Labor: What To Do When It's Time To Push

A Guide to the Second Stage of Labor

Woman having labor pains
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The first time you have a child, you probably don't know what to expect. After all, no one really knows how labor will feel until they're in the thick of it. Perhaps you worry primarily about whether you'll be able to handle the contractions during the first stage of labor, when the cervix is opening up so that the baby can descend into the birth canal. But what about the second stage? What happens when it comes time to push?

The Second Stage of Labor

This stage of labor is characterized by the slowing down of the mother's contractions. They begin to occur less frequently. Where before the mother was probably told to "stay out of the way" of her contractions, now she must actively work with the contractions to give birth.

The Urge to Push

Some women will feel what is called an urge to push. This is generally caused by the baby being pressed onto the Ferguson Plexus of nerves, creating Ferguson's reflex: the urge to push. Not all women will feel this urge. Whether or not you do may be affected by your use of regional anesthesia (epidural, etc.), which can make you feel numb and unable to respond to your body's signals. At this point, some doctors will dial back the epidural so as to enable the woman to push.

The Rest and Be Thankful Phase

Once you are completely dilated, you may experience up to an hour of no contractions.

This has been fondly named the rest and be thankful phase. In some hospitals and birth centers, moms are required to push during this phase even if they don't feel the urge. This is not always beneficial to either mom or the baby.

Labor Positioning

Upright positioning can be favorable during the second stage of labor, as it allows gravity to assist the mother.

There are numerous positions available in modern birth beds, including the squat bar and foot pedals.

Out of bed positions are also becoming more popular. These include:

Side lying positions are also sometimes used to slow down a very rapid labor, and are great for protecting the perineum during a rapid birth.

Semi-reclined, or laying on your back with stirrups, is still very common in many hospitals, particularly if you have regional anesthesia or will be having a forceps or vacuum delivery. This position does not use gravity and increases the length of the pushing stage and increases the necessity of an episiotomy, vacuum extraction, and forceps. You can request a different position if you're uncomfortable with this option.

Purple Pushing

When you are asked to hold your breath to a count of ten during contractions, you're practicing purple pushing.

Why? Because of the attractive image of poor mom turning purple, eyes bulging out, blood vessels breaking, and a room full of people screaming, "PUSH!"

Purple pushing came into play as epidural rates increased. We now extend it to nearly everyone having a baby.

Other options for the second stage of labor include:

Laboring Down: allowing your body to push the baby out on its own. This means that you don't assist the pushing efforts of the uterus unless you have an overwhelming urge to push. 

Spontaneous Bearing Down: With this method, you wait for your body to tell you when to push. 

It's important to remember that, once you are completely dilated, it's anyone's guess as to how you'll respond to the second stage of labor. Some have very short pushing stages, while others push for quite awhile. With the use of various positions and bearing down techniques, you can achieve the most comfortable possible second stage for your body.

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