Few pregnancy and birth-related books today discuss all three phases of the pushing stage. Instead they make it seem that mothers should simply start to push as soon as they reach 10 centimeters. Thanks to Penny Simkin and other recognized childbirth experts, it is now known that the second stage of labor includes three separate phases:
- the resting phase
- the descent phase
- crowning and birth
It is crucial for mothers to know about these phases so that they can start to push and push more effectively when their body is ready to do so.
Descent Phase - Are You Ready to Push?
After a pause in labor where the contractions space out a bit (known as the resting phase), the baby moves down further into the mother's birth canal. Contractions pick back up again in the descent phase and mothers will typically feel an urge to push. This urge will become stronger as the baby descends more. It is important to wait until the urge to push comes and not to push simply because the cervix is fully dilated. Studies show that delaying the onset of pushing decreases the overall length of time the mother spends in the pushing stage.
If the mother has an epidural, her urge to push will be reduced. She can request a period of time to "labor the baby down" and delay pushing until her baby's head is at a +2 station in her pelvis in order to not waste precious energy.
Pushing Without an Epidural
The laboring mom can use a variety of ways to begin bearing down efforts. If she is unmedicated, she will typically feel an urge to push and not have difficulty pushing spontaneously with each contraction.
Most mothers without an epidural need only to have encouragement when they are pushing well and support in various positions since they will respond to their body's urges to bear down. They seldom need direction or "coaching" to push, but if they do, directed pushing (see below) can be used.
Pushing With an Epidural
Directed pushing may be needed with a mother with an epidural. Mothers can be directed by labor partner or doula to take a few cleansing breaths, then after the next deep breath, bear down to a count of six to eight, take a quick breath, bear down again to about six seconds, followed by one last breath and another push to six seconds. She should end her contractions with a cleansing breath to completely relax. Resting in between pushing contractions is very important for all laboring women.
Moms who are using an epidural will need feedback to know when they are pushing effectively. They will also need lots of encouragement to keep going since pushing is known to take longer with an epidural. Since they will be unable to support themselves or hold up their legs, mothers with an epidural on board will need even more physical support during pushing than without an epidural.
Positions During Pushing
Mothers should be encouraged to change positions for comfort as frequently as she desires. Sometimes the positions that restrict the mother to pushing in the hospital bed are not the best ones to allow the baby enough space to descend. Being able to change positions freely during the second stage of labor is one of the many advantages of not using an epidural.
If the baby is not descending well into her birth canal, a good rule of thumb is to change positions approximately once every 30 minutes. Some of the best positions to push in include side-lying, all fours, kneeling and squatting. Check with your birth doula, labor nurse or midwife during labor to see which positions work best for you during the descent phase.
What Should You do During the Descent Phase?
Mothers should continue to rest in between contractions, sip fluids and change positions frequently during the descent phase of labor. Partners can offer a cool washcloth on her face, forehead, chest and neck since she will tend to perspire a lot with her bearing down efforts.
How long should she expect to be pushing? With a first baby, pushing can take as long as two to three hours. The good news is that second or later babies tend to take much less time. Bigger babies and babies that are in a posterior position can often make pushing take longer. All mothers need patience, encouragement and belief that their bodies are working during the descent phase, not to be setting time limits on pushing or watching the clock.
The more mothers know about pushing and how to help their bodies do what they are designed to do, the more they will be able to manage the challenges of the descent phase of labor.
References:
Simkin, P., The Birth Partner, Harvard Common Press., 2008
Lane, B and Kirsch, I., Knack Pregnancy Guide, Globe Pequot Press, 2009
Brenda Lane - Brenda Lane is a published author, Lamaze certified childbirth educator, DONA certified birth doula and approved birth doula trainer.
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