In the movies, pregnant people push as hard as they can for hours and are encouraged to keep pushing harder, told they are doing a great job when their eyes are bulging and their faces turn red. In real life, many people are encouraged the same way, but is it really the best way? Is this an accurate representation of the amount of effort someone should need to utilize in order to have a baby? Is the pressure good for baby? Is it good for the pregnant person?

NO!

Valsalva pushing - increases blood pressure, reduces blood flow to perineum, increases tearing, increases risks to baby

What is the better way?

The better way is to learn from what works in an unmedicated birth and utilize this knowledge in all births. When people have an unmedicated birth, it is easier to recommend following their instincts. Their instincts are intact, but when pitocin and/or an epidural are used they effect your body’s responses and your instincts become difficult to follow. Pitocin can make contractions more intense than your body is ready for, and cause more fatigue than necessary. Epidurals cause your pelvic floor to become lax which means you cannot feel pressure against it and your baby’s head does not get the pressures it needs to instinctively move through the birth canal. The use of Pitocin and/or epidural does not mean that we should be ignoring all we know about how natural birth works. We can still incorporate a lot of the knowledge we have about delivery positions, how to push, and how to avoid fatigue.

Unfortunately, most medical providers have not seen a vaginal delivery in which no medication is administered. This was really surprising for me because pregnancy and birth are their field of study and area of expertise. Haven’t they seen all types of labors? As shocking as it may sound obstetricians are not experts in natural delivery. They are experts in labor and delivery their way. They are definitely experts in cesarean and if you know that you or your baby’s health are at risk then obstetricians with a team of nurses and pediatricians is what you want to make sure you both receive the medical care you need. That being said, birth is not a medical event in and of itself. Without a medical condition, there is no need for medication or a medical team. Midwives are trained in healthy births, and most have a good amount of knowledge about how to make delivery easier and less traumatic to both the birthing person and the baby.

Pushing can be too fast

Everyone celebrates when someone does not need to push very long in delivery, but when the delivery/pushing phase is too fast then perineal tearing is more likely to occur. This can definitely be hard to assess yourself due to lack of experience, and due to being focused on the actual pushing part. Having a midwife, obstetrician, or nurse who is experienced in guiding people to slow down their pushing can be helpful to be sure the vaginal and perineal tissues have a chance to stretch slowly without tearing.

Pushing should not begin until your baby is at a +2 station

Many people are cued and encouraged to begin pushing as soon as they get too 10cm, but 10cm does not guarantee your body is ready. There are five major cervical changes that need to occur.

• Softening - The cervix is firm and closed throughout pregnancy, but needs to soften or ripen as pregnancy and then labor progress. A soft cervix will be able to further change as needed to birth your baby.

• Effacement - measuring the length of the cervix. The cervix needs to get short, to almost nothing before the baby can leave the uterus. 90% effaced means the cervix has thinned 90% of the way to the very thin state that is needed for baby to be birthed.

• Dilation - The opening of the cervix. This is the change most talked about, and while important is NOT the only measure needed to be considered.

• Position - The cervix points posteriorly and will shift more anteriorly toward the vagina throughout labor.

• Station - The cervix sits up high during pregnancy, but needs to move closer to the pelvic floor in order to deliver your baby. If your cervix is at your sit bones or even higher, then it is best to wait until the cervix (and the baby’s head) moves down to the pelvic floor. This can mean delaying pushing for 30 minutes even while your body does the work needed to bring your baby down.

In first deliveries, often softening and effacement occur first, followed by dilation and position, and last station. Upright position helps gravity to pull your baby down onto the cervix which helps to encourage the above cervical changes to occur. This means that if dilation is slow or station is not changing after other changes have completed, then moving to an upright position might help.

Free pelvis positions are best

There are three joints to the pelvis. If any of these joints are held in place, then your baby will have more difficulty navigating through the birth canal or the free joints will have to move further than they should. Free pelvis positions are positions in which 0-1 bones of the pelvis are held in place which allows the three joints to move freely and your baby to travel through the pelvis more easily. Examples include standing, all fours/quadruped, side-lying, sitting, squatting, and lunging. Notice that lying on your back is not listed. Lying on your back holds 2/3 joints in place, presses the bottom of the sacrum and coccyx into the pelvic outlet (the opening at the bottom of the pelvis) making it smaller, and increases the chance of perineal tearing. Also note that when a person is lying on their back the birth canal is pointed upward once the baby reaches the pelvic floor at a +2 or +3 station. This means that when you deliver on your back you have to push your baby up against gravity.

Do not push for 10 seconds while holding your breath

In unmedicated births, we know that people tend to push for 5-7 seconds, 2-3 times per contraction, with breaths in between. This pushing pattern allows for slow stretching of the pelvic floor muscles, with good oxygenation, and rest time in between pushes. It reduces the rate of tearing, improves blood flow to the baby, improves bloodflow to the perineum, and does not increase maternal heart rate or blood pressure.