Information about Pushing in Labor

I just listened to a broadcast by Gloria Lemay, birth attendant extraordinaire.
If it interests you (which I assume it does if you’re reading this) please go have a listen! She is so knowledgable about birth, it’s crazy.

The broadcast was all about pushing for first time mothers in labour, so I wanted to write about it because I feel like it’s not talked about enough.

I’m sure we’ve all seen birth portrayed in the media in some form or another, where the nurses check the mother and she’s at 10cm so they all instruct her enthusiastically to PUSH!!!

We’re going to learn right now why this is actually quite counterintuitive.

For starters, minimal pushing = better chances at intact perineum.

Birth is a private, intimate, physiological event that, should be allowed to unfold naturally and remain undisturbed until an actual evidence-based concern arises. It requires patience and respect.
I can tell you first hand that at pretty much all of the hospital births I’ve attended, at some point or another a nurse walks into the room, voice booming, asking questions to the mom, trying to do a vaginal check, disrupting whatever flow was going on.
While I understand that they are doing their jobs, it doesn’t always feel like they are giving the most individualized care. They deal with labouring women all the time, it’s not new to them like it is to a first time mom (and this isn’t to say that all nurses are like this because I’ve also come across some very lovely, calm, gentle ones who respect the space).
If instead we allow birth to unfold as it’s supposed to, we can guarantee a lot more positive outcomes.

When the mother, after hours of labour, says “I have to push!” this is not immediate cause for concern. The natural next step for most people would be to perform a vaginal exam, ‘are you 10 cm and ready to push yet?’. However, performing said vaginal exam risks not only uterine infection, but stalling of labour. Not only is it super painful for the birthing woman to be checked at this point, but it disturbs the whole flow of the birth, and can set the progress back a few hours.

External Observations of Dilation Progress

Instead, there are external observations that care providers can make the determine what’s going on:

1. If the mother feels the urge to push at the peak of the contraction versus at the start, there is still more dilation to do.
2. Does she grunt & bear down with every push or every other push? If it’s not every single time then there’s more dilation to do.
3. What is her rectum doing? If it’s not flaring with every contraction there’s more dilation to do.
4. A dark red/purple line appears at the top of the rectum going up between the bum cheeks in active labour, if there’s no line, there’s most likely still dilation to do.

If mother starts involuntarily pooping, that’s a very good indication that baby is close by!

A lot of the time when the mom says she has to push, she feels it in her abdomen, not her rectum. It’s normal to feel baby move down inside of you, and it’s not cause for concern.

Encourage mom to listen to her body and that gentle easy pushing, if she feels the urge, is fine. Swollen cervixes do not happen because of this, they happen because of pushing when she is not ready & feeling the urge.

Update January 2019 : The Rhombus of Michaelis is another way to determine the progression of birth!

Good Things Take Time

Each expulsive sensation shapes the baby’s head to the contours of the mother’s pelvis. This takes time, gentleness, and care. It does not mean failure to progress. It’s normal for baby to feel ‘stuck’, but the head is just elongating and moulding to fit through the birth canal. Encourage mom to hydrate & sleep as much as she can during this time.

*Don’t forget, baby is an active participant in the birth process & should not be forced out before he is ready!*

It’s very important to not disturb the birthing woman, by doing vaginal exams, asking questions, having side conversations in the room, etc. What she needs during this time may vary from woman to woman, but when she’s in the last little bit, she goes into a trance-like state. She needs quiet, dark, solitude, & privacy. This is a time where she is her most primal, most vulnerable, and needs to be able to birth the way she needs to.

A great quote that Gloria Lemay mentions is “birth is a no-brainer”. Of course it is!
When you’re giving birth, you don’t think. Ahead of time yes, you plan, you research, you get all your ducks in a row. But during the birth process, it’s too primal to think. Birth is like any other elimination process, ie pooping, coughing, sweating. It’ll happen when you stop thinking about it.

One last tidbit I want to share is this. When it’s tough, and you’re tired, and you may even be at 10cm but it’s not just happening; imagine dilating to 11cm.
Some women may just need that extra bit, and while it’s not a known physiological thing that we can dilate to 11, just imagine it. The power of mindset is strong.