Dealing with fear in pushing phase

[RoadBuddy]

So I'm preparing for birth #2. I'm reading all I can, but can't find much on dealing with fear and panic in the pushing stage, after managing the rest of labor well. It seems to be all about contractions, which I feel confident in my ability to handle. I need to get my head around how to deal with the pushing phase. More details below, but any help is appreciated!

*****

I think I managed most of labor pretty well with my DS. It was maybe 10-12 hours from first contraction to birth, and while painful, I was able to manage. I never felt out of control or unable to handle it with contractions, even a pretty nasty transition phase. Basically, I dealt with each contraction as it came, since there was nothing else I could do about it. Out of my control and all that.

Pushing, however, was really hard on me. Maybe not physically as much as emotionally. I wasn't ready for this - all the books seemed to talk about it being instinctive and easy. Nope. I had the *urge* to push, but it hurt and I think I was afraid to do so. There's something different about contraction pain, which comes weather you like it or not, and pushing pain, which I had to make happen. It was pretty overwhelming. Then DS was born limp and not breathing - he had multiple rounds of oxygen in the room. His first two APGARS were bad (3), then he perked up to a 7 and got to stay in the room. No lasting problems, no known reason for the problem. I wonder if my panic while pushing caused some issues. Or if there was something else going on with him that caused the panic. Or if it's unrelated.

I don't know how long I was pushing - maybe an hour? Less? I had a small tear, but nothing horrible. DS was positioned normally and was 7lbs 12oz, so no special challenges there. Drug and intervention free birth. Supportive DH and doula. I did have to wait awhile to push, for my doctor to arrive (I trust her, the on-call doc at the time not so much), so maybe that contributed? Anyway, I need to learn to deal with this before the baby is born (due March 4), so any help is appreciated.

[MsBlack]

you really don't have to make 'pushing pain' happen. It really is ok to keep breathing through those contrax, let your uterus do all the work without adding extra effort or oomph. In the hospital, usually they direct the pushing, they want you pushing a certain way, for a certain length of time, in a certain position. But this is not really needed, not at all for the great majority of women. Even if you don't consciously bear down, your uterus will keep up with the ejection contrax--and I have seen 2nd stage go so much easier for women who focus on the breathing/relaxing, rather than the pushing.

Who can say why your baby had oxygen difficulties--but it *could have been* related to pushing, especially if you were pushing under direction as described above. Not all babies do best if mama is in that semi-reclined or reclined position, with her knees held way up, chin down and bearing down with all her might and main. For some babies, this actually reduces oxygenation, especially if you are being directed to push while holding your breath to a count of 10. Side-lying, hands and knees or knees-and-leaning-against someone/something so your body is more upright, standing, squatting--there are many positions in which to give birth well and more comfortably, and it is best if mom gets to choose.

I have seen many a baby get born with moms in various positions and most always following their own bodies rather than someone else's instructions. Some moms do push quite hard, but few hold their breath at all--they yell with semi-open throat instead. Some just quietly breathe the baby out, focussing on staying relaxed (even if standing up) and letting it happen.

Read up on this stuff, there are many articles and discussions here on this topic! Pushing need not be something to fear...but you may have to choose to take more control into your own hands, and be creative at that point.

Last thing--first babies are often the hardest...it's your first time! Now your body knows how to do this, most women find subsequent births somewhat easier in some ways.

good luck!

[RoadBuddy]

Thanks! I had thought of birth position being an issue. I tried squatting, a squat bar on the bed, and standing. I think I ended up sitting in the bed with sort-of-directed pushing. There was no breath holding, but I think I needed someone to tell me when. The panic or whatever made the more natural style not work This is what I want to avoid next time. Any other suggestions for getting my head in the game?

[JL83]

If it helps, I just had my second and pushing was entirely different this time around.

With my first, pushing didn't hurt. It felt good. I pushed and pushed and pushed with each contraction. I felt like I was in control. I was really looking forward to it this time.

But... (there's always a but) This time was nothing like that. I didn't feel the urge in the same way. It was like the urge would come and go during the pushing contraction. I'd feel the urge and start to push and then feel lost because the urge disappeared. It was really really strange. I even changed position a few times. It sounds like what you're describing. It also hurt in a way that made me not want to do it.

If I hadn't had the first experience, I think I would be really nervous about doing it again.

My only advice is to remember that every labor is different.

[at_the_hip]

I have had very different pushing experiences...my first was long and difficult, with no urge due to residual epidural, and very painful due to a posterior birth. My second was also long and I hated it...due to scar tissue from the epi the OB did with my first. My third and fourth were much much shorter, with a strong urge to push in the sense of it being very painful UNLESS I pushed hard. Even with #4, who was also born face-up, the pushing phase was 100% better than the first two. Don't worry, it will probably be different.

[kitkat5505]

I am terrified of the pushing stage. I know I can handle labor, I think I handled my 2 days of labor with my last one very well, even through transition. But pushing was horrible. I was in awful pain from cntrx and also from a nerve being hit that sent shooting pain down one leg non-stop, I couldn't catch my breath and felt extremely out of control and emotional. I couldn't not push, but there were times I wanted a break so bad I was crying. And after 2 hours I'd had enough of the pain with no progress and ended up transfering to hospital and having emergency c/s (due to problems with babies heartrate), and by then I was begging them to put me under. So I definitely understand fear of the pushing stage, that is my biggest fear for next time I get pg. I still haven't figured out how to get over it. Even typing about it now gets me shaking.

[Sweetiemommy]

I agree that it is easy to panic when the time comes to push. It makes it worse if people are staring at you and even worse if they are yelling "PUSH, PUSH." We had shoulder dystocia with my first two boys and that was fairly traumatic, the hard pushing stage followed by having the baby yanked out of my body. Followed by feelings of failure (unfounded, but still my feelings). Anyway, the second time is waaay easier, because you have done it before and you can keep telling yourself, "I did this before." With my third I was able to get into a better position (I was kneeling in front of my bathtub with my back to the midwives) and I had a great mantra: "The only way out is through." Any time I wanted to escape the pain or panic, I just thought, there's only one way out of this. And that was to push like crazy. So I took control of the pushing and got that baby out with no shoulder dystocia and no drama. It was very empowering. Good luck, I think you will have a much better experience for number 2!