Please help me understand the pushing stage

[AlaaJ]

Is it normal to have to "push like you're having a bowel movement" to get the baby out?

Most of my friends and family members who have given birth vaginally seem to have one primary thing in common: a loooong strenuous pushing stage. They reach 10 cm and then have to push and push and push, usually to the coaching of the doctor. A lot of them never experience the "urge" to push -- they just have contractions and with each contraction are told to hold their breaths and push.

I read somewhere that it is actually normal to have a "break" from contractions after reaching full dilation and before having the urge to push. Is this true? If that is the case, then maybe most women are pushing when they should actually be resting before the "urge" comes on?

I hope that someone who has witnessed/experienced a lot of *natural* births can help me understand what a natural pushing stage should look like.

I can't help but feel that pushing like you're trying to have a bowl movement seems wrong. You're not even supposed to PUSH when having a bowel movement; that's called constipation and leads to pelvic organs prolapse. I feel that your body is just supposed to "do it" involuntarily -- whether pushing to poo or pushing the baby out..

(I can't speak from my own experience in birthing because I was induced the first time around and baby practically shot out and second time around I was too drugged to properly know what happened.)

[Smokering]

I've wondered about that too. I've heard "never experienced the urge to push", but that begs the question of how long "never" was, you know? If the doctors had let them rest for another hour or two, maybe they would have. Although, things can go wrong at pretty much every stage of childbirth, so I wouldn't be surprised if some women genuinely didn't have the fetal ejection reflex...

I had the fetal ejection reflex, and it was amazing - not in a fun, Christmassy way. :p But incredibly powerful. I've heard it compared to throwing up, and I think that's accurate - really full-body vomiting where there's no way you can stop or control it. I had to "pant through" the pushing urge for a while because of a cervical lip, and it was awful. It was a great relief to finally be allowed to just go with it. I think the only time I consciously bore down without the urge was when they were trying to manually extract the placenta (there was a complication). I may have "helped" the pushing urge along for a few pushes when DD was actually emerging, but I don't know that it was even necessary.

SIL recently had a natural labour with a long pushing stage. The MW blames Hypnobabies for making her "too relaxed", which I think is ridiculous. :p It sounds like she had a natural "pause" between dilation and pushing, and the other issues might have been due to the baby being in a funny position. In the end the only position that worked was on her back with her legs up by her chest (which I think is usually associated with a baby in a slightly odd position? I know her babe was posterior during some of her labour, but turned by the end). So - hard to know! She was still having contractions, so she couldn't have just slept for a few hours; but she was doing OK and comfortable thanks to Hypnobabies, so I wonder if the MW shouldn't have backed off a bit and just waited.

[Jayray]

I had the urge to push early, too, and had to pant for a while.  Once that part was over and I was fully dilated, I did feel a bit of a "rest."  My contractions spaced out and I really did feel better than during transition, felt like I could rest and regroup between contractions.  However, I definitely had the urge to push during the contractions--although I did additional "pushing" with the pushing my body was doing.

There was a woman in my birth class who also delivered at the birth center I did and she said she never felt the urge to push.  I thought it was so strange.  I couldn't even imagine it.

[C.Arden]

I never felt the urge to push with my 1st.  I had an amazing homebirth with a very experienced midwife.  She let me do things my way and only suggested that I do some small practice pushes to see if it felt right when I had been at 10 cm and complete for an hour and a half with no urge to push.  My baby hadn't descended completely though so I'm guessing that had something to do with it.  My midwife suggested I try some small pushes while on a birth stool to try to help him go down.  I tried it and it really didn't feel good at all.  It felt so hard and so wrong so I stopped for a while and let the contractions do their thing a little longer.  He still wasn't coming down and I was getting exhausted and dehydrated and frustrated (it had been about 20 hours of very intense labor at that point) so my midwife coached me through pushing to get him down and out.  I just really needed it to be over at that point.  I finally got the pushing figured out and was able to move him down.  It was such a terrible feeling to me, almost unbearable and even though I had figured out how to push effectively, my body just didn't like doing it.  I could feel everything that was happening, I felt the baby move down, I felt him move into position and I felt his head right there, ready to come out and I still didn't feel the slightest urge to push.  I pushed on and off for a total of nearly 2 hours

Then with my second, the urge to push was frightening.  My midwife and her assistant were in the bedroom resting and  very suddenly, I couldn't NOT push.  It wasn't the fetal ejection reflex because I think I could have controlled it or stopped it if I had really needed to for some reason and put a lot of effort into it, but I didn't have any reason to.  I was actually really scared, I didn't know if it was "ok" to be pushing so I had my husband get the midwife and she just encouraged me and only "coached" me if I looked to her for reassurance or help.  I ended up only pusing for about 20 minutes that time.

