Teach me about Pushing?

[Belleweather]

I know I've read quite a bit about how and when to push on this forum, but I let it go in one ear and out the other knowing that we'd have a whole class in my childbirth series about how to push.

Well, last week was the how to push class, and I don't feel like I understand it yet, so enlighten me please!

In class, we talked about putting your chin down, and counting, and trying to push three times in a contraction... but there was a lot we didn't talk about.

I remember reading that for some women, there is a pause between being completely dialted and feeling the urge to push, and that it's best to wait until you feel the 'urge', and even that for some women it feels like their body does a lot of the work on it's own. Is that true? Or perhaps more usefully, is it common?

I also remember someone talking to me about pushing with the contractions, and listening to them so that your pushes and the contractions work together to get the baby out both faster and with less tearing. Can anyone speak to that?

Or even does anyone else have any resources or advice to point me toward since when it comes to pushing I feel like I get it intellectually, but I don't really grok it deep in my body yet.

[AugustLia23]

For me, I had a hard time pushing in the right place, which meant my body didn't have ENOUGH of the urge to push yet. Once the urge really came, I pushed right where I needed to. FTR once I really began pushing, he came out fairly quickly and I only had 1 tiny tear. I can't tell uou how long I was pushing for exactly though since I was pretty much fully dialated before 11am, but had a small cervical lip and DS had his head turned in a funny way so I didn't deliver until almost 12 hours later.

Don't try to think too much about your labour, because it is very likely that something will happen that you didn't prepare yourself for. The best advice I have for labour is to listen to your body and stay open to the unexpected.

[starlein26]

Originally Posted by Belleweather

I remember reading that for some women, there is a pause between being completely dialted and feeling the urge to push, and that it's best to wait until you feel the 'urge', and even that for some women it feels like their body does a lot of the work on it's own. Is that true? Or perhaps more usefully, is it common?

I also remember someone talking to me about pushing with the contractions, and listening to them so that your pushes and the contractions work together to get the baby out both faster and with less tearing. Can anyone speak to that?

Or even does anyone else have any resources or advice to point me toward since when it comes to pushing I feel like I get it intellectually, but I don't really grok it deep in my body yet.

i definitely remember having a pause between fully dilated and having the urge to push. unfortunately for me, i was told to push (go figure...thanks m/w for not trusting the first-time mom) and the urge came shortly after. this is an *intense* and i mean truly intense urge where every fibre in your body wants to push. i'm sure my body could have done it on its own but it felt *so* good to push along with it. it's almost like i had to! and i had ZERO desire to push when the contraction was over i just closed my eyes and rested as much as i could (i was exhausted in between). i did tear though which i think was probably unavoidable with a 9lb 13 oz baby. but, i didn't even feel it.
don't worry...you'll absolutely get it when you're experiencing it. it's something you can only 'get' intellectually until life allows you to experience it. it's not something you can actually prepare for, kwim.

[Pandora114]

Umm.

Push like you gotta poop.

Go with your body, not the counters/cheerleaders.

If you are unmedicated you'll know how.

[cottonwood]

Originally Posted by Belleweather

In class, we talked about putting your chin down, and counting, and trying to push three times in a contraction... but there was a lot we didn't talk about.

I would recommend not trying to be aware of what you're doing, or doing it the "right" way. If you're thinking "oh, I have to breathe this certain way now, or push this many times, or for this long..." you're in your head, not in your body, and that's going to hinder the birth. Your body already knows what to do, it really does, just like it knows how to make and sustain a baby and start labor. It is a myth that the baby will not be born properly unless you learn how and do it according to others' directions. That said...

I remember reading that for some women, there is a pause between being completely dialted and feeling the urge to push,

Yep, the "rest and be thankful stage". Not all women get it, but many do if birth is spontaneous and not directed or managed. It seems that usually it occurs between transition and pushing, but my labor actually stopped for an hour last time, then contractions went on for another hour before I started pushing.

and that it's best to wait until you feel the 'urge',

Yes, but that should be qualified: push only as much as you feel the urge to. In other words, feeling the urge doesn't mean to start bearing down as hard as you can. Good rule of thumb: if it doesn't feel involuntary, don't do it.

and even that for some women it feels like their body does a lot of the work on it's own. Is that true? Or perhaps more usefully, is it common?

