Labor and Delivery: Pushing

Labor and Delivery:

by Marianne Fuja, RN, BSN

During the first stage of labor your "work” is to focus inward and conserve your energy allowing the uterus to work efficiently. The contractions thin (efface) and spread (dilate) the opening of the uterus (the cervix) that leads into the birth canal (vagina). The first stage is over when the cervix is completely ready – 10 centimeters dilated and 100% effaced.

The pushing stage begins. Your "work" is different now. You will feel an urge to push, and that is exactly what you can do, PUSH! Pushing is hard work; you will follow your body’s signals and use your energy to push your baby out. You will work with the contractions to birth your baby.

During pushing, the contractions last approximately 60 seconds and come every two to five minutes. Your "work" is to focus your mind and get your body ready. For a first delivery, the pushing may take a few minutes or up to three hours.

Positioning and breathing will impact your pushing. Discuss your choices with your caregiver during your prenatal visits. Ultimately you should be able to choose the position that allows your baby to descend and is comfortable for you.

Squatting may open yor pelvis to allow more room for the baby. It utilizes gravity and takes some pressure off of your back. The baby’s head presses evenly on the edges of the vagina. Some hospitals have squat bars, or you can squat with the support of your partner. Squatting may be hard for you if you haven’t practiced. Some caregivers may not be used to women squatting for birth. You may be able to squat for pushing and then be asked by your caregiver to lay back for delivery.

The side-lying position may help ease back pressure during pushing. You may hold your top leg, or your partner can, or it may be placed in a leg rest on the bed. Pushing may take a little longer in the side-lying position.

Lying on your back with your feet in stirrups is a common position for pushing. This position is convenient for your caregiver, especially if an episiotomy will be neccessary, or if the vacuum extractor or forceps will be used. You will be able to see your caregiver. You may experience more back pressure, and you will not be using gravity to aid your pushing efforts.

Whatever position you choose, it will be helpful for you to tilt your pelvis, round your shoulders, and put your chin to your chest while pushing.

Some women grunt and exhale during pushing while others hold their breath for a certain count. Discuss the different breathing techniques for second stage with your childbirth educator or caregiver. Practice the techniques and then during pushing use the one that is most comfortable for you.

During pushing, your baby descends through the pelvis and vagina. Each push brings your baby closer to your waiting arms. With each push you will use your abdominal muscles as well as your uterine muscles to provide the strong force necessary to birth your baby. As you push, your vagina will stretch to allow your baby to pass through. You may feel stretching and burning or stinging sensations. This is normal. Use these feelings to guide your pushing efforts.

The pressure of your baby’s head will cause bulging of your perineum (the area between your vagina and anus). Some caregivers will use warm compresses or massage the perineum to relax and to help stretch the tissues of the perineum. Concentrate on relaxing your thighs and pelvic floor.

As your baby becomes visible at the vaginal opening, the scalp will appear wet, wrinkled, and may be streaked with blood or vernix (a protective coating). You may want to use a mirror to see your baby’s head or you may want to touch your baby’s head. Discuss this with your caregiver.

Your caregiver will instruct you to pant or blow at this point to allow for a slower delivery of the head and shoulders; this allows your perineum to stretch. Do not hold your breath. Usually babies are born facing the mother’s back. Once your baby’s head has emerged completely your caregiver will suction the excess mucous from your baby’s mouth and nose. Your baby will probably cry at this point. As the shoulders get into position for delivery your baby’s head will rotate to face one of your thighs. With the next contractions you will deliver the shoulders and the rest of the body.

Congratulations! You have delivered your baby.

Editorial by Marianne Fuja, RN, BSN, Lead Prenatal Instructor at Central DuPage Hospital in Chicago, Illinois