by Rosemary Romberg
I. SYMPTOMS OF IMPENDING LABOR AND BEGINNING OF ACTUAL LABOR
During the last few days of pregnancy a number of symptoms may occur which indicate that labor will soon begin. In general those events tend to indicate that labor will begin within the next few days, or perhaps the next few hours. These symptoms, of course vary widely from woman to woman. Few of these occurrences are experienced by all expectant mothers. If you listened to a group of ten women who had all previously given birth, each would tell a different story.
Prior to the onset of labor the baby’s head (or presenting part) settles down further into the mother’s pelvis. Common terms for this occurrence are “dropping”, or “lightening.” The technical term for this is “engagement.”
During the last few weeks of pregnancy many women feel a sense of pressure in their chest and lung area and with this a shortness of breath, due to the growing uterus and baby. After dropping takes place, most women tend to feel more room and comfort in the upper chest area. However, as a result of dropping most women feel much greater pressure in the lower pelvic area. Symptoms that may indicate that the baby has dropped include:
1. Frequency of urination. This, of course, is due to the baby’s head placing direct pressure on the bladder.
2. Lower pelvic pressure, perhaps with general achiness in the front pelvic area. Frequently women find that they become uncomfortable if they are up walking around for very long.
3. Backache or back pressure. Whether pressure is felt in the front or back area of the pelvis may depend on how the baby’s head is positioned.
Dropping or engagement can occur several days or a week or two prior to the onset of labor for some women. Other women experience this just a day or two, or perhaps a few hours before labor actually begins. Others do not experience this until labor has actually begun.
4. Hyperactivity, or a burst of energy sometimes takes place during the last day or few days before labor begins. Some women clean out all their cupboards and drawers, mop and wax their floors, stock up on groceries, or put up food by canning, freezing, etc. Some of this activity makes sense because of the fact that once the baby is born they will be tired, physically taxed, and preoccupied with the baby for quite some time. Some women, with the knowledge of this, have a feeling that they must get everything done up now, or they will never be able to at all.
Many animals, especially those that live in the wild, have natural nesting urges. They are instinctively know, shortly before labor begins, that they must begin to dig a hole, gather brush or leaves, or pull out their own fur, to prepare a nest for their young. (Rabbits kept in cages frequently go through digging motions in their cages prior to delivering.) There has been considerable speculation that some common types of behavior that women often undergo shortly before labor begins may be related to the nesting urge.
It is important, however, not to allow oneself to become exhausted shortly before labor begins. Labor will be much easier to deal with if you are well rested in advance.
5. Insomnia. The inability to sleep can be a problem during the entire second half of pregnancy for many women. However insomnia can particularly tend to occur shortly before the onset of labor and can also be related to the nesting urge. Perhaps it is preparing you for the fact that you will have to get up with the baby during the night for several weeks after he/she is born!
If you find that you are unable to sleep, it is important that you rest as much as possible, so as to preserve your strength and energy for actual labor. Quiet activities such as reading or watching TV may be helpful If your membranes have not ruptured, a warm bath can be relaxing. If you are having a bout of false labor a warm bath will probably make the contractions go away.
The following are other symptoms that women sometimes experience prior to the onset of labor:
6. Hypoactivity, or lack of energy. In direct contrast to the burst of energy experienced by some, other women feel a pronounced lack of energy at this time. They want to lie down, rest, and not do or think about anything.
7. Lack of appetite. Some women tend to not want to eat much shortly before the onset of labor.
8. Diarrhea. Some women experience a natural enema or emptying out process prior to the actual beginning of labor.
9. “Menstrual” type sensations. Many women have a particular way that they tend to feel shortly before their menstrual period begins – sort of bloaty, achy, or restless. Some women tend to have these same type of general feelings shortly before labor begins.
10. Braxton-Hicks contractions. The uterus actually contracts regularly throughout one’s entire lifetime. However, under ordinary circumstances most women are not aware of this because the uterus is small. During the final trimester of pregnancy, nearly all women are aware of their uterus occasionally tightening up and becoming firm all over. This sensation tends to last around 30 seconds to 1 minute. These are Braxton-Hicks contractions (named after the doctor that identified them). In most cases Braxton-Hicks contractions occur at random, with no set pattern. Sometimes they are especially noticeable in response to a sudden movement or change in position, or can occur as a result of sexual arousal. In most cases Braxton-Hicks contractions only feel like pressure, and no discomfort is felt with them. Often unless the mother is paying attention to it she may not notice these contractions.