Yes, it is true -- that is what normal physiological birth looks like. It's not common, but only because women are not usually allowed to labor normally, and told to start pushing immediately upon full dilation.

Or even does anyone else have any resources or advice to point me toward since when it comes to pushing I feel like I get it intellectually, but I don't really grok it deep in my body yet.

Do a search for "pushing" or "second stage" here at MDC.

This might be helpful (although I disagree with her about perineal massage):

http://www.gentlebirth.org/archives/pushnot.html

and this:

http://www.midwiferytoday.com/articles/pushing.asp

[Moon Faerie]

Originally Posted by Pandora114

Go with your body, not the counters/cheerleaders.

If you are unmedicated you'll know how.

:

With my ds (hospital birth), I had about a 20 minute break between being complete and having the urge to push. I tried doing the whole push to the count of ten 3 times per contraction thing. My ds started going into distress, and I ended up on oxygen. I pushed how and when I wanted to after that.

With my dd (birth center), I progressed really fast. There was no break. It was just super intense contractions on top of each other, then bam, there's a baby coming out! My body 98% of the work, and I just pushed a few times once she was crowning.

[RiceMomma]

This is why I don't want anyone "checking" me and then telling me when to push. Just relax and listen to your body. It will tell you when and how much to push. It will also tell you what position to be in. You might not be able to hear it if you have a bunch of other people telling you what to do.

Good luck.

[Spark]

fourlittlebirds... I'm such a fan!


Well said.

[2+twins]

In Bradley we teach it like this...

Once you feel the undeniable urge to push, you should. You should not try pushing before this point unless there is an urgent medical reason which warrants the baby being born NOW.

Assuming now that you have this urge, as a contrax begins you would take a nice slow breath in (through your nose) then out (through your mouth), repeat this, and repeat one more time only instead of exhaling on the 3rd breath you'd hold your breath as you place your chin to chest (which closes your glotis, making it difficult for air to escape). The point of this breath holding is that it creates a cushion of air which puts pressure on the top of the uterus which helps squish the baby downwards (if that makes any sense). Anyway, at this point you push, as though you're trying to poop. It can take a few trys to get the feel for it - that's normal. As far as the number of times to push per contraction, it totally depends on you. You should push each time only to the point of comfort. Do not hold your breath any longer than it takes you to push to the point (length) that feels right to you. When you need a breath, you lift your chin, take a deep breath, and put your chin back to your chest and push again. You repeat this as long as you're still having a contraction and as long as feels good. I think 3 pushes per contrax is great, but it all just depends on your body, your baby, and your labor. There's no right answer to that one. Oh, and the reason for the 3 deep breaths before you begin pushing is b/c you're basically gearing up for the peak of the contrax to push. Taking these breaths gets you to that point so you don't begin pushing before you have the full force of the contrax behind you.

Yes, some women reach 10cm but don't feel an urge to push. Some even say that they waited a long time and still didn't have the urge so assumed (from what I gather) that it wouldn't happen that way in their case. I don't know. But the positioning of the baby contributes to that urge. I had a friend with a face presenting baby who had a real tough time pushing b/c she just wasn't having the urge the way she did with her first dc. Her mw actually reached inside during each contrax to press on the spot that the bones of the head would typically be applying pressure. This gave her that undeniable urge. So maybe in those cases the baby just wasn't positioned quite optimally or maybe nature was just giving the mama a break. Pushing can sometimes take a very long time and having a break before hand could be what saves that woman from exhaustion. Other times it all happens very quick (I've had it both ways - 2nd time I didn't even try to push - my body did it all for me).

Feel like I'm rambling, but I hope this helps. Follow the sensations and you'll do great. Cheerleading-style pushing is just awful. Don't do that!

[alegna]

Okay- throw out everything you learned in any class really. No other mammal has to be taught how to birth- why should we? Don't think about pushing. Your body will let you know what to do.

Did you take a lesson in pooping?

-Angela

[ABand3]

Originally Posted by Belleweather

...to get the baby out both faster and with less tearing. Can anyone speak to that?

There have been threads here about pushing and tearing. I seem to remember the consensus being that tears are more likely when you push in an unfavorable position and/or when you push too fast/too much.

