Physiologic Labor

Pushing

One of the most common questions among first time mothers is, "When will I know it's time to push?" The most common answer among experienced mothers is, "You'll just know!" The body is designed to begin pushing when pushing will provide assistance at getting the baby out.

Once you have hit transition, you will soon be upon the time when contractions spread out again. They generally move to about five minutes apart but they may stop completely. Some women experience what is known as a "rest and be thankful" stage. This occurs because once the baby passes through the cervix, the uterus may need to "catch up" to be snug against the baby, because the contractions will only move the baby when the uterus is snug against the baby.

The urge to push is caused by the baby's head being pressed on the nerves that signal the need for a bowel movement. You may feel this several times in one contraction, and then not feel it at all in the next contraction. That is normal. Remember, sometimes the uterus needs to "catch up" to the baby. Simply pay attention to your body and push when your body tells you to push and breath when your body tells you to breath. This is not a race, and you will not get any medals for pushing your baby out in 10 contractions rather than 12 or 13, so work with your body rather than against it.

Some women get the urge to push right away, and their bodies simply involuntarily bear down as if they were suffering from uncontrollable diarrhea. Other women wait as the contractions bring the uterus back into contact with the baby. Do not be alarmed if your contractions seem to have stopped, or space out without an urge to push. That urge will come when the baby is in the proper position to be pushed out. It does you no good to push before that, since it will not move the baby and will exhaust you.

If the urge is only at the peak, changing position will either take the urge away, or will allow the baby to slip further into the birth canal and begin strong urges to push. Some women find that simply leaning forward is enough to remove the pressure from gentle urges to push. If the urge to push is not strong, it may be better to change position or lean into the contraction until the pushing urge is strong. This helps to prevent fatigue and allows the strongest pushing to be done when it will be the most effective.

When left alone to push as necessary, most women will do between 3 and 5 pushes that last approximately 6 seconds in one contraction. The variation in length, duration and number of urges in a contraction is due to the position of the baby. Sometimes the baby moves enough with a push that for the next contraction the uterus needs to contract to get tight against the baby again to push on the baby and put pressure on the rectum. Every contraction will have a different pushing pattern.

Some mothers find that they have no urge to push, the baby is simply pushed out by the contractions of the uterus. Most women find that it is most comfortable to hold their breath while they push. Taking in air and holding your breath puts a pocket of air above the uterus to help align it properly, and many women find it lessens any discomfort they feel. Other women find no need to hold their breath, or prefer to exhale as they push to allow them to remain relaxed. Whichever method is comfortable for you, remember to breathe when your body calls for more oxygen. Women who are left alone to push as their body indicates generally push for six second increments rather than the 10 that is commonly asked for in maternity wards. If someone is asking you to push longer than is comfortable, simply smile politely and continue on about your work.

When you begin pushing, you will probably be excited again, and then work through the serious and may even get to self-doubt if the pushing stage lasts long enough. It is normal to go through all the emotional signposts again during pushing. You may begin to feel that you are making no progress, pushing can take time and there is no proof that it is safer for a healthy baby to be pushed out in less than two hours than it is for the healthy baby to be pushed out in four hours. Simply work with your contractions, and enjoy the break you will have between contractions. Eventually you will be able to see your baby's head.

Pushing is done when the baby is outside of the mother. This can take anywhere from 20 minutes to over three hours. After the baby is out, the third stage of labor begins. This is the expulsion of the placenta. It is generally less than 20 minutes and is no more uncomfortable than giving a moderate push when the pelvis feels full.

Crowning

You will first be able to see about a quarters worth of your babies head during pushes, and it will disappear when you stop pushing. Some women find that by reaching down and touching the baby, they are better able to focus their energy for pushing. The baby will seem to take two steps forward and one step back until suddenly your skin begins to stretch and the widest part of the baby's head is passing through your vagina. When the widest part of the head is passing, it is called crowning.

Many women feel that crowning as a burning and stretching sensation. Some women remark that it feels as if their whole body were tearing in two, even if they did not tear! The skin does stretch, and it can be painful, but it is important to remember that the baby's head is putting tremendous pressure on the vaginal and perineal skin. This pressure cuts off the circulation and numbs the surrounding tissues. That does not mean that you will not feel the stretching as your baby crowns, but it will be a duller sensation than you might think, like putting pressure on your foot when it is asleep.

When you feel your skin stretching, it is your bodies signal to stop pushing. This is important as it helps to prevent your skin from tearing by moving the baby through too fast. God simply set it up to work this way so the discomfort from crowning will prevent you from pushing. You should also fully relax your pelvic floor muscle at this time (bulging your kegel) to allow the most stretch possible for the baby's head. Keeping the pelvic floor relaxed will help you prevent a tear as well.

Once the head is out, the baby will begin to turn to work the shoulders through the pelvis. It is then just a matter of pushing the body out with one good push. Sometimes the body just slides out once the shoulders have been released. As your baby comes out you will feel a gush of water as the rest of the amniotic fluid empties. Your baby will still be connected to the umbilical cord, but it should be long enough for you to hold and breastfeed your baby while you wait for the placenta to be born.