"CAN'T BUT PUSH" is our mantra for birthing! Let's break it down.
I heard this mantra from Dr. Aviva Romm on her podcast and you can also read this interesting article about life and breathing here!
The pushing phase is often the most daunting part of labor and birth. We all see the Hollywood movies of birthers laying on their back with their legs either in stirrups or being held up for them (I'll save this topic of why someone else holding/pushing your legs for you is not ideal for another post because it's a long one! You'll learn all about this and what to do instead in my Birth Ball Basics Workshop!).
Tip #1: Birther Directed Pushing
When women are being told when to push and for how long and "don't stop until we've counted to 10", this is called provider directed pushing or "purple pushing" and can actually increase the length of the pushing phase (yikes!) by not working with your body! It also increases the risk of nerve damage and structural damage to the pelvic floor due to the sudden increase in internal abdominal pressure and rapid expansion of the vagina and perineum.
Mom tires out extremely quickly from the excess exertion, eyes straining and popping out from pushing, blood vessels breaking, people screaming at you to PUSH! and the mom actually turning purple from the lack of oxygen which in turn gives the baby less oxygen and leads to increased risk for fetal distress, episiotomy, emergency Caesarean section, neonatal resuscitation, and/or NICU stay.
But, there is a better way to birth! A calm, empowering, primal, birther-directed, physiological way to push. When YOU feel the contraction wave, that's go-time to push with your body and you are much more likely to be pushing for much less time!
Tip #2: Ride the contraction wave until you can't do anything but push!
As you feel the contraction at its peak, surrender more into that sensation, and use the breathing techniques you've learned in Birth Ball Basics (BBB) workshop until you can't do anything but push to help greatly reduce the chances of tearing by listening to your body and working with your contractions!
Tip #3: Use Movement
Change positions frequently, especially if you are in a bed! Tucking and untucking your pelvis, side to side lunges, birth ball circles, dancing/swaying with partner, etc. Get up and around as much as possible to use gravity to your advantage to help baby get into their best position available to them.
Tip #4 Pushing Friendly Positions
As you feel a contraction beginning, get set into whatever position is working best for you at that moment in time. This can change quickly from contraction to the next. If it doesn't feel like its working, try a new position based on what feels good to you or ask your doula for a suggestion for the most productive contraction!
Your doula may be able to know (ask them if they have this skill!) by your sounds, emotions, movements, smell, where you are feeling the contractions, or a cervical exam checking for the station of the baby. Based on where your baby is at in your pelvis and/or by visual cues, you can get into positions that will support the baby's level in your pelvis. Typically, some great positions are in hands and knees with toes tucked, on forearms and knees, holding onto your partner and swaying/dancing, squatting, leaning over a birth ball, sitting on the toilet, etc. Being on your back is not a pushing friendly position, rather a provider-friendly pushing position.
When we are in ideal pushing positions and feel in-control and relaxed, we often help our baby descend by finding intuitive birthing positions that also manage our pain better. These positions can help to reduce pressure on the spine and pelvis and increase pelvic mobility, allowing for a more comfortable experience.
By choosing an upright position, such as standing, swaying, or sitting on the toilet, gravity can assist in the downward movement of the baby, potentially aiding in a quicker labor process. While the hands and knees position can help to relieve back pain and encourage optimal fetal positioning. Both of these positions offer birthers the freedom to move and find what feels best for them during this special and empowering time.
For supporting a natural birth or even if you are planning to have some medication to help alleviate labor pains (there is always the chance that it doesn't work properly!), it is important to listen to your body and find/interview healthcare providers who are willing to follow your lead and only intervene if you or the baby are not coping well.
#5 Tip: Take it Slow
Unless there is a reason the baby needs to come out ASAP, use the can't but push mantra and go slowww while pushing. Only push when YOU feel your body bearing down to slowly expand the vagina and perineum. This is key! Let the uterus be the driver of pushing instead of trying to force the baby out.
Relax your jaw, your shoulders, your legs... find a low toned grunt, uhhhh, ohhhh, mmm or whatever comes naturally to you while focusing on breathing through the wave.
Of course there are more way to decrease tearing and may nuances/scenarios that could happen, but these are by far my favorite and I always go over and practice with my clients and BBB participants. Let me know if this resonates with you or you'd like more tips!
Resources
(2020), Second Stage of Labor: Pushing Your Baby Out. Journal of Midwifery & Women's Health, 65: 439-440. https://doi.org/10.1111/jmwh.13126
Huang J, Zang Y, Ren LH, Li FJ, Lu H. A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci. 2019 Jun 20;6(4):460-467. doi: 10.1016/j.ijnss.2019.06.007. PMID: 31728401; PMCID: PMC6839002. [PubMed]
Looft E., Simic M., Ahlberg M., Snowden J.M., Cheng Y.W., Stephansson O. Duration of second stage of labour at term and pushing time: risk factors for postpartum haemorrhage. Paediatr Perinat Epidemiol. 2017;31(2):126–133. [PubMed]
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