I didn't experience a pause between 10cm and feeling the urge (and with my most recent birth I was not checked for complete before pushing). However, I did start out 'grunty' and later on my body was just pushing on its own. I couldn't stop pushing any more than I would be able to stop my body from vomitting (sorry for the gross comparision, I didn't actualy throw up during pushing, just that's the best way to describe it for me). When I was 'grunty' I was just doing little pushes here and there - only as long and as often as I wanted, slowing increasing. I think if I had been coached at this point as you were describing, I would have just gotten tired/frustrated and it may have taken longer with more discomfort.

Originally Posted by Belleweather

Or even does anyone else have any resources or advice to point me toward since when it comes to pushing I feel like I get it intellectually, but I don't really grok it deep in my body yet.

I know for intellectual people it's hard to abandon the method that's taught for just winging it when the time comes, but if you are unmedicated, supported but not coached, and free to listen to your body, you will figure it out. It's a leap of faith, but I believe you can do it.

[Monkeybutt]

I agree with everyone else. Your body will let you know when its time to push. I remember worrying the same thing when I was pregnant. And it was such a shock to me when my body was pushing all on its own! It was amazing! I just went with it. You really cant control it. (Atleast I couldnt.)

Don't worry about it! You can do it! It'll be great! Just trust your body!

[flapjack]

After more than an hour of no contractions with Isaac (and no urge at all) I agreed to push intellectually, rather than physiologically. Hardest thing I've ever done in my life, and I have no intention of doing it again. I'm sure that's also one of the reasons why my third (and later) stage was such a mess.
With Alex, otoh, I felt pushy continuously from 8cm and just went with it.

[Artisan]

You've already received a lot of great advice. I put it in my birth plan that I wanted no directed pushing -- that I would push when and how I wanted to. I had an epi with my first birth and was told when to push, so I had to trust that I would know when to do it. And I totally did -- as the pps have mentioned, you don't get a choice when your body is ready to push. It is involuntary and overwhelming and you don't even think about technique.

I remember sitting in the tub in transition and feeling tons of pressure, and then a huge pop as my water broke. It was immediately followed by a tremendous urge to push. I had a moment of panic because it didn't feel good or different in a nice way like I had read. (For some women, it does feel better to push, but it didn't in my case.)

After I yelled that I had to push, my MW said, "Go ahead and do whatever feels right. Listen to your body." I had a vague sense of disorientation, as in, "No one is going to tell me which position to get in and to hold my breath and push for 10 counts three times with each contraction?" After my first birth (and much cultural conditioning), it took a second for me to realize that this was totally up to me and I had to do what my body told me.

I let one more contraction go by because pushing hurt so much. You do get longer breaks between pushing contractions, and I remember laying there being grateful that I was out of pain for a minute or two.

I pushed out the baby in five pushes with no tearing, in the position of my choice (side-lying). I also think that's another key to minimizing tearing -- to push in the position of your choice, preferrably off of your tailbone so your pelvic outlet is as wide as possible.

Sorry for the ramble... when the time comes, you will be given all the information you need BY YOUR BODY and not by anyone else.

[AutumnMama]

You've gotten some great replies here, so I'm just going to share my stories with you (short, hopefully ).

I had my DD in the hospital, ended up having a spinal (like an epidural, but not a catheter just one shot into the spine--it only lasts a few hrs.) so I basically didn't feel transition.
Sooo, they had to tell me that I was fully dialated and told me to start pushing.
Well, even when I was fully feeling the contractions I always started pushing right away, so it felt like itwas all me, all my own effort doing the pushing. I was being a good patient and pushing 2x every contraction like they told me.
I tell you what, that was the LONGEST 2 1/2 hours of my life! It was literally all I could do to make myself keep pushing...I was almost hysterical at the end
I was so utterly exausted I could barely look at my DD when she was born .


I had DS at home, and had learned ALOT more about the birth process from MDC and reading natural childbirth books. I had a very speedy labor with my son (3 1/2 hrs total, compared with 20+ with my DD).
The midwife had been at our house for about 5 min's and was making the bed while I was in the dining/living room laboring. I had no idea how far I was dialated as she hadn't checked me....I had only been in labor for about 3 hours so I thought I had a looong way to go yet.
The next contraction I thought I was going to throw up (I figured I had hit transition then because I threw up with DD). It was the oddest sensation, because I was totally convinced I was going to puke and all of a sudden my body was pushing.

