How to Push Baby
You know you better than anyone else. You can push baby without any direction - in the most gentle way or with all your might. Yes, even as a first time mother. If you remember nothing else for birth, this is the most important. It isn't about empowerment - it is the most true statement that can be made about your birthing body. Your body has carried you this far, made to gestate life, made to birth life, made to nourish life. No one tells it how to do that - it just does.
Your birthing body is as intelligent as your elimination functions - like bowel movements, peeing, coughing, sneezing... breathing. Your birthing body does not need help or guidance, though it does prefer an environment supportive of biology. This doesn't mean that it requires suggestions. You don't have a doula, midwife, or obstetrician holding your legs, directing positions, or ready to cut fecal matter out of you each time you have a bowel movement, do you? Sure, maybe there have been times the suggestion of a squatty potty, an abdominal massage, or a laxative have supported you or someone you know, but that's certainly not the norm (or, rather, it shouldn't be).
You Don't Have to Push Baby Out
Your uterus is amazing. You're amazing! Your uterus contracts to dilate the cervix. Yup, that's right - the uterus dilates the cervix, not the baby's head pushing against the cervix. Sure, how the baby is positioned can influence dilation, but often in terms of where most of the effacement and dilation is happening as well as the amount of patience your birth team will need. Your alignment and soft tissue health also has a significant influence on dilation and effacement as well.
As the muscles of the uterus pull open the cervix around the baby's head - all that tissue has to go somewhere and mostly it gathers up near the fundal area. Ideally all this occurs in an even mostly comfortable fashion based on overall health, wellbeing, and a supportive birth environment. Now, the top of the uterus has a nice thick mass to provide force to push baby earthside - no extra help needed. While many moms do feel an overwhelming urge to support this, actually gentle, force - when listening to their instincts, they often don't "push" for very long at a time providing themselves with plenty of moments to catch their breath and have the energy for as long as this phase takes.
Get OFF your Bottom to Push Baby
For the love of all whole perineums and energized mommas, get OFF your butt (and providers, stop propping moms up with pillows in this uncomfortable position with the inclination that it's the more optimal position). Unless (through no outside direction) your body encourages you to be on your bottom or your back, being in some sort of upright, often forward leaning position, allows for the most optimal movement of the pelvis and sacrum, not to mention the soft tissue and the baby. It widens the vaginal opening while giving you a bit of leverage for strength by being able to use your arms.
Being in a propped up squished-over-your-belly position has to be the worst for actually working with your body and getting any sort of lung capacity to avoid exhaustion. And when they add in "let me hold this leg back while Dad holds that leg bag," OY! It is NOT better than being flat on our back. Yes, getting off your back is beneficial to birth and fetal health - but pushing a baby out in a way that compresses the perineum between baby's head and a surface below the perineum is asking for an uncomfortable tear.
Listen to Your Body to Push Baby Out
Moving through labor AND the birthing [pushing] stage by following your instincts increases the safety of birth. It doesn't matter if a provider has caught 5, 500, or 5000 babies. YOU know YOUR body more than anyone. Only YOU can feel what baby is doing inside of you. A machine cannot. Only YOU can feel your pelvis, your ligaments, your uterus, your discomfort and your comfort. A provider or birth professional cannot. YOU are intelligent enough to make these decisions. What your birth team should be doing is supporting you in these decisions such as helping with light levels, loving words, comfort, holding you up, and generally keeping the environment calm and quite so your hormones can work at their optimal level (hormones that love the quiet, calm, and dark). While at some point you may desire some suggestions if there are some alignment influences - when and how to push is not one of those suggestions needed and almost always causes exhaustion to some degree in the mom. You DO know what to do, even as a first time mom. You don't need to be told where to push baby, though wisdom for birthing positions that support biology, as well as education prenatally and confidence building at any stage, can be valuable for allowing the instincts to be heard.
The Ring of Fire
Take your pointer fingers and place them inside your mouth - pull your mouth open gently and let the skin of your lips slowly stretch. The more supple the skin with healthy hydration, fats, and nourishment - the more easily you'll be able to stretch. The slower you go, the more time the elasticity of the skin will work with you.
As baby's head moves through the perineum, the stretching sensation can sometimes be intense (though not always) and is often described as the "ring of fire." Note that not all moms experience this. The beautiful thing about this moment is that it doesn't last long, and if you are following your instincts, typically any uncomfortable sensations trigger you to instinctively slow the support of pushing through panting, holding back as best you can any urge to push (often by blowing or altered breathing), or some other variation (including perineal, labial, or clitoral support by touching and adding counter pressure as you would through any other discomfort).