Braxton-Hicks contractions differ from actual labor contractions in that they tend to merely bunch up around the baby, while regular labor contractions dilate the cervix and propel the baby downward. Also, true labor contractions occur at regular intervals and become increasingly stronger and more uncomfortable for the mother.
Some have speculated that since the uterus is a large, powerful muscle which has a tremendous job to do during labor and birth, it needs to practice by having Braxton-Hicks contractions.
During the last few days prior to the onset of actual labor many women experience a large amount of Braxton-Hicks contractions. Sometimes Braxton-Hicks contractions do gradually turn into regular labor contractions. Frequently during the early stages it is difficult to know for sure whether or not she is experiencing true labor or simply a lot of Braxton-Hicks contractions.
Some women experience false labor. This is simply a large bout of Braxton-Hicks contractions which seem to be coming at regular intervals and become somewhat uncomfortable. Occasionally women go to the hospital or birth center, or get set up for home birth only to have the contractions stop. It is certainly very discouraging to become psychologically ready for giving birth only to have to call it off and wait several more days.
However, some women are not sure whether or not they are in labor until actual birth is imminent. One is better off being safe than sorry in these instances. If you think you may be in labor but are not sure, it is a good idea to contact your doctor or birth attendant and be checked for cervical dilatation. Many hospitals have a policy of allowing expectant mothers to come in and be checked or observed for a few hours without officially admitting or charging them.
The ten above listed symptoms of impending labor are not, in most cases indications to contact your doctor or birth attendant. They are simply normal events which you can be alert to and know that they mean that pregnancy is nearing its end. you may wish to mention these symptoms to your doctor or birth attendant at your next regular appointment.
There are three official ways in which labor can actually begin. If any one of these events happens, notify your doctor or birth attendant:
1. Loss of the mucus plug. During pregnancy a plug of mucus develops in the inside of the cervix. This mucus plug serves to protect the uterus from infection by keeping out bacteria. Before or during early labor the cervix begins to dilate, thus loosening the mucus plug. The plug of mucus is attached to the inner walls of the cervix with tiny capillaries which rupture. Because of this many women experience what is commonly known as the bloody show which is a small amount of pinkish or watery blood, which accompanies the loss of the mucus plug. The mucus plug itself is about 2 inches long and 1/2 inch across and has a thick, jello-like consistency. Sometimes the mucus plug is expelled a few days or a few hours before actual contractions begin. Sometimes this occurs at the very beginning of labor. Sometimes this does not occur until labor is well established. Sometimes women never notice the mucus plug.
If you lose your mucus plug and are experiencing no other signs of labor, you should wait until regular office hours before notifying your birth attendant. (Remember that any blood that is bright red, like a period, should be brought to the attention of your doctor or birth attendant immediately!)
2. Rupture of the Amniotic Membranes:
Commonly this is referred to as “the water breaking”. In the uterus the baby is surrounded by protective membranes and floats in a watery solution known as amniotic fluid. These membranes must break and the fluid must escape before the baby is out and on his/her own.
Approximately one out of ten labors begins with the rupture of the membranes. This is a tremendously psychologically shocking experience because it happens quite suddenly with no advance warning, Sometimes this begins with a slow leak and the mother may not be certain if what she is passing is amniotic fluid or urine. Other times it happens in a sudden gush. Fortunately, in most cases it does not immediately result in a huge puddle and you do have time to get to the bathroom and tend to it.
If you are some place other than home and your membranes rupture, it is best to stop whatever you are doing and get someone to take you home, or to the hospital or birth center if you are going into actual labor. (You will probably be too shaken up to drive.)
Once the membranes have ruptured, the fluid continues to leak out, sometimes with each contraction bringing in a gush of it. It is a good idea to place a clean towel between your legs and change it periodically as it becomes soaked. (Don’t use a dirty towel that’s been hanging on the towel rack.) Labor tends to be messier when it begins this way.