Anyway, there are two of my experiences, it's crazy how very, very different labor can be for the same person

[Tumble Bumbles]

My pushing stage was very short, about 15 minutes and it was involuntary. It actually felt kind of good (in a really weird way). I mean, it hurt but it felt like ... hard to explain, kind of like the full body 'vomit' reflex Smokering explained but it was satisfying. It's hard to articulate lol but no, I didn't have to push and work really hard during that stage (although like I said, it definitely was far from pain-free).

[love4bob]

I felt the urge to push, and it IS like having a bowl movement exactly!! With my home birth, I actually told my midwife that I had to go to the bathroom! hahahaha! I had no idea that the feeling I had was actually to push the baby out! So, DD2 was born over the toilet! 

With DD3, I felt the urge to push STRONG, but the nurse was not letting me push yet since the doctor wasn't there yet. She was crowning practically as we arrived to the hospital, so it was fast! She had her hand against DD3's head to hold off the urge for a minute, but in the end, we couldn't stop it, and the nurse delivered her.

Be pushing stages are very urgent and very quick. Both of my natural births(DD2 and DD3) were about 10 minutes until they were here. 3-4 pushes.

Also, I think that being standing up helps a lot with the urge. When you feel that baby being pulled down by gravity I think it makes you feel it that much stronger.

[chewynotcrunchy]

I never felt the urge to push.  I had a lovely homebirth with an experienced midwife.  My doula and midwife thought I was pushing because the sounds I was making changed.  I really don't know if I was or not.  So, the midwife checked me after I had tried a couple practice pushes and felt that I was 10cm and that DD head was really low.  I tried pushing in several positions and I just didn't feel the urge.  I needed and appreciated a lot of coaching with my midwife providing pressure where I should concentrate my pushes.  I only pushed for 45 minutes, so I must have been doing an OK job, but definitely never had an *urge*. 

I was leaning back against DH with my knees at my ears when she came out.  I realized that when I pointed my toes everyone got excited that I was doing a great job, and when I didn't point my toes they didn't.  So I started pointing my toes with each push.  I realize that sounds really weird, but that's what worked.  I didn't feel like pushing, but I could feel that I needed to tilt my pelvis and let DD spill out, if that makes any sense at all. 

I was told to hold my breath to push, but I could.not.do.it.  I *had* to yell as I pushed.  Holding my breath was not an option at that point.  I didn't feel that the pushing stage was painful at all (until the ring of fire that is).  I could feel my contractions but they weren't painful anymore.  It was the most bizarre and incredible experience ever!

[quiero a mi bebe]

I definately felt the urge to push.  All of the nurses thought I was not having the baby until the next day and @ 5pm I yelled that I had to push and sure enough I was ready to go. They broke my water and I told them it felt like I needed to go to the bathroom, they said if that happened they would deal with it, so I kept pushing and never did have that accident.  My contractions were not painful during pushing either, and I got lots of time to rest between, but I did have to use all of my strength, dd was facing sideways and born that way, so that may be why. But after 2 hours of such hard work she was born and I was so weak, dh had to feed me because my arms would not lift up to feed myself. I felt better the next day though,  But I do remember that once dd's head was out they said not to push and I didn't but my body did, so out she came unexpectedly.  So I guess I experienced a little of both, the urge to push but having to actually work at it, until the very end.  Crazy experience, I guess it always is with birth though.

[lifeguard]

I did NOT feel the urge at all. Pushing was awful & painful & exhausting. And apparently pretty ineffective as I got him about halfway down & then he just wouldn't descend any further. They kept telling me he was almost here but then he wasn't. It was very frustrating. Eventually we used forceps to deliver him & quite frankly I don't regret it in the least. I was beyond exhausted & had nothing left in me to push & he just wasn't coming down. After he was born I had a crazy overwhelming desire to push for the placenta. It totally caught me off guard.

I fully intend this time around to tell EVERYONE that I will be waiting for the urge to push. Perhaps it's possible it won't come but I would like to see if we can get there on our own & if that means taking a little break & waiting I'm ok with that.

