Coaching to Tell You if You Are Pushing Effectively

[Azadehhast]

My mother, who had unmedicated births and coached pushing (the kind where they scream PUSH!! and count to 10), recently told me that a woman giving birth should have someone to coach her pushing to tell her if she is pushing effectively, because, she says, you can't tell.

To which I thought, um, wait a minute, can't you feel it? Don't you feel your baby passing through your bones, your body? Or, if you can't feel that, can't you reach down your hand and feel your baby's head? My mother has always compared birthing to having the biggest poo of your life...and well, I've never had a poo that I can't feel coming out of me (sorry, that's gross, I know!). When I said these things to her, especially reaching down to feel your baby, she suggested that the belly is too big to reach around and feel...but, again, Mama, how is a pregnant lady care for her toiling needs if this is the case?

So, the whole conversation seemed pretty dumb, but before I roll my eyes and discount it, I thought I should hear from someone (else) who has actually given birth. Did you need someone to tell you if you were pushing effectively? Could you not feel your baby moving through your body? (Let me add that this question is only for those who had unmedicated births, as I know you cannot feel much with an epidural)

[samstress]

DDCC

i didn't have anyone telling me if i was pushing "effectively" although they were counting for me and reminding me to take a breath (things i probably didn't really need either), but helpful nonetheless.  i definitely knew when my pushes were effective, but more from my effort than anything else.  there were some instances when my heart just wasn't in a certain series of pushes and i could also tell that those weren't as effective. 

i enjoyed your responses to your mother.

i'm guessing she's just trying to be helpful.  perhaps connect with you -- something that you two will share.

[thomlynn]

I need someone to tell me, but I also have never felt the desire to actually push, and it's by far the worst part of labor for me.  I'd probably try to get up and leave if someone wasn't telling me what to do.

[nigellas]

My first son, I needed to be reminded of the right way to push (like you are pooping, seriously).  I did not need anyone to tell me when to push though, that was very obvious and nearly beyond my control.  :)

[Mummoth]

I wasn't told to or when to push, I felt that on my own, but the midwife got right in my face and made some deep, grunting noises a few times. It sounds funny, but it totally refocused me. You make high noises if you aren't pushing or if you're starting to panic, and low noises if you are pushing effectively.

With my son, there wasn't a lot of feeling of him moving down, but most of that was the top half of his head... XH said he was just recognizing an ear, and then there was a whole baby. I thought DD was going to be 3 ft long, because she had her hand up over her face, so she didn't get small enough to slide the rest of the way out until her elbow was out.

[Right of Passage]

DDCC too. I didn't need help pushing. When I had coached pushing I ended up with a cesarean, when I did it according to me I had quick easy pushing phases.

[zuleicamoon]

I have always told my dh and my midwife that I will murder anyone who counts at me while I am pushing.  That is, imo, one of the most ridiculous and counterproductive things that can happen during the pushing stage.  I might be open to some (very!) gentle advice about how to push if I were having trouble, but that seems to be an area where my body knows what it's doing and takes over.  Even with my first birth when I had an epidural, my body pushed when and for how long with each contraction it needed to...I couldn't feel it like I could with my two natural births, but my just began to bear down when it needed to.  And I could absolutely feel my babies moving through me with all three.

[mammamo]

Originally Posted by zuleicamoon 

I have always told my dh and my midwife that I will murder anyone who counts at me while I am pushing.  That is, imo, one of the most ridiculous and counterproductive things that can happen during the pushing stage.  I might be open to some (very!) gentle advice about how to push if I were having trouble, but that seems to be an area where my body knows what it's doing and takes over.  Even with my first birth when I had an epidural, my body pushed when and for how long with each contraction it needed to...I couldn't feel it like I could with my two natural births, but my just began to bear down when it needed to.  And I could absolutely feel my babies moving through me with all three.

this is me too, and i told my mw with my first (at the hossy) that if anyone told me to not push then I would have my MIL put on a pair of gloves and do it....and she would!

[clutterbug]

DDDC as well...I didn't want coached pushing for any of mine.  The first was in the hospital and the only coaching I got was to vocalize in a lower voice (which did help focus the pushing).  Nobody counted.  In fact, my doctor told me not to push until I felt the contraction peaking, and just go with the urge.  As others have said, I found when the urge was there, it was impossible to resist.  This was even more so for the second 2 kids...to the point that with my recent birth, the midwife was saying (kinda similar to my doctor the first time) not to push if I didn't feel the urge and I was like "I DO feel the urge, I can't NOT push!"  I find just at the moment of crowning my urge to push slows way down and I catch my breath a bit.  It's pretty neat, really.