In most cases the rupture of the membranes stimulates the uterus to contract regularly with normal labor contractions and results in the birth of the baby. Occasionally the membranes rupture but labor does not begin. Once the membranes have ruptured there is a greater chance of the uterus becoming infected. For this reason most doctors choose to induce labor after a certain number of hours if the membranes rupture and labor does not begin. For women planning to give birth at home or in a birth center, prolonged rupture of the membranes without regular labor contractions would necessitate going to a hospital to give birth. Induced labor poses more risks to the baby and most birth attendants will not induce at home or in a birth center.
If your membranes rupture, contact your doctor or birth attendant immediately!
In many cases the membranes rupture of their own accord after labor contractions have begun. Frequently the contractions become stronger after this happens. Often the membranes will rupture while the mother is pushing. If the membranes have ruptured and labor continues to progress, there tends to be less and less fluid coming out as time goes by because the baby’s head comes down and acts like a stopper. Rarely the baby is born with the membranes intact and they must be broken immediately so that the baby can start breathing.
An old-fashioned term that our mothers or grandmothers may have used is “dry labor” – when referring to labor contractions after the membranes have ruptured. This is not an accurate term because the body continued to produce amniotic fluid throughout labor even if the membranes have ruptured. Also, although labor contractions may seem somewhat “sharper and closer together after the membranes have ruptured, this type of labor is not particularly more difficult than labor with the membranes intact. Any increase in the intensity of labor is counterbalanced by the benefits of speeding up the process and getting the baby born somewhat sooner.
Some doctors and birth attendants choose to artificially rupture the mother’s membranes during labor as a means of speeding up the contractions. This is a two-sided issue, and may not always be a good idea.
It is important to know that the amniotic fluid should be clear. If it is brownish or greenish, this means that the baby has passed his/her stool, called meconium. Sometimes this can be a danger signal indicating that the baby is in distress. If something has threatened the baby’s oxygen supply this can cause its muscles to go limp, including those in the lower intestines, which results in the passing of meconium. Do not hesitate to contact your doctor or birth attendant immediately if there is meconium in the amniotic fluid. If you had planned to give birth at home or in a birth center, you will probably have to give birth in a hospital instead. In most cases in which there is meconium in the amniotic fluid the baby is perfectly okay. However, occasionally such a baby is in need of immediate medical attention. There is also a danger that the baby might accidentally get some of the meconium into his/her lungs.
Finally, the amniotic fluid should be odorless. If it has a bad odor, this could mean an infection. Get medical attention immediately!
3. Regular Uterine Contractions: This is the most common way for labor to begin. Sometimes Braxton-Hicks contractions gradually become true labor contractions. In the early stages the sensation of labor contractions is often felt as a low backache or a low abdominal ache like menstrual cramps. As a rule, labor contractions occur at regular intervals such as every 20 minutes, 15 minutes, 10 minutes, or 5 minutes Many expectant parents choose to time the contractions with a clock or stopwatch. As labor progresses, the contractions gradually become closer together and more intense.
SUGGESTIONS FOR EARLY LABOR:
1. Take a warm bath. This can be very relaxing and will probably stop the
contractions if it is false labor.
The standard advice has always been: Do not take a tub bath if your membranes have already ruptured, although a shower is okay. I always adhered to this principle when advising other mothers. Then I chose to give birth to my last baby in my own bathtub, well after my membranes had ruptured.
The concern is that the water could introduce infection into the uterus. However, many birth attendants are now revising this advice, since water-birth has proven for many to be a safe, relaxing, and positive option for giving birth which should be promoted as a non-interventive alternative to artificial induction or anesthesia during labor.
2. Give yourself an enema. Many women have given birth very comfortably without having an enema during labor. If you are constipated, an enema is probably a good idea. Some birth attendants require all mothers in labor to have a routine enema. If this is the case, your birth attendant may be open to allowing you to give yourself an enema at home during early labor. This will be much more comfortable at this time than being given an enema later in the hospital during advanced labor.
3. Eat lightly. Once active labor is established it is not advisable to eat. Few women feel like eating once established labor is underway. Attempts to eat anything solid almost invariably result in nausea and possibly vomiting at this time. However, many women experience many hours or even days of very mild, early labor contractions. If this is the case, it is extremely important to keep up one’s energy and strength. If you have gone a long time without eating anything substantial you will be in a weaker, more exhausted condition by the time active labor is established. This will make labor much more difficult.
