When it comes to pushing out your baby, it is clear that a more natural approach, known as "laboring down," is beneficial versus pushing as soon as you are fully dilated. What do you need to know about laboring down if you are preparing to give birth?
What is Laboring Down?
Laboring down is a technique that is used once the mother is fully dilated. Rather than pushing as soon as she is 10 centimeters, a mother who labors her baby down will refrain from pushing for an hour or more. During this early phase of pushing, her uterus will be contracting to press her baby down through the birth canal, without the help of her voluntary pushing.
In essence, her body is doing all of the pushing while she conserves her energy to push later. She begins pushing at the point where she feels a strong urge to push or when her baby is much lower in the birth canal. In some cases, this may mean waiting for an hour an more after complete dilation before pushing.
Can I Labor My Baby Down if I Have an Epidural?
The answer is yes, you can labor down with an epidural! In fact, you may even be able to wait longer before beginning to push since your urge to push will likely to be reduced with an epidural.
Since mothers who use epidurals will not typically feel a strong urge to push, a good rule of thumb is to request to labor down until your baby's head reaches a +2 station or about halfway through your birth canal. This can be measured by a vaginal exam during labor by a labor nurse, midwife or physician.
What are the Benefits of Laboring Down?
Research shows that the benefits of laboring down include significantly decreasing the length of time the mother pushes. In fact, waiting up to 90 minutes before beginning to push decreased the mother's pushing time by more than 50% without increasing complications for either mother or baby. Laboring down can also decrease the use of instruments such as a vacuum extractor or forceps being used since it helps to conserve the mother's much-needed energy.
The baby also benefits from a mother's laboring down technique, according to medical evidence. Mothers who waited before beginning to push had fewer problems with their baby's heart rate decelerating and the baby's oxygen levels were improved in the groups where the mothers labored down, versus the moms who pushed right away.
Will My Nurse and Doctor be Familiar with Laboring Down?
While some care providers may be familiar with and do encourage their patients to labor down, it is still common practice for mothers to be directed to push forcefully as soon as they are 10 centimeters dilated. This is a practice known as "directed pushing" and according to the Journal of Midwifery and Women's Health, it may be the more common technique for pushing in today's birthing facilities.
A care provider may also be familiar with the concept of laboring down, but use other terminology. Expectant moms should make a note that other medical terms that mean the same thing as laboring down include "passive descent", "resting phase" and "delaying the onset of pushing."
How Can I Request to Labor Down?
It is recommended that mothers-to-be discuss as many birth options with their care provider during pregnancy, rather than waiting until the throes of labor. This is another reason why writing a birth plan and discussing your preferences with your care provider well in advance of childbirth can avoid potential conflict.
As long as both mother and baby are healthy during labor and birth, most women can easily employ and benefit from the technique of laboring down prior to pushing.
References:
Lane, B., Kirsch, I., Knack Pregnancy Guide, Globe Pequot Press, 2009.
Kelly, M., "Delayed versus immediate pushing in second stage labor," The American Journal of Maternal Child Nursing," Mar-Apr 2010.
Roberts, J., "Best practices in second stage labor care: maternal bearing down and positioning," Jnl of Midwifery and Women's Health, May-June 2007.
Brancato, RM, "A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor," JOGYNN, Feb 2008.
Simpson, KR., "Effects of immediate versus delayed pushing during second stage labor on fetal well-being: a randomized clinical trial," Nursing Research, May-June 2005.
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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