And as someone else said, I hate the pushing part, too.  But even though I am hesitant to do it, I can't help but do it.  Confusing much? LOL!

And yes, you will be able to reach to feel your baby emerge.  I am not a small woman and even I can do it :P

[sarahtar]

For my hospital birth with #1, I had written into the birth plan that nobody was to count at me, and both the doula and DH were on Counting Patrol, lol. I have not needed to be told to push with either birth. THAT SAID. No, I could not feel whether or not my pushes were doing anything with #1. I mean, there was quite a while there (45 minutes?) where i was pushing with no visible signs that the baby was moving anywhere. i couldn't see or feel him, inside or out. The last 15 minutes, I could see and feel him externally, and of course right before they come out there's the ring of fire and that comes with a strong desire to stop pushing to stop the hurt.

And while, in retrospect, I was very tired of hearing people tell me to push like I was pooping, it wasn't a bad reminder. What I needed more was the encouragement I got from the doula, who was right by my ear telling me I was doing great, those were great pushes, etc. Someone who had been there done that who could give me encouraging feedback. (Because honestly if DH had said that i would have at least been thinking 'yeah, whatever, what do you know about it?")

With #2, I pushed like 3 times, and after that, assumed they had been effective, since she flew out, lol.

[Mayachel]

FWIW-Even if a woman doesn't push-if everything is lined up, and the baby is work their way down, the body WILL involuntarily push the baby out. So it's not as though you can really do it "wrong". Directed pushing "Hold your breath, bear down, count to 10" can be helpful to forcibly push the baby down when the baby is still higher than the nerve stimulus to trigger the involuntary pushing, or if a woman has an epidural or other pain medication that may interrupt that signal to the brain. Left to their own devices, most women do feel their baby coming down and can reach around to feel the head of the baby emerging.

[Azadehhast]

Wow, everyone, thank you for such a variety of wonderful responses! This is great.

[Mummoth]

A few people have mentioned being able to touch the babies' head... I'm big and was able to with my DS. I didn't want to but my mom convinced me that I should. I will never, ever do that again, I found it extremely disturbing and if anything made me more hesitant to push! 

[clutterbug]

Originally Posted by Mummoth 

A few people have mentioned being able to touch the babies' head... I'm big and was able to with my DS. I didn't want to but my mom convinced me that I should. I will never, ever do that again, I found it extremely disturbing and if anything made me more hesitant to push! 

I've only reached down and felt once in all three births.  With #1 and #3, I was asked if I wanted to and refused.  I am too much in the head space of "just get that baby out of me, OMG I need to push push push I can't stop!!" to really get into it, I think.  LOL.  With #2 I think my midwife said "reach down and feel your baby", so I did :P  It was neat but I had no desire to keep feeling it through the whole process of pushing him out. 

[Czarena]

Whomever said that your body will push the baby out is correct. I have given birth to three children and pushed exactly 6 times - 3 times for the 3 heads, 3 times for the 3 bodies.

It is very rare that you NEED to push before your body is telling you that it's pushing with or without you. Caregivers tend to think - "You are 10cm, that means it's time to push" I call BS. Your body will start to push the baby out on its own and you can choose to help it at that point.

[APToddlerMama]

I don't remember feeling any progress with pushing actually.  I pushed for 2.5 hours (coached and counting....blahhhhhhh) and ended up with a vacuum birth.  Honestly, it was the middle of the night and I was beyond exhausted and was fine with the vacuum as DS's heart rate was dropping and it was that or a c-section.  I didn't know if I would have gotten him out without the vacuum.  Despite not feeling progress with pushing, I know there was, because DH was keeping me informed as to where the head was, how much hair he could see etc.  I did not reach down to touch the head because there is something that really wigs me out about that (but then again I have to talk myself up not to pass out with a blood draw even) but I absolutely could have reached the head if I had wanted to.  I don't know for sure, but I think all the coached pushing tired me out so much.  I think had I been able to listen to my body and when to push more myself, I may not have needed the vacuum.  Guess I'll find out this time... And as far as feeling like pooping...it did not feel that way to me at all either even though that is what I had heard from many people.  When DS popped out entirely, THAT progress I could feel.  My memory is fuzzy (even though I was drug free) but I feel like his head and entire body all came out at once within a split second. 

[sarahtar]

Originally Posted by Mayachel 

FWIW-Even if a woman doesn't push-if everything is lined up, and the baby is work their way down, the body WILL involuntarily push the baby out.