It is advisable to eat foods that are both nourishing and easy to digest. Foods that are high in natural sugar such as fruit or fruit juice, or easily digested sources of protein such as eggs or soup are especially advised. It is advisable to avoid foods that tend to be difficult to digest such as dairy products, fats, greasy or fried foods, nuts and seeds, or large amounts of meat. These types of foods may cause nausea.
4. Rest. If possible, sleep between contractions. Most women are naturally excited about going into early labor, so resting and relaxing is often more easily said than done. However, it may be several hours or possibly days before early labor becomes established labor. It is very important to conserve your energy. Active labor and birth itself will be much more difficult to deal with if you are exhausted at this point.
5. Do little tasks, as long as you are comfortable doing them. Put last minute things into your suitcase if you are going to a hospital or birth center. Get out your supplies if you will be giving birth at home. Read, watch TV, knit, sew, etc., any type of quiet activity that does not take a lot of energy.
6. Use techniques of body relaxation: A
wide variety of different types of body relaxation techniques are commonly taught in prenatal classes (such as Kitzinger’s touch-release, progressive relaxation, neuromuscular release, and Yoga relaxation chants.) This is the time to actively apply the principles and techniques of relaxation that you were taught in prenatal classes.
7. Breathing techniques. Different childbirth classes teach a wide variety of breathing techniques for use during labor. As long as you are comfortable without using specific breathing techniques, you should not use them. When the contractions reach the level of intensity that you feel more comfortable following a specific type of breathing, this is the time to begin using whatever methods you were taught in prenatal classes. If you were trained in the Lamaze method, you should use the slowest method of breathing for the beginning labor contractions – commonly called slow deep chest breathing.
What not to do during early labor:
You should not go out and buy groceries, start cleaning your house, or any other type of strenuous activity. For some women labor can progress very rapidly and it is important to be ready to go to the hospital or birth center, or get ready for home birth by the time active labor is established. It is also extremely important to rest and conserve your energy for the challenging job of active labor and giving birth that lies ahead.
II. ESTABLISHED LABOR
In most cases labor begins with several hours of early labor or pre-labor which consists of mild but regular contractions which gradually increase in frequency and intensity. Some women experience early labor for several days. During early labor the cervix dilates from completely closed to about 3 or 4 cm.
Established labor, also called active labor or working labor, refers to the next phase of labor in which the contractions become much more intense. During this phase the contractions last longer, are closer together, and require full concentration, relaxation, and use of prepared childbirth techniques. During established labor the cervix dilates from around 3-4 cm. to around 7-8 cm. As a rule the phase of established labor takes less time than the preceding early labor stage. Very commonly women are in established labor anywhere from one to twelve hours. Very rapid labors involving only a few contractions for the entire labor, or active labor phases that are much longer than 12 hours are not at all uncommon.
Very commonly during active labor, contractions are approximately 5 minutes apart and are about 60 seconds long. During this stage of labor most women prefer to sit or lie in one place and give their full attention to dealing with labor. Few women feel like reading, carrying on a conversation, or any other type of activity during active labor. If you are trained in the Lamaze method, this is the time at which you will probably want to switch from the slower, deeper breathing to the more rapid, shallow breathing which requires more concentration and generally is more effective as the contractions become stronger (i.e. panting or “hee-hee” breathing.)
If you are not already set up for home birth with necessary people present, or are not already at the birth center or hospital where you plan to deliver, you should be on your way, or have your home birth attendant on his/her way to your house at this time.
Suggestions for Established Labor:
1. The husband or labor coach(es) can do many things at this time to help the mother, both by giving her reassurance and encouragement and to make her more comfortable.
a. Sponge her back, arms, face, etc. with a cool, wet wash cloth. Most women tend to feel hot during labor and find something like this soothing.
b. She should not have any solid food during active labor, but it is important that she have clear liquids throughout labor to prevent dehydration. Substances containing natural sugar help to keep up her blood sugar as well. Sips of water, ice chips, or a cold wet washcloth to suck on between contractions are helpful. If you are in a hospital this may be all that they allow or that is available. Natural fruit juices or herbal teas sweetened with honey are also often helpful. (Peppermint, raspberry leaf, cohosh, or mixtures specially formulated for use during pregnancy are often recommended.) Spoonfuls of honey offered between contractions can also aid blood sugar levels. Some mothers suck on lollipops for this same reason. This, however, is a less natural form of sugar.