I figured it must've been a fluke and I shouldn't be pushing because I *knew* I was only 7 or 8 cm :LOL
The next contraction I wasn't thinking of pushing at all, I was just going to breathe through my contraction like all the other ones. Well, as it started going my body completely and utterly on it's own started PUSHING!
I really felt like there was absolutely no way I could've done anything to stop it.
It was AMAZING.
All of my pushing contractions were like that, I barely felt like I was exerting any effort; my body was doing all the work, and I just closed my eyes and rested deeply between contractions.
ONE time I tried to start pushing before my body was ready, I then understood what had happened during my DD's pushing stage...I didn't do that again, and just let my body push when it was ready!

I pushed DS for about 25 minutes, and while I was very tired (giving birth just takes it outta ya! :LOL ) I was not utterly exausted the way I was with DD.

So, yeah...not all that short, and I hope the first story didn't scare you....it wasn't my intention, I just wanted to show the huge difference between listening to your body's cues and not!

At any rate, I wish you the best of luck, and wonderful labor vibes

[Belle]

I felt the urge to push in transition. I think that was the worst part was waiting for "permission" to push. I had a lip of cervix left and I was threatend with a C/S if I pushed.

Once I was fully dialated, somebody started counting while I was pushing. I hated that! I started feeling dizzy because they would only let me get a quick breath, then push again to ten.

After I told them I was seeing stars, they put O2 on me and I ignored their counting. I would push for about 5 seconds and breath as long as I wanted to before pushing again. This felt much better to me.

We had taken Bradley classes and I knew that the counting didn't really work and just made me oxygen deprived.

BTW: I'm not having another hospital birth.

[staceyshoe]

My midwife has only had to stitch 5 women in 23 yrs of practice because she doesn't coach pushing and lets women follow their instincts. That's my #1 advice. I never felt an "urge" to push but my body started pushing involuntarily. I've read that the strained and extended pushes women are often coached to do leads to tearing and even decreased oxygen for the baby (i.e., the whole chin-to-your-chest, make no noise, push to the count of 10 deal). Also, the whole laying on your back and grabbing your legs thing causes more tearing. Feel free to try different positions, small and big pushes, whatever seems right. Try a few different ways and you'll know whether it's right or wrong. Many people recommend squatting for everyone but it's not recommended if the baby is coming really fast. Just don't get locked into a "right" or "wrong" way and go with the flow. Your body knows what will be right in your situation.

[orangebird]

Originally Posted by Belle

I felt the urge to push in transition. I think that was the worst part was waiting for "permission" to push. I had a lip of cervix left and I was threatend with a C/S if I pushed.

This happenned to me at home, but I was 7 cm. My midwife just said go with it. I'm like are you sure? I'm only 7 cm. Kindof funny because even if she said "don't push" I wouldn't have been able to stop. I just jumped in the tub and went for it. He was out in a few pushes. Probably about 5. It was painful though, almost like I was still going through transition (I probably was) during the whole pushing phase. And the pain continued after he was out. By far my most painful birth. No tears though despite a nuchal hand.

The birth before that one, at the height of transition I said the classic "I can't do this!". MW felt and said I was 10cm. The pain stopped. I jumped in the tub and within minutes I was feeling the overwhelming urge to push. I take that back, my body was pushing whether I liked it or not. Pushing felt good. I just did whatever my body told me to. No tears.

Birth number one. Long story short I had an epidural, cheerleader pushed over two hours. I couldn't feel what I was doing, I was totally numb. Ended up getting cut and vacuumed.

[mandib50]

i agree to let go intellectually and to listen to your body. i don't think there is a 'right' way to push, for every woman the right way to push is only how her body dictates.

i had the rest and be thankful phases - not everyone does. believe me, when you get the urge to push, you will know it and you won't be able to stop it. you can't help but push. the breathing will come naturally with maybe the exception of the crowning phase where hopefully your c/g will guide you to pant or blow but even then i think if we're in tune with our bodies then you will naturally do that (me, i need to be guided ).

your body will guide you to positioning for pushing as well if you listen. hopefully you are in a fully supportive birthing environment where you are encouraged to listen to your body and are given the space and encouragement to do so.

mandi

[kavamamakava]

Don't push the river, let it flow. The article that was posted at unassistedchildbirth.com is gone Does anyone else have it?
I had the most success when I didn't push. The baby came out faster than the others and I didn't tear.
Here's a nice article http://www.havingababytoday.com/articles/pushing.asp