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To Push or Not To Push?

#1: Don't Stop Breathing (and cultivate a strong breathing practice)

First up, the importance of breathing during contractions and the reason this may be easier said than done.

When we are in fear and/or pain, the natural physiological response is to curl up, contract the core, and halt or speed up the breath. This is beneficial when we need to protect ourselves - fight/flight; however, during labor it is important to remember to BREATHE.

Halting the breath or breathing quickly (hyperventilating) causes stress hormones to rise. This directly opposes the natural progression of labor (aka slow progress) and it decreases the blood flow/oxygen to baby.

The best thing we can do for pain management and emotional wellbeing during labor is to breathe - continuously, rhythmically, and deeply.

It’s so vital to begin practicing this deep connection to breath (and baby) early, so that when it’s go-time, the mind•body has been trained in this way.

Because we stated earlier that this isn’t always the initial response to the pain of contractions, having your partner and/or doula there to remind you to relax the hands, forehead, and jaw and the guide your breathing is extremely beneficial.

#2: Don't Hold the Breath While Pushing (exhale on exertion)

There are quite a few points I’d like to make on pushing (like should we even push at all), but first let’s shed some light on what most women are told to during this stage of labor.

The pushing encouraged by most health care providers is to hold the breath during the push. Something like, “ok take a deep breath, hold it in, and push for 1,2,3,4,5...”

This type of pushing may get the baby out faster, but many repercussions will likely follow.

1.) The faster (and more forceful) the baby is pushed out, the less time the perineum has to open and stretch. Also, the breath holding places extra pressure on the pelvic floor, leading to an increased risk of tearing, hemorrhoids, and pelvic floor issues postpartum.

2.) Holding the breath decreases amount of oxygen for yourself and for baby, so baby’s heart rate/O2 may drop.

3.)This type of pushing is extremely taxing on the body; therefore, there is an increased likelihood you’ll tire out and need other types of intervention.

#3: Don't Push Until You Feel the Urge (your body knows best)

Medical staff sometimes jumps the gun on cueing the mother to start pushing.

It was (and in some places, still is) common practice to have the mother start pushing as soon as the cervix has dilated to 10 centimeters, but there are many benefits to waiting until you feel the urge to push.

The urge to push is different for each person. Some women feel like pushing before the cervix is dilated to 10 centimeters, some feel like pushing right after the cervix is completely dilated, and for some it takes time after the cervix is dilated to 10 centimeters and the baby has moved down into the vagina canal – called “laboring down” – to feel the urge.

If you are able to wait until you feel the urge to push:

  • You are more likely to push for less time,

  • You are less likely to need help with a vacuum tool or forceps to get your baby out,

  • You are less likely to get so tired you can’t push anymore, and

  • Your baby is less likely to have heart rate problems while you are pushing.

If you have an epidural, the question is always, “how will I know if I’m numb.” While the epidural blocks the pain, you will still feel the pressure of the baby descending and usually, the medical staff will stop the medication to allow for better feeling. 

#4: Breathe The Baby Out (let go to allow nature to take it's course)

Have you ever tried to rush a poop? Really, think back. Did all that forceful pushing feel good, or did relaxing and allowing nature to take it's course work a little better?

Many women don’t believe me when I tell them that the mother’s job is to surrender during labor and delivery. Don’t force anything, don’t try to control the situation, just let go. This decrease stress, anxiety, and pain, allowing for better labor progression. Letting go allows the body and baby to work together. When you place trust in your own innate abilities to bring you baby into this work, it's the quickest way to holding that newborn in your arms.

This goes for pushing as well. When many women approach the second stage of labor exhausted and are told they now have to forcefully expel their baby out of their bodies. This opposes the natural rhythm of the uterine contractions that are already helping the baby move into the vaginal canal.

When we approach pushing with the mindset that we have to bear down, hold our breath, and pop a few blood vessels in our eyes to get that baby out, it places stress on the entire system (baby included).

Continuing to breath rhythmically and diaphragmatically is the best course of action when it comes to “pushing.” So, instead of "pushing," we can say "breathing the baby out."  Practice at home with a balloon and a deep squat.  My pelvic floor feels better already!

#5: Make Some Noise (open-glottis pushing)

So how do we “push” or "breathe the baby out?"

Nice rhythmic inhales and exhales will decrease the strain and pressure on the pelvic floor, and on the baby. In addition, women do best when they are told to push only when they feel the urge to, and to do what comes naturally to them.

In most cases, if the woman feels safe in her space and confident in her body's abilities, this will include making noises during the push. We call this open-glottis pushing.

Open-glottis pushing decreases pelvic floor pressure and strain by better controlling the intra-abdominal pressure through the opening of the airway - allowing for exhale on exertion. You may grunt or make deep noises; this is a sign you are pushing well, and your efforts will add to the work on the contraction.

Most women enter into that primal mama zone; this is where the magic happens. But in some cases if a woman doesn't feel safe, supported, or encouraged to make noise (i.e. if they are told to hold their breath), the opposite occurs.

The more supported the mother feels, the more likely she is to report feelings of strength, decrease in tearing, and view their birth experience as a positive one- even if her birth didn't go as she planned.

This is why I strongly believe it is essential to help women through their pregnancy to feel empowered, to create an environment to birth in that meets their needs (mind/body/spirit), and to allow them to find that innate knowing of how to birth their baby, noise and all!

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