c. Time the contractions, using a clock or watch with a second hand, or a stop watch. Many couples like to keep track of the intervals between contractions.
d. Emotional support and verbal reassurance is of utmost importance at this time. There is no one right way to labor coach. Some women benefit greatly from constant attention such as breathing with her or talking to her through each contraction. Other women find such constant attention bothersome, but still have the psychological need for their husband or labor coach to be there.
Remember that going through labor and giving birth together can be a loving, family experience—an event which brings the mother, father, and possibly the older children, and the baby together as a family.
2. Get up to urinate at least once per hour during labor. Sometime during labor one can lose the sensation of needing to urinate. However, the kidneys do continue to send urine into the bladder. Keeping one’s bladder empty throughout labor will help make you more comfortable. In addition, periodic trips to the bathroom help to break up the monotony of several hours of labor and if contractions are slow, sometime getting up, moving around and changing positions that this requires can help get the contractions going.
3. Rest and conserve your strength and energy as much as possible between contractions.
4. Deal with each contraction one at a time. When contractions are challenging, requiring considerable concentration and attention, the thought of possibly several more hours of labor can be overwhelming and frightening. It is important to stay in present time with each contraction and not focus on either all of the contractions that you’ve already had, or all of the contractions that are yet to come.
5. For some it helps to approach labor with the concept that you are assigned a certain pre-set number of contractions that you must have (perhaps 50, perhaps 80, perhaps 100, for some much less!) before you reach your desired goal of a baby. Then as you finish with each contraction, you can consider it one more contraction out of the way towards reaching your goal.
Very commonly transition is the most challenging and discouraging part of labor. This phase refers to the final stage of labor in which the cervix dilates from approximately 7-8 cm. to 10 cm. which is full dilatation. At this point the cervix virtually disappears, the uterus and vagina become one single passageway, and the mother is ready to push the baby out into the world. Transition usually lasts anywhere from 10 to 60 minutes. 30 minutes is the average length of transition. The experiences of different women vary greatly. Some women go through established labor until they find that they are fully dilated and ready to begin pushing without having any recognizable symptoms of transition. Other women have nothing but several hours of early labor until suddenly transition comes on with very intense contractions.
During transition the contractions usually occur quite close together, averaging 15 seconds to 2 minutes from the end of one contraction to the beginning of the next. At this time the contractions may become longer, lasting up to 2 minutes. During transition, contractions may have more than one peak, which may actually be two contractions together with no let up in between.
A number of symptoms are often associated with transition. Not all women experience all of these symptoms, however. These are simply general guidelines:
1. Frequently women experience confusion, disorientation, a sense of restlessness, irritability, or wish to escape. Some authorities have suggested that these sensations are caused by a lack of blood going to the brain at this time. Statements made by women in transition often reflect discouragement, or will simply not make much sense. (For example: “I don’t want to have the baby after all!!” or “Why did I think giving birth was going to be so much fun?!”)
Sometimes expectant fathers become targets of anger during transition, for having gotten her pregnant in the first place. Take this in stride as typical transition behavior and remember that she will be very happy once the baby has arrived.
2. During transition many mothers experience:
a. A whirlpool sensation—a sense of the room and people in it blurring or floating around.
c. Nausea and/or vomiting.
d. Chills and/or hot flashes.
e. Not wanting to be touched. (“Leave me alone!!”)
These symptoms are said to be caused by hormones.
3. The baby’s head (or presenting part) is starting to come through the cervix and down the birth canal. Often associated with this is strong back pressure or rectal pressure. Also commonly during transition many women begin having the urge to push. Very often this urge comes on before the cervix is fully dilated and the mother should not push yet. Premature pushing usually hurts. Pushing before you are fully dilated can damage or tear the cervix and can prolong this stage of labor.
As soon as you feel the urge to push, ask your birth attendant, or the nurse on duty, to examine your cervix for dilatation. Even if you were examined recently and were not dilated very far, sometimes progress can take place very rapidly! If you are not fully dilated, use whatever method of panting, blowing, or deep breathing that you have learned in prenatal classes to keep from pushing at this stage.