[Chloe'sMama]

DD1 I had an epidural and noticed intense pressure on my tailbone... I was 'ready' to push.... it took an hour and a half...

DD2, wonderful homebirth... I was birthing on the toilet and my transition noises suddenly turned into grunty, pushing noises and after 2 contractions, I could feel her head right there... I moved to the bed and delivered in 3 contractions... I just listened to my body. ( I was never checked, so I didn't know it was going to happen that quickly.  But I trusted my body and it was all good!)

[cappuccinosmom]

I had the fetal ejection reflex, and it was amazing - not in a fun, Christmassy way. :p But incredibly powerful. I've heard it compared to throwing up, and I think that's accurate - really full-body vomiting where there's no way you can stop or control it. 

oh my gosh, great description!

I had that with my second and third.  Who knows if I might have with the first but it was all doctor-managed and coached.

THe midwives were telling me to "slow down". ha!  When those babies wanted out, they wanted OUT and there was no stopping them.  15 minutes of pushing with those two, vs. 40 minutes with the first.  I think I described the second one's delivery with the phrase,"He came barrelling out like a steam locomotive".   It was...intense. 

[laohaire]

Your friends have all had long pushing stages? Meet me: I'm the 6 hour champion :)

Ah, but I'm actually not even the longest pusher I know... a friend pushed for 8 hours. We both did it at home of course, no hospital would "permit" that.

I had the fetal ejection reflex. I did not make any effort to push beyond what my body did involuntarily, until the end (I chose to push beyond the reflex, and chose to tear, to get DD out finally). When my body was pushing, I had bowel movements too, and I was glad I knew to expect that and not be self conscious about it. In fact my midwife was happy to see it and told me it was a sign my body's pushing was effective.

I did indeed have a "break" between transition and pushing. I have absolutely no idea how long it was, since I was in laborland. I don't think it was very long, maybe 5 minutes, but really, I'm not the person who would really know. I did rest, and gratefully. I also initially experienced the pushing stage as a relief; still intense and painful but in a different way than transition, and it was a blessing. However, after about an hour or two of it, it was back to being something I had to go back into laborland to cope with it. Prior to motherhood, I had always assuming (based on stupid movies) that it was the pushing the hurt. While some women find pushing to be the most painful stage, most of us find the opening of the cervix more painful than the pushing through the vagina. Which makes a ton of sense.

So the pushing stage for me was, yes, like throwing up in the sense that there is almost nothing you can do to stop it. Like throwing up, sure, you MIGHT be able to stall it (breathe through) for a little while, but not that long, and it's not easy. (It didn't actually feel like throwing up though - just that basic of a reflex). It was like contractions - I didn't make the contractions. I was just floating around in my birth pool and all of a sudden, whoa, my muscles bunched up and PUSHED. It was not like a bowel movement really, because while there is a reflex there, you are also controlling it a lot more (thankfully, or we'd never reach the toilet in time).
 

[Serenity Now]

I never understood how it feels like you are having a bowel movement. Unless my bowel movements are weird, pushing out a baby just felt like, pushing out a baby. It's a completely different set of muscles than the ones used for a bowel movement.

I've had 2 short pushing phases, and one long. I tend to go from not very dilated to fully dilated in about a minute. With my first labor I was 2 cm's when the broke my water (very medicalized premature induction for medical reasons), and I went to 10 in about 2 minutes and had the urge to push. She was out in 3 pushes. My other girl was also like that pretty much. I didn't dilate for a long time, and when I suddenly was dilated fully and had the urge to push. She was out in a couple of pushes as well. With my son, he was positioned badly, so pushing was over an hour and a half. Once I got his head through my pelvis he came right out.

[Peony]

With only child that I've vag exams with was DD1. I was pronounced to be 10 and could push, but I had no urge, pushing sucked, it took an hour, and I never really had the urge. With the next two children, I've pushed when I felt an overwhelming urge to push, those babies came out quickly. Who knows if I had been sitting at 10 for a while and then the urge finally came, or if I just felt it. I do believe that there isn't some magic switch that is flipped when 10cm is reached, maybe for some they feel an urge right away, but for others I think it can take a while. 

[Smokering]

It's funny how perceptions of a "long" pushing stage vary! My first stage of labour seemed to take forever, but pushing felt like it was really quick. It was an hour, but it felt like 15 minutes, if that. Afterwards the MW commented how I'd just "breathed the baby out", which seemed hilarious at the time because my body was doing the full-on vomit-type fetal ejection reflex, and it didn't feel like there was anything gentle or subtle about it! But I guess she meant that I didn't do any purple pushing. (And I didn't tear!)

