This is the last in our 3-part series. In our Childbirth Preparation Overview, we focused on helping you understand what actually happens during labor. The, in our Stage 1 Breakdown, we provided strategies for managing through the 3 phases of stage 1 — from pain management, to position practice, to stamina training. Now we are ready to move onto helping you prepare for Stage 2 Labor (the “pushing” stage). The tips below can help make your pushing more effective, reduce the duration of the pushing stage, and minimize stress to your body (especially your pelvic floor). We will discuss the following three elements of pushing: Timing, Position, and Technique.
Let’s first discuss when pushing begins. Once the cervix has dilated fully to 10 cm (which marks the end of Stage 1), typically the doctor will cue a woman to begin pushing almost immediately. This type of managed pushing (or instructed pushing) approach is externally derived, and some women (especially first-time moms) may value the direction given by a seasoned medical professional. However, you may not feel quite ready to push just because you are 10 cm dilated. That is because there is often a period of quietude that exists in between Stages 1 & 2 – a phase that does not get attention in traditional medical circles – in which contractions may slow or stop altogether. This happens to allow the baby more time to perform it’s complex series of cardinal movements so that it is truly ready to be pushed out.
If you can take these quiet moments to breathe deeply, re-center yourself, and prepare physically and mentally for the final “push” (pardon the pun), then the process can be much more efficient. This type of internally-derived know-how is called instinctive pushing (or physiologic pushing). All you need to do is listen to your body — and be in an environment that’s supportive of you doing so — then begin pushing only when you feel the uncontrollable urge to do so.
The length of Stage 2 varies widely by individual. First-time mothers typically (but not always) have longer Stage 2 labors — up to 2 hours. Those women who’ve had prior births often have shorter Stage 2 labors — even as short as a few minutes. When instinctive pushing is used though, it can often make Stage 2 shorter and more efficient for all.
Now that we’ve discussed when to push, let’s discuss the various positions to push in. The most common birthing position today in a hospital setting is when a woman is reclining with her legs bent with knees in stirrups. This position enables doctors to have access to see, maneuver, and (if necessary) perform interventions. However, if we take a brief look at how our more “primitive” ancestors gave birth — when they were left to their own devices to do what felt natural for their bodies — the most common positions were standing (supported), squatting, or hands-and-knees.
One notable position you do not see above: lying flat on the back. This was not a natural or intuitive laboring position for women when left to their own devices, as it did not offer the advantage of gravity’s downward pull. The back-lying, or reclining, position came later with obstetrical developments like hospital gurneys and epidurals.
So what can this teach us today? Interestingly, newer research being done on self-selected birthing positions (in which women choose their position as opposed to being directed how to position themselves) reveals what those “primitive” people intuited: maternal choice of positions can improve labor outcomes (for mother and child). Some of these positive outcomes include a shorter second stage, lower pain scores, and fewer operative deliveries (Gizzo et. al, 2014).
Finally, let’s discuss the actual technique of pushing. Traditionally, when doctors cue to push, they instruct a woman to hold her breath and bear down for several seconds while trying to help expel the baby. This breath-holding during exertion creates excess intra-abdominal pressure, which can help create more force to push the baby out. However, the excess pressure this creates in the body can have some negative repercussions, including reduced oxygenation to the baby (which can lead to heart rate deceleration) and increased pressure on the mother’s perineum (the tissue between the vagina and anus). Newer research is now pointing to better outcomes for mom and baby when the mother is allowed to instinctively push. When a woman is permitted to push in a way that feels natural, often she will not hold her breath for as long as when she is instructed, thus reducing oxygen deprivation to the baby and perineal pressure (Lemos et. al., 2011).
PROnatal Fitness teaches a different pushing technique that does not involve breath-holding. We begin by teaching women proper Pelvic Floor Activations (PFAs) during the earlier stages of pregnancy. These movements involve working the pelvic floor muscles through a full range of motion — relaxing and lengthening on the inhale, and contracting on the exhale. Once you’ve mastered these, Pushing Prep involves keeping your pelvic floor muscles relaxed even as you exhale. In other words, inhale and relax your pelvic floor muscles, then exhale as you draw your navel to your spine, but keep your pelvic floor muscles relaxed. This does require a bit of practice, but this relaxed pelvic floor is critical because you need to learn to let go of tension in the muscles that are the exit point for the baby, or else they won’t stretch as far, making you (and baby) have to work hard to finish the job.
We typically recommend women begin Pushing Prep in the 7th or 8th month of pregnancy (actually practicing on the toilet can be the best way). Anecdotally, first-time postpartum women say that they thought they were pushing when instructed, but didn’t make progress because weren’t pushing effectively. They didn’t know how to push. So begin practicing before your big day comes.
Want more support?
We believe a major performance event like childbirth takes proper preparation and training. Consider working with one of our expert in-home trainers or online trainers. Or, to train on your own, check out our self-guided online programs. We also highly recommend attending a childbirth education class (especially Birth Smarter).
Another wonderful consideration is to work with a doula (birthing coach) to support and coach you during childbirth. These professionals will help you with every element we’ve discussed in this 3-part series, and provide the critical mental, physical, and emotional support needed to help you succeed in what will likely be the greatest physical feat of your life.
Engelmann, G.J. (1882). Labor Among Primitive Peoples. St. Louis: JH Chambers.
Gizzo, S., Di Gangi, S., Noventa, M., Bacile, V., Zambon, A., & Nardelli, G. B. (2014). Women’s choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BioMed research international, 2014, 638093.
Lemos, A., Dean, E., & Andrade, A.D. (2011). The Valsalva maneuver duration during labor expulsive stage: repercussions on the maternal and neonatal birth condition. Brazilian Journal of Physical Therapy, 15(1), 66-72.