The Pushing Phase

[Mawood]

I gave birth to my daughter 21 months ago and as I am pregnant again now I am starting to visit the birth more often. I think I was blessed with an easy labor and I labored for the most part at home with my doula and my husband. It was very peaceful and I was coping so well. We had planned to do a natural birth in the hospital which I would call now unmedicated birth as there is nothing natural about a hospital. We managed to go in late and when I was put in triage I was already completely dilated and wheeled into the LDR. I think I was only in the LDR for 90 minutes tops until my daughter was born. I labored on the toilet, did one squat and then her head was crowning. My husband and I were so surprised as we had thought it would take longer and I had not thought that I would cope so well with the contractions and her descending. It seemed easy up to that point. However the upcoming pushing scared me and my doula said she had never seen anything like this but my daughter actually went up again a little and from a point where my doula said a birth usually just runs itself it didn't. It felt so hard to push her out and all my focus, being centered and strong was gone. I didn't think I could push her out and suddenly felt helpless and weak. I did feel a bit rushed too as my OB had another birth that was close to the baby being born as well and I could tell that my daughter's birth needed to happen fast. After 20 minutes he offered me to help pushing her out with a cut and I ended up having an episiotomy. I honestly was relieved at the moment that I did manage to push her out that way. It was such a relieve to have my healthy baby. She did have meconium though and needed to be suctioned right away. I am sure that she let the meconium out during the last 30 minutes of the birth as she could feel my stress. It must have been very stressful for her. 

Now that I am pregnant again I feel like I am not afraid of the labor but I am already wondering about the pushing phase. I would be interested how you felt while you were pushing and if it is maybe common to feel like this or if it maybe was a specific reaction that I had to the hospital transfer. We are currently talking about having a home birth but we may not be able to do it as we would have to pay it out of our own pocket. 

Thanks for any thoughts or insights of yours!!!

[lifeguard]

With ds I pushed for 2.5 unproductive hours. I had no desire to push & it was painful & exhausting. I ended up having an unmedicated forceps delivery which at that point was a relief.

During dd's pregnancy I was worried about pushing, primarily that when I got close to pushing I would be scared or panicky due to ds' birth. As it turned out it was completely different, I started pushing involuntarily 'cause the desire was so strong & altogether it was only about 20 minutes.

[craft_media_hero]

JME:

With both kids I labored with no outside pressure at home until the pushing took over itself--it was an uncontrollable, instinctual behavior. I think you can be 10cm and still not ready to push (maybe babe is still positioning or your body is taking a short rest to gear up for the last stretch) tho med staff may tell you to do so. Waiting til my body demanded it insured a very short pushing phase, maybe 10 mins tops? Or less, even. I would encourage you to ignore as much as possible any outside sensations and dont even think about pushing just wait for it to come upon you; it is an unavoidable stage that will arrive unhindered if we just give it time :) IMO, when it's the right time to push, a mama will not need to be told to do it because there's no way she will be able to NOT do it.

btw, my 2nd was hb, and it was great! We paid outta pocket, and it is the best $ I've ever spent! I don't think you will regret it.

[EchoSoul]

Agreed with above. Push when your body tells you to do it. I pushed when I was 8 1/2 cm dilated and the entire birthing staff nearly had a cow! But that's when my body told me I needed to do it. Ignore outside forces as much as possible. They are there for YOU, you are not there for them, so you take just as long as you damn well please!

[stellabluz]

Couple of things struck me that may change how you may do/feel next time!

~a twenty minutes of pushing with a first baby seems like warm up time to me...in my first un-medicated birth @ hospital, I was just kinda learning how to effectively push at that mark, took me 2 hours to get my daughter out (she was posterior and I on my back etc, ugh). I realize that is a semi-normal amt of time to push with a first time birth and given circumstance. You weren't given a whole lotta time before the episiotimy...

~I would say the pressure you had and that you were feeling was or is directly involved in why it feels so hard even now. That kind of bs is not only disrespectful of you and your laboring mind and body but also your baby's well being. In my opinion that is probably the #1 reason you might have had a harder time. At home you have all the time in the world.

I think my last two home births, I was so releived to push because I knew I was close. Both 2nd and third births were also posterior babies, and my last almost ten pounds, but I pushed for 25 and 15 minutes. Much shorter than the first.