If you happen to be giving birth on your own, with no trained person to examine you for dilatation (not recommended, but this can happen accidentally!), you should try to refrain from pushing for as many contractions as possible. If the birth of the baby is inevitable, the baby will begin progressing down the birth canal anyway. If the urge to push becomes overwhelming you should try to push gently at first. As a rule of thumb if you are not fully dilated and ready to push, attempts to push will be painful and will get you nowhere. If you are fully dilated and ready to push, then pushing will feel right and be inevitable.
Suggestions for Helping with the Transition Phase:
1. The husband or labor coach should be aware of the possible symptoms of transition. The mother may not recognize that she is in transition at this time.
2. Frequently face-to-face coaching, in which she looks her husband or labor coach directly in the eye, breathing right along with her, or counting each breath with her as she does a rapid but measured type of breathing is needed to keep her in control of the situation.
3. As with established labor, the principle of taking each contraction (or possibly each breath) one at a time applies here.
4. The husband or labor coach can give verbal reassurance to help her over feelings of discouragement. Remember that your reassurance is very much needed even if she does not respond positively at this point. (For example: “You only have a few more contractions” is likely to be answered with “I don’t want to have ANY more contractions!!”)
IV. EXPULSION (PUSHING)
All women who give birth vaginally go through a number of labor contractions which open the cervix until it is fully dilated (10 cm.). When the cervix is fully, or nearly fully dilated most women experience an urge to push. The sensation is an unmistakable and powerful downward tugging. Most women find it extremely challenging not to push once the urge to push is present. Frequently the body will push involuntarily of its own accord, even when the mother is not actively putting energy into pushing
Pushing requires an immense amount of physical energy. However, many women feel a great sense of relief when they have reached that stage in which they can actively push. They find this part a welcome change from simply lying there dealing with their contractions. If you questioned a group of new mothers who had recently experienced a natural, vaginal birth, probably half of them would say “Oh, it felt so good to push!!” while the other half would say “Oh, pushing was really awful!!”
The pushing stage varies considerably from woman to woman. As a rule this stage tends to be longer and more challenging if the woman is having her first baby, and is shorter and easier if she has given birth before. In some cases the larger the baby the longer the pushing stage will be, although there are many exceptions to this rule. There are women who have had 10 lb. babies with very little pushing, and there are women who have had 5 lb. babies and have had to do a great deal of pushing.
It is not at all uncommon for a first-time mother to have to push for an hour or more, or for a second-time mother to have to push for a half-hour or so. Very frequently women who have given birth before to have their subsequent babies with no active pushing. As a rule the birth canal opens up more easily and the baby comes down more quickly when previous births have paved the way. However, occasionally a woman who has had a previous birth that was very easy and rapid can have a longer more challenging pushing stage with a subsequent birth, especially if this baby is larger or in a more difficult position. No woman can know 100% what to expect with each approaching birth, regardless of what her previous births may have been like.
Occasionally women, especially those having their first babies, need to push for 4 or 5 hours or more. Pushing for several hours with little or no progress may mean that the baby’s head is in a difficult position and medical intervention such as assistance with forceps may be necessary for the baby to be born. Or this could mean that the baby’s head is simply too large for the mother’s pelvis and the baby must be born by Caesarian delivery. If you are attempting to give birth at home or in a birth center and push for several hours with little or no progress, it will probably be necessary to go to the hospital.
One big advantage of giving birth at home, in a birth center, or in a hospital with a birthing room is the convenience of not being moved to a delivery room. For the first time mother who may have to push for quite a while, she especially benefits from the freedom of movement that a birth bed offers. Pushing in a squatting position can especially help speed up the expulsion stage for the first time mother. For the woman who has previously given birth, second stage can take place very rapidly. If she is moved into a delivery room she may have to struggle to keep the baby from being born until she is set up and in place on the delivery table. For her it is especially advantageous to be able to stay in the same place for giving birth.
If you will be delivering in a hospital in which labor will take place in the labor room and birth will take place in the delivery room, most hospitals observe the following rule: The first time mother stays in the labor room and pushes until the head is crowning or at least is well into the birth canal. The mother who is having her second or subsequent baby is taken directly to the delivery room as soon as she feels the urge to push. This is because second stage is almost always much more rapid for the woman who has previously given birth.