All in all my birth was pretty awful and I had some trauma afterwards, but the pushing stage was way better than contractions. It felt productive at least, and for the first, last and only time in labour I felt like I knew what I was doing. I was kneeling on the bed (hospital bed, so the back was right up at a 90 degree angle), but then at some point it just felt right to squat instead. I think the combination of squatting and not deliberately pushing was why I didn't tear, even though DD had a nuchal hand. Looking back, it was kind of cool.

[DevaMajka]

I'm in the "couldn't NOT push" group too. I didn't want to push- if I could have taken a break, I totally would have! I'd be in the middle of saying "no no no" about pushing, and have to push. At the end, the mw told me to not push and I tried, and I think I did ok, but I HAD to push, so I tore a little bit.

I don't really remember what it felt like, but "pushing like you have to have a bowel movement" doesn't sound right to me. Nope, I don't think it's the same type of pushing. I mean, I think that when you push to get a baby out, there is pressure in that whole area, so you *are* pushing around your anus. But the focus is a lot different. You aren't specifically pushing like you would to poop, it's just incidental pressure if that makes sense. That's how I remember it, but I could be wrong. The birth hormones did a great job of making me forget everything that hurt. lol.

[jen.g]

I didn't have the urge at all for DS#1. I was told I was 10 cm and to push for 10 seconds with each contraction, etc. I ended up pushing for 3 hours with him, in every position you could imagine (birth center). It sucked. He finally came out a little off center and I had some tears to fix up.

For DS#2, I was suddenly pushing involuntarily after a few hours of labor, and I remember the birth center midwife saying to mark me complete at that time. I can't remember a rest phase, but this uncontrollable urge to push was pretty scary--about 20 minutes, no tears.

For DS#3, I was at home, and my whole labor had been around an hour when my body started pushing uncontrollably. I couldn't believe it was time, and tried to stop it, but couldn't, so I just went with it. The midwife told me I didn't have to push extra at all if I didn't want to, and so while I helped a little to get him through, I mostly just didn't resist. About 15 minutes later, he was born. No tears.

I'm expecting again, sometime in the next few weeks. Pushing is the only part I'm worried about, so I'm hoping it will be short! My midwife told me that for a fourth baby, I don't have to push so much as not resist pushing and baby.

To the OP, I think the bowel movement idea is to help people tie it into something that most people know, and once the midwife helped direct me to the right focus point a few inches from there ;), it was kind of helpful. Sure, you shouldn't have to really push, but I think most people have had to at some point. But all the pressure there isn't something that people who haven't had a baby have experienced, so I think it is working with what they know.

[IdentityCrisisMama]

Originally Posted by C.Arden 
  He still wasn't coming down and I was getting exhausted and dehydrated and frustrated (it had been about 20 hours of very intense labor at that point) so my midwife coached me through pushing to get him down and out.  I just really needed it to be over at that point.  I finally got the pushing figured out and was able to move him down.  It was such a terrible feeling to me, almost unbearable and even though I had figured out how to push effectively, my body just didn't like doing it. 

This kind of describes my thing - although I did have a sensation that I mistook for the urge to push and ended up pushing a bit with a cervical lip, which may have complicated things.  In the end, I pushed for about 4 hours (2 at home and 2 in the hospital) with no real urge to push.  I ended up getting the "1, 2, 3, PUUSSHH" type coaching from the doctor on staff in the hospital and that worked very well for me.  

I would love a nice strong pushing urge for my next birth!  

[Mamatoabunch]

All 8 of my vaginal births happened at home. I was never pronounced 10 I just pushed when I had the urge. My last 7 were unassisted. I know w/ one or two I had the urge before I was completely dilated. Even w/ my first vaginal pushing was never long. I think there is way too much emphasis put on being "10" and starting to push in hospitals.

[camprunner]

With my first, I felt the urge to push. It was a strong urge. I felt the baby moving down and did light pushes even when instructed not to because it felt good.

With my second, I never felt the urge to push but the contractions were coming stronger, harder, and closer together and the midwife was urging me to push and I was refusing.  In the end, I realized that the pain was going to get worse, or I could push the baby out. I pushed the baby out to avoid the contractions getting worse.

I definately preferred the first birth!