I also second extending your budget to include the home birth! And my favorite midwife for ever and ever serves some areas in so-cal. check out Mary Jackson for the most beautiful midwifery care you will ever find! :)

[nia82]

I have read from many moms about pushing when you don't feel the urge. Certainly me. DS was a hospital birth and I was 10cm, I felt relieved when they said time to push. Labor had been so painful with him being posterior (back labor), it felt like hell to me, he did turn through some maneuvers we did (he was small after all), so I felt a relief that I could "push now". But my body wasn't ready. I had no urge. After 2:30h they wanted to hang Pitocin to make my contractions stronger, at which point I decided to push without contraction to stop interventions and just be done with it. I pushed him out in 6 minutes. I tore in 2 places (insignificant labial tear, barely 2nd degree perineal tear). It healed up quickly with no lasting effect, but still. DD was born in a birthing center and when the midwife proclaimed 9.5cm, basically just a cervical lip, I was relieved again to start pushing. It took the contraction's pain away, but I didn't have an urge to push, just an urge to make the contraction pain go away. I again pushed for 2h. We then decided to break the water and get out of the water on all fours. Only then I finally felt the urge to push, a sensation so clear, I can tell I never had it with my son, probably because I was on my back and scared. I gave birth to DD within 5 minutes after being out of the water, tear-free, skidmark-free, just a little bruised. If I have another baby, I do not want to push until I feel the urge to do so. It's much more productive that way. 

My SIL actually had her second in a hospital with a progressive doc, and she was dilated to 10cm for 1h before she felt like pushing and nobody pressured her. She then had her DD quickly. I think pushing without urge is somewhat futile. 

[Almi]

I kind of feel like I don't really count, but -

First birth was twins, unassisted, and I pushed for three minutes or less with each one.  No pain, just a second of discomfort when my perineum stretched over their heads.  I was on my knees leaning forward for each one.  But they were only 4 and 5 pounds...pretty small heads.  Born at 36.5 weeks.

[prothyraia]

I'm generally a fan of waiting to push until your body tells you to, but it sounds from your story you didn't actively push at all and all of a sudden he was crowning and stayed there for 20 minutes?  In that situation I think some directed pushing is fine.  I can understand why that was surprising and difficult for you!

For me, with my first I had an epidural and never felt a pushing urge.  Second was full-on fetal ejection reflex- one contraction to crowning, one more contraction, and on the third he flew out.  My youngest I actually did have a pushing urge, and he came out in three or four pushes I think.

[Cassiani]

ho boy-

it's totally different the 2nd time around.  Every time around, really.

My first, I had an epidural that had worn off, so I pushed out my OP son in 1 1/2 hours, painfully, tediously, it was such a relief to be pushing though, after over 16 hours of back labor w/ no medication and 5 hours w/ the epidural.  I think the pain of waiting to dilate, plus the relief that the baby was really going to come out made pushing a terrible yet exciting time for me.

My second birth was jammed up by transfers from home to birth center to hospital- I got into the birth center, but due to the posterior position of the baby, couldn't get a good heartbeat, so crossed the street to the hospital, and as they finished checking me in, I guess I started pushing.  I didn't notice.  I was busy ignoring everyone.  But my midwife told me to hold up, checked my cervix, said I wasn't totally dilated but that if I felt the urge to push to go ahead.  I didn't know I was pushing, I just found myself doing insane sit-ups, grunting like I like was doing Olympic level sports, and had a baby in 5 pushes.

Third birth, I stayed home.  I was done with midnight rides to the hospital, stalling out, etc.  I never got the urge to push.  But finally, after 6 hours of back labor, we decided to just start pushing and in 25 min pushed out a beautiful baby girl.  

Fourth baby- didn't want to push.  Straight up said that I didn't want to push.  Only 3.5 hours of labor, and pushing was more painful than I was ready for.  But I had squatted, and already started on my own.  I think back labor made pushing a relief, anything is better than hours of back labor.  The midwife told me "Don't worry, that baby will just come right out."  I did push insanely, without thinking about it.  

So- you may find you have the urge this time.  Or you may find that you have a birth attendant who helps you deal with it better.  It's different every time.