Techniques for pushing vary tremendously in different prenatal classes and new ideas are constantly being presented. A few years ago childbirth instructors advised mothers to push with all their might and to hold their breath for as long as they possibly can. Today the trend is toward advocating gentler, less forceful and strenuous methods of pushing, on the idea that the pushing effort does not have to be so extremely exhausting to be effective.
Be aware that pushing is done during the contraction. When you feel a contraction beginning is when you should begin to take one or more deep breaths and then start to push the way you have been trained. When the contraction is over, ease yourself back down slowly and rest quietly between contractions. The husband or labor coach can be of immense help reassuring her, encouraging her efforts, helping her to ease back and relax when the contraction is over.
Today most childbirth instructors advise that you keep your eyes open and your face relaxed while pushing, instead of scrunching up and making a horrible face. If a mirror is provided, most mothers want to watch the head crowning and the baby being born. The labor coach may need to remind her to watch in the mirror. This often helps the mother to focus in on the purpose of all this effort.
Pushing in the Labor bed, or Birth bed:
1. If it is a standard, adjustable hospital bed, the head of the bed should be cranked up to a 35 degree to a 50 degree angle. The foot of the bed should be flat. If one is giving birth on a regular (non-adjustable) bed or other surface, several pillows can be put under the mother for support, and/or the husband or labor coach should get behind her and support her.
2. Some techniques recommend that you sit up to push. Other techniques suggest that you lie down and are only slightly raised during pushing. You may wish to experiment with different positions to find which is the most comfortable for you.
3. Spread your legs as far apart as possible and hook your hands around or under your knees. (This is where the exercises such as deep knee bends, pulling legs apart, etc. will be of benefit.) As an alternate method, you may wish to get up and squat to push. Most women need one or two other people to help them when they choose to squat. Yet another method is to lie on your side and hold your upper leg while pushing.
4. Pushing techniques vary, but as a rule you push down with the diaphragm muscle while releasing the pelvic floor. The sensation is not the same as pushing towards the rectum as in having a bowel movement. During practicing, you don’t really push. Practicing can only begin to give you an idea of what it will be like when it’s the real thing.
Delivery Room Pushing:
If you are taken to a delivery room to give birth, the technique of pushing is the same, but the position varies. In most cases your legs are placed in stirrups, sometimes with “leggings” or sterile drapes covering them. A few progressive hospitals allow the mother to keep her legs up and out of the stirrups if she prefers this.
At one time it was common practice in hospitals to strap the mother’s arms down to the delivery table. Fortunately, today this is rarely practiced in most hospitals. Most delivery tables have “hand grips” which the mother can grasp while pushing.
The traditional position for delivery has been to place the mother flat on her back on the delivery table, and to place her legs up in stirrups going straight up and out from her body This position is advisable if the mother is heavily medicated, or if she has had spinal anesthesia. The woman who has had spinal anesthesia must not raise her head for a number of hours after it is administered. However, most women who are giving birth without medication prefer to be sitting up at a more comfortable angle. Delivery tables are usually adjustable. The stirrups can be lowered to an angle that is more comfortable and in line with the body. The back of the delivery table can be raised or pillows can be placed behind her back. (These options should be discussed in advance with your doctor or hospital staff prior to admittance to the hospital.)
The husband or labor coach should stand behind the mother and should help lift her and support her as she pushes during each contraction and should ease her back down in between.
Sometimes at the very end it is necessary to stop actively pushing during a contraction. If the head is crowning, perhaps the birth attendant can get the baby out without an episiotomy if the mother cooperates. Perhaps as the baby is being born the cord needs to be untangled from around the baby as it comes out. Or perhaps it is simply necessary to keep the baby from being born too fast. Techniques such as rapid blowing, panting, or deep breathing are effective in overcoming the urge to push.
If you are giving birth at home, in a birth center, or in a very progressive hospital, you may wish to reach down and touch your baby’s head as it is coming out. As the baby’s body is born some mothers wish to catch their own babies. A hospital with more traditional rules will not allow this however.
c. 1982 (Revised – 2012)