Fetal Ejection Reflex
There is this amazing moment where our body decides that having baby earthside is safer (in ancient views) than having baby continue inside that cozy womb. You get an overwhelming feeling that you need to push with all your might and have baby in your arms. In some cases, this can cause moms to push so hard that they may increase their chances of tearing. In most cases, listening to these urges (even for first time moms) is encouraged. Warm compresses can be helpful if you find this comfortable to help support the skin (especially if blanching of the skin is noticed); though it really depends on if you want people touching you and your baby. If blanching is noticed (and especially if you're in a position with pressure on your bottom) listening to the encouragement to slow our pushing urges at this point may be helpful in reducing or preventing tearing.6
When Guidance on How to Push Baby is Valuable
Keep in mind that you do NOT need guidance. Keep in mind that the more you listen to your instincts - your body - your spirit - during pregnancy and especially the early parts of labor, the more able you will be to trust your instincts through the birthing phase and into parenting. First time mothers sometimes have the most powerful instincts, but out of fear (whether self-induced or provider-induced) they learn to not listen to these voices in their head. They are told by so many that they have not experienced this before and can be guided. They even often ask for guidance because they are so uneasy about their skill and understanding (a significant side effect from a culture so detached from the birth process throughout life). They may be with a provider that totally supports and encourages mom to listen to her instincts and then the birthing phase comes into play and that trust gets thrown out the window (a modern medicalized approach common in all birth settings with all providers). Whether birthing in a hospital with a medical team to birthing at home with a midwife - and everything in between - your body will move baby out. Even mothers with epidurals can be placed into more biologically-friendly positions by her birth team to support the birthing phase rather than up on her bum, legs held back, and coached.
This isn't football...
That being said, guidance on how to push baby isn't wrong. Most pushing guidance is well-meaning. Some supportive guidance may be helpful when mom has not been supported or guided to let go and listen to her body and her birth team doesn't know how to encourage those thought processes. A few situations where guidance through the birthing phase can be very valuable (though most of these are guidance on positions rather than the pushing itself) may be:
- When there are misalignments or health implications that are not supporting a smooth labor and birth experience.
- When baby is coming fast and slowing things down may reduce tearing.
- When there are variations or complications that elicit the need for a wise voice in the mix to prevent unfavorable outcomes.
- When mom has been listening to her body for some time and she is getting discouraged and sleep and rest are not an option for various reasons... or in general when mom is in some way unable to let go and listen to her instincts. This is very common in a birth with too much going on or too many people present. Get back in that quiet, calm, and dark mode of labor and continue this through birth and the first few hours after the birth.
How to Push Baby Without Suggestions
- Eat well to encourage efficient muscle contractions, hormonal balance, and spontaneous labor
- Be aligned to encourage efficient muscle contractions, hormonal balance, and prevent funky baby positions
- Wait for spontaneous labor to ensure your hormones are at the best level they can be for pelvic mobility through labor and birth
- Be patient through all labor transitions so your pelvis has optimal movement time and baby's head can mould as needed
- Practice confidence during pregnancy by keeping a journal of food, symptoms, your own prenatal care (along with your provider's as you like) so that you have a more active approach during appointments and feel less at the mercy of others. The more you learn now and are able to communicate to others, the more confidence you will have during labor. This goes for Dad and whomever may be your main birth partner or people on your birth team. You can make the decisions - make them!
- Don't allow fear (or lack of health) to prevent you from moving during labor. If you are so scared because you're unprepared, or haven't taken care of influencing trauma, that you don't want to move out of one position - you'll encourage misalignment, discomfort, and a not so fun birthing phase. Learn all you can. Get counseling. Communicate. Find a provider that sees your fear and helps you. Hire a doula. Change your birth choices. Dance. Get in a shower or birthing tub. Get out of the shower or birthing tub and move. Do what it takes to increase your level of calm, confidence, and instincts.
- Labor instinctively through positions and relaxation, eating and drinking so that you're aware of your instincts during the birthing phase.
- Listen to your instincts during pregnancy and labor so you learn to hear them. If you have to pee, don't wait. If you have to poop, don't wait. If you have to adjust your lifestyle to accommodate these things as well as your stress level - take the initiative and make it happen. Don't allow yourself to let everyone else dictate your health. This is your job.
- Wear earplugs if you have to block out any noise around you... or earbuds - whatever floats your boat.
- Ask anyone to leave that is not supporting your instincts. Say, "No Thanks." Have a partner or doula that can remind others in your space that you will be following your instincts through the entire adventure. Ask them questions like, "Where are some towels?" "Could we get some more pillows?" "Would you be able to cover the machines, turn down the lights, get me a cup of coffee, grab a snack, give us some privacy...etc.?" Whatever questions give them something to do other than providing suggestions. If you're in a space that doesn't let this happen... consider changing your birth plans.
- Talk with your providers well well ahead of time so it is very well known that you want all talking and suggestions minimized at all parts of labor and birth - no matter if you're birthing in a hospital or at home.
- Avoid vaginal exams - especially the one many providers do to "check for full dilation." This doesn't feel good and is incredibly disruptive to oxytocin and the flow of labor hormones needed not only for comfort and physiology, but the safety of the birth as well. If you're feeling pushy, go with it - there is a very low risk of swelling your cervix if you're following your body's signals. There's a pretty logical chance that if you're feeling pushy, you're ready to push. It's like when you feel like you have to pee, you probably have to pee. Kind of funny how our body shows us signals like that.
- Relax and let go. Sometimes easier said than done, I know.
OH, right... how to push... So, you'll see you don't NEED suggestions for pushing because YOUR BODY ALREADY KNOWS. It's ALL about the environment - the birth team and the birth location - that supports your body to do its thang.
How was your birthing phase? What position(s) did you choose?how to push baby