. The pushing also took a long time because my baby was posterior. I had to transfer afterwards because my contractions slowed down so much that the placenta wouldn't come out.

I really feel a lot of it was my own fault and that it won't be like that for my next baby. I don't think I was pushing very efficiently, and I didn't have anything in my house to keep my energy up (he came earlier than expected and we weren't ready).

[tessie]

I gave birth in a hospital and she was out in eight minutes. I think I only consciously pushed twice, she just sort of came out on her own. I don't really remember having any urge to push, I was laid on my side and declared I couldn't do it any more, the midwife had a peek and informed me she could see the head and I decided to kneel up against the end of the bed and she pretty much just popped out. Strangely the pushing bit did not hurt at all.

I think it's probably a lot of luck, a bit of genetics (quick and easy labours run in my family) and a bit the position of you and the baby.

[jeliphish]

1st birth: 1hr 42min
2nd birth: 4 pushes

Both hospital, both with epi -although with DD2 I didn't get epi until i was ready to push and it didn't take effect.

[fazer6]

I was using hypnobabies for a natural birth. Unfortunatly due to PROM I had to go on pit. Now the hard thing about timings is that in hypnobabies I'm sure Kerry tells you that 20 mins will only seem like 5 mins or something like that. Anyway I'm pretty sure my OH agrees that the pushing stage was about half an hour. I count pushing as starting when I had the urge to push. When I say urge I mean the complete inability to do anything else. It's like saying people falling have an urge to put their hands out. I could attempt to not push all of every pressure wave, but that took a lot of effort. I exhale pushed rather than purple pushing and managed to stay in control.

I've always wondered if the 'urge to push' was so strong for me because of the pit. I'm hoping to avoid it this time and see what it's really like to have normal pressure waves.

When it comes to how long someone pushes it depends on so many things, baby positioning, relaxation of the mother, epidural... Have a look at spinningbabies for advice on positioning and how it can affect your birthing time.

[gentlestrengths]

Originally Posted by clemrose

I don't believe that being fully dilated necessarily means that one is ready to push. I've often heard women say they never had the urge to push and wonder if some of those times things would have been different if they had not been told it was time to push.

I definitely agree with you (and others who've said the same).

I can attest to this whole "being told when to push" thing. It isn't necessary, and it isn't useful unless the baby is in danger.

I was told I was at the magic 10 for my first 3 births. I didn't have the urge to push but was encouraged to. I pushed for about 50 minutes. First time around is a little tougher especially without the urge (at first), usually, for most women. The tissues have never been stretched before, and it just takes longer (usually).

With my 2nd, he was posterior. ANd he was born posterior. It was TOUGH pushing - hurt like heck - times a million. BAD. I thought something was wrong because it hurt so bad (he felt like he was trying to come out my bottom!). I was urged to push even though I didn't want to because his heart rate kept decelerating. It took 20 minutes (20 traumatic minutes!!!).
With my third, I was at 9 for HOURS and HOURS. Contractions were fine, but I never had that tough transition, they were always manageable and fine - I think I needed a nap, but I think my midwife just wanted him born. She suggested pushing. So I did. And he was born in about 10 minutes. I push slow. When the tissues start stretching I slow down big time. I don't like pushing with all my might (some women just want it over with and push hard and fast). With my 4th baby, I didn't push until I had the urge. Have you ever heard of the fetal ejection reflex? If so, you'll understand when I say I totally experienced that. I was in the tub, and had no idea of how dilated I was, but was sure I was almost done because of the MAJOR cxts on top of cxts, and suddenly (I was on my hands and knees), my body shot straight up and onto my knees and just PUSHED. I felt the babe's head move down considerably, and told my husband "I think I just PUSHED". The cxts were still hard and tough and I didn't have a huge urge to push, but it felt better TO push, so I did, and I could feel her moving down, I checked myself, and only got about a knuckle and a half in to find her head in the way. I think I pushed for about 10 minutes with her too. She was BIG though - 10 pounds and just huge.

As far as epidurals go - they definitely can impede pushing - since the woman cannot feel to push as well as without the epidural.

I know someone who pushed (her first baby) for 5.5 hours. It happens. I don't think it happens often though. As a doula and a student midwife, I have been to a number of births and I have never been to a birth where anyone has pushed for more than 3 hours. And most are between 5 minutes and an hour.

[tndixiemom]

I have had two births and two epidurals. Both times I pushed for maybe 5 minutes. My first birth was a 25 hour induction and my second was 3 hours.

[seaheroine]

I pushed for about 1 hour 45 minutes with DD, at home. It didn't feel quite as long as that! She was posterior and had a nuchal hand...came out asynclitic.

For me, pushing felt GREAT. Compared with transition, it was like complete relief. As long as there was terrific counterpressure, there was no pain and I felt no ring of fire. I couldn't feel contractions, either -- just small twinges I guess I would call them, and no coaching. I just bore down with each twinge.

I am hoping I don't have to push as long with this one!

[*MamaJen*]

Pushing was the easiest part of labor for me, by far. I had a home waterbirth, and at some point near the end just I started reflexively bearing down. I wasn't really pushing, just bearing down. Actually, I wasn't even doing it consciously at first, my body just started doing it all on it's own, and then I kind of figured out how to work with it. Transition kind of sucked, but pushing felt strangely good. Sort of satisfying, y'know? I guess I was bearing down for about 30 or 45 minutes? The baby came out in four easy pushes. On the first the sack bulged out (he was born in the caul). On the second I pushed his head halfway out, but it felt like I was stretching a little too much so I relaxed and let it pop back in. On the third push his head came all the way out, and he was born on the fourth push. I didn't tear at all.
Pushing was so instinctive and gentle for me, I couldn't imagine someone else telling me how to do it.

[vegasgrl]

This is so fascinating, thank you all for sharing. I'm not sure why I had it in my mind that this should only take 20 minutes, but I'm sure glad to find out BEFORE I have the baby rather than during!

[boigrrrlwonder]

I've had one child. Between when I started feeling the urge to push and when the baby came out was about 20 minutes. I never consciously pushed - I slept between contractions even after I felt the urge to push. I didn't want to push the baby out yet, since we weren't at the hospital. I spent the car ride on my side until I realized that I felt her head between my legs, struggled to get my pants off (the car was still moving at this point), and by the time I got them off, she was out. She was posterior.

[orangefoot]

I've had four labours, one on my back, one in water and two with pit one on my side and one upright and I honestly can't remember pushing for very long at all with any of them. NO coached pushing or telling when to push either.

Each time I have felt 'pushy' like a far off urge and then a real hard pushing urge in the sense that you feel that you have no control - like when you have to vomit and there is nothing you can do to keep it down.

With my second I felt pushy while I was still being monitored so they got me to the pool and he was out 10 minutes later.

My fourth child was brow presenting and because of this I consciously didn't add my effort to my body's effort and the pit iyswim. It had taken almost 3 days to get to this point so to be honest feeling that pushing urge was very welcome!

I felt a pop/thud as her head passed my cervix then the next thing I knew my mw was telling me to keep breathing to ease her chin out. Then she slid out. She is 3 now and still tries to put clothes on forehead first!