Pushing Your Baby Out

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The Second Stage of Labor - Pushing

Caucasian man helping girlfriend deliver baby
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Second Stage: Once you've dilated to 10 centimeters, you are in second stage of labor, the pushing phase. This will end with the birth of the baby. This stage can last a few minutes or several hours.

What You Might Be Feeling

  • Contractions that are very manageable
  • Urge to push
  • Rectal Pressure
  • More energy

Behavior & Attitude

Now that you've come through the hard work of transition, you might get a second wind or burst of energy. After all of that relaxing, it feels good to actively help birth your baby.

Ways to Cope

You may find that you have a brief lull in contractions from the harshness of transition to the pushing stage. Remember to use it wisely, as one childbirth educator aptly called it the "Rest and be thankful phase!"

Here are some suggestions of things to do:

  • Remember to relax
  • Find a comfortable, productive position to push in
  • Figure out whether spontaneous or directed pushing works best for you

What Your Partner Might Do

  • Stay with her
  • Encourage her to find a comfortable, productive position
  • Praise her
  • Count for 6-10 seconds, if that is helpful for her

The position you choose to push in should be mainly productive and comfortable for you. Gravity will really help bring your baby down, particularly when pushing is difficult. If you're having a fast second stage choosing a position to slow the birth is good as well.

Squatting:

This also uses gravity and opens the outlet of your pelvis up to 10% or more. It's jokingly called the midwives forceps, but it's very beneficial. Can be used in conjunction with monitoring equipment. (See picture.)

Hands and Knees:

This is a great position is you have a backache! It allows the baby to come out of the pelvis slightly and encourages it to turn and assume a better position if it is posterior (or facing your front), it also provides some relief for contractions and removes gravity. Being in this position also allows you to do pelvic tilts for comfort and gives your partner great access to your back for massage and counter pressure. Can be used in conjunction with monitoring equipment. (See picture.)

Side-Lying:

This is a good relaxation position. It is gravity neutral and can help slow a fast birth or ease the pain of some contractions. It can be used in bed and in conjunction with monitoring equipment or may be requested if you're having complications with your blood pressure. (See picture.)

Lithotomy:

This position, also known as lying down sometimes with the head slightly raised, is most frequently used with epidurals and other anesthetics. It does not utilize gravity and can actually make a tear or episiotomy more likely. Even with medications there are better positions that you can assume, for example sitting more upright. Can be used in conjunction with monitoring equipment.

Overwhelming Urge: 

This is the uncontrollable urge to push. It really takes every ounce you have not to push with the contractions. A gravity neutral position may help decrease this urge if the birth is happening quickly.

So-So Urge: 

Mom may have the desire to push with every other contraction or only at the peak of the contraction. It may be that this is simply early second stage and the baby hasn't hit all the nerves to signal the overwhelming urge.

No Urge: 

As with the so-so urge, positioning and time are the best bets if this become a problem. It also might help to switch to directed bearing down.

Ways to Push

Spontaneous Bearing Down: 

This simply means that mom pushes as she feels the desire to do so. The proponents of this method claim it's less stressful to mom and baby and can make for a shorter second stage. Generally, the instinct moms have is to hold their breath for shorter periods of time and to relax other areas of their bodies.

Directed Bearing Down: 

This helps the woman who cannot feel her body push more effectively. You simply begin each contraction with a deep breath, blow it out, inhale again and hold the breath, using it to curl over your body and push down, while someone (partner, nurse, doula) counts to ten. You quickly release your breath, inhale again and repeat until the contraction is over.

Laboring Down: 

This method is gaining popularity with nurses and staff particularly for women who have anesthesia. The mother does no active pushing until the head can be seen. This is less tiring and better, particularly when mom can't feel to push.

We often think of the mother as doing all of the work during labor. This is actually not true. During the first stage of labor, the baby is twisting and turning trying to find the path of least resistance to allow themselves to be born.

During the second stage as the uterus is pushing the baby, and mom is working on pushing, many times the baby is also pushing itself out through the birth canal. Choosing positions to enhance this stage also help.

Stirrups & Foot Pedals

Breaking the bed down, or the use of instruments to help you push can either be beneficial or not. You can choose to give birth simply with the end of the bed attached.

Stirrups are the most common and are generally used with anesthesia, and sometimes after a very long labor. They hook on to the end of the bed and will support at least the calf area of your leg and sometimes the entire leg and foot. If you prefer to pull your legs towards you as you push you can do this. The drawback is that this can hyperextend your legs (pain later), most women are laying too far back to utilize gravity, and it can increase the pressure on your perineum making the tissue less resistant to tearing.

Foot pedals or heel cups are simply places to rest your feet while pushing. This can make the bed more like a birth chair. Many women, even with anesthesia, can use this type of support.

There are also a variety of other enhancements, like the squat bar, designed to help you squat on the end of the bed. It can also be used to place your feet against while pushing. Be sure to ask around to several people to find out if you have this available.

Birth Ball:

birth ball might also be helpful in assuming a variety of positions in labor. You can use a standard ball or a special ball called a peanut ball, which is helpful for mothers who need to stay in bed because of an epidural or for other reasons.

Third Stage: The Placenta

When you've got your baby in your arms this stage often gets neglected, but it begins with the birth of the baby and ends with the birth of the placenta. It generally takes less than an hour, though it can go on longer without complications for some women.

The placenta will detach from the uterine wall and be expelled through the vagina or birth canal. Your practitioner will be able to tell that your placenta is ready to be born either by a small gush of blood or a lengthening of the cord.

The third stage is fairly anticlimactic for most. While you're holding your baby the doctor or midwife may remind you to push gently to help expel the placenta. "My midwife with my second baby told me, 'Small pushes, this is easy, no bones for this one!' I laughed, and all was said and done," said one mother.

Sometimes the placenta is delayed. Nursing your baby will help stimulate contractions to help bring the placenta, because it will release oxytocin (hormone) into your body. Also coughing, sneezing and laughing can be used as techniques to help you expel the placenta.

What You Might Be Feeling

  • Contractions that are very manageable
  • Joy, relief, a mixture of emotions

What Your Partner Can Do

  • Hold the baby if mom can't
  • Remind her of relaxation and breathing techniques if need be

Some women and their families wish to see or save the placenta. Your practitioner can give you a quick tour of this amazing organ that nourished the baby for so long. In a homebirth setting, it may be your responsibility to dispose of the placenta. Be sure to ask.

Planting the placenta is seen as a ritual for some families. You need to dig a deep hole, at least 16 inches deep and bury the placenta. You must wait a year before trying to plant a tree or anything over it because it will be too rich and actually kill the plant.

The Birth!

Despite all of the technical information you'll find here, remember to enjoy the birth of your baby. Watch with the use of a mirror, or by looking down. Touch your baby's head as it emerges. Talk to your baby as he or she is laid on your abdomen for the important skin to skin contact

Sources:

Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD002006. DOI: 10.1002/14651858.CD002006.pub3

Lemos A, Amorim MMR, Dornelas de Andrade A, de Souza AI, Cabral Filho J, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD009124. DOI: 10.1002/14651858.CD009124.pub2

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