Yeah, with DS, I was trying not to push (they were worried about his heart rate) and my body just started doing it for me. It was seriously freaky. I mean, in a good way, but soooo unexpected.

[AshleeS]

With my first I was pushing for 4 hrs....we had to wait a long time for his head to mold enough to fit through my pelvis.  My midwife is the most hands-off home-birth midwife you could imagine, but she did coach gently to insure effective pushing because I was incredibly exhausted after not sleeping the night before and being in labor for 32 hrs.  

The second baby came in literally a matter of an hour and a half start to finish. In fact, I was just talking to my husband last night after I used the bathroom and told him how it reminded me of how similar and involuntary a BM and pushing out a baby are.  I told him - you don't need someone to tell you you re ready to poo!  And you don't need someone to tell you you re ready to push your baby out!  Really, there was NO controlling or holding back pushing my second baby out.  I didn't even realize I was past transition until my body started pushing the baby out on its own.  I was home only 30 min before the baby arrived.  Head midwife didn't make it, but my sister who is an apprentice midwife was there 10 min before baby was born. Truly an amazing experience.  Trust your body.  But also know that it is normal and common for first labors to be longer and more difficult...so sometimes you need reminders. 

[Aka mommy]

DDCC-

I have only had one coached pushing and it was with my epidural. But even then it was the biggest joke because I was the one that told the nurse i felt like i needed to poop (30 minutes after they had checked me at a 2) and she told me it wasn't possible and to just poop since it would be taken care of later. Thankfully i was very adamant that she check me and watched in glee as she hurried around getting everything ready and calling the doctor since baby was RIGHT there. Now when having an epidural, yeah it can be semi helpful as you don't feel everything. But your body still does what it needs to do and 28 minutes later dd was out (she was my first).

Now my 3 unmedicated home births, if anyone had dared to count to 10 while i pushed i probably would have kicked them out lol. Really a contraction doesn't always last 10 seconds. And if it's only lasting 10 seconds . . .it's not going to be a very useful contractions and quite frankly, you shouldnt be pushing yet. With dd#2 i decided that i wouldnt flinch a muscle till i couldnt do anything else. 1 push and 30 seconds later, she came flying into my dh's hands (mws had gone into another room). There was no need for coaching or cheerleading (as i call it). DD was born posterior with a nuchal hand no less. With the last 2 births, again, no need to be coached. With the very last birth my mw's didn't even know how dilated I was when i started naturally pushing and it was more of a i need to grunt and crouch and bend and move my body this way and that, and then oh wow I need to get on hands and knees and move this baby OUT, sort of thing.

Now in more trying labors, when mom has been pushing for hours and she's exhausted, baby is exhausted and it feels as if she's at the end of her rope. . . this could be a good thing. As long as the coaches are willing to listen to the mom and not count (again who ever set contractions to being as long as to the count of 10?). But more along the lines of positive affirmations and letting her know she is amazing, she is beautiful that she is doing it right and to keep pushing and to listen to her baby.

Trust your gut on this. Our mothers come from a different era of birthing so sometimes they don't understand our 'new fangled' ideas of birth lol. But you will not lead yourself wrong. Happy birthing!

[BennyPai]

This has been an area of confusion for me.  Each birth has been different.  I never felt the "urge to push" until my third birth.

My first dd was born with a CNM at the hospital.  My water had been broken for me with an intimidating tool with a hook to check for meconium.   I was semi-reclined in a garden tub with DP behind me.  I was exhausted and hungry and just wanted to rest, during transition.  I was coached to hold my slippery knees and told when to push.  I never felt an urge.  I think it was a combination of factors - including exhaustion and my position.  I ended up needing some stitches.  I hadn't had any medications or IV - the only interventions were breaking my waters and I was hooked to an around the belly fetal heart monitor on the bed twice.

My second dd was born at home in a birth pool, 17 days past her EDD and, after two rounds of castor oil,  I had badly inflamed hemorhoids and was nervous about pushing.  I never had an urge to push.  Eventually, my MW told me to. I needed two stitches - I tore along the scar from my previous birth. 

My third dd was also born at home in a birth pool.  She came in her own time.  I was relaxed and had complete control of the birth environment.  I waited until I couldn't ignore the signs from my body.  I involuntarily started pushing.  I said out loud something like, "I think I'm pushing."  And my MW assured me that I probably was.  My third dd moved through me so quickly her slippery body surprised the MW and her assistant when it shot out.  My most ideal birth experience, by far.  She was 9lb 14 oz and my easiest birth. I didn't need any stitches.   I hope this one is similar ...  I plan to wait for my body to start pushing on its own again.