Learning how to push!

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GentleBirth Posts: 750
Posted this on RC for Mums to be. ------------------------------------------------------------------------ Thought I'd start another thread following on from the 'epi' thread about the 2nd stage of the birth process - the 'pushing' stage. So how do you learn how to push properly? That's easy - you don't! This stage of birth is completely out of your control. Your uterus has grown into one of the most powerful muscles of your body and it will do nearly all of the work for you. A Mum to be in a coma can give birth to her baby. For me it felt like a massive spasm.....my body just pushed without me doing anything. It helps to understand how it all works. During labour the top of the uterus is starting to get really thick....while the bottom of the uterus (the cervix) thins out. When you get the urge to push the top of the uterus has moved down around your baby and starts to squeeze your baby down. The uterus sorta turns into a big tube of toothpaste with the end of the 'tube' rolled up to get the toothpaste out iykwim. No doubt you've seen the scenes on Private Practice or Portland Babies of Midwives shouting 'come on give me one more....put your chin to your chest, hold your breath and push into your bum.....keep it coming...keep it coming...' All the while Mum is purple in the face and has effectively turned off all the oxygen to her baby and to that marvellous muscle. Coached pushing is no longer considered best practice - and yet we still see it in many maternity wards today simply because old habits die hard. We know that in studies out of the UK - Mums who followed coached pushing tend to end up with more perineal injury, pelvic floor problems, more bladder injuries, high blood pressure and exhaustion. What about the babies? Babies born to Mums who have continued to hold their breath for extended periods get less oxygen which makes labour harder for them to tolerate the last critical minutes of this phase. Even Midwives who still follow coached 'purple' pushing will tell you to NOT push as the baby's head begins to emerge......what they mean is don't help the contractions/surges with any of your own pushing - your uterus will keep nudging your baby down regardless. Slow comfortable breaths are important.....no special breathing techniques are required. Follow your body's lead - most Mums who aren't coached will take a breath at the peak of the sensation but won't hold their breath for excessive periods - while their Midwife encourages and supports her rather than instructs her. How do you know you need to have a bowel movement? Do you have an expert at home who tells you when it's ok to go? For most people - as the waste matter moves down through the colon it excites the stretch receptors which send a message to your brain to find a loo soon! What about a Mum who has an epidural? Do you need to be taught how to push if you have an epidural and can't feel anything? Surprisingly in most cases no.......delaying any coached pushing and allowing the baby to descend passively means better outcomes for Mums and babies. In one study 94% of instances of fetal oxygen deprivation lasting >2 minutes occurred during active pushing.... Even though you may not feel anything with the epi - your uterus is still nudging your baby down. And if you're upright with an epidural even better again! Less chance of needing some 'help' with a foceps or vacuum. So what if you don't have an urge to push right away? This is known as the 'rest and be thankful phase' and it just means your body is getting your baby into an optimum position and the uterus is moving down behind your baby. Imagine someone instructing you to go to the bathroom right now and have a bowel movement! Unless you've had the urge to go nothing will happen but you'll definitely go purple....exhaust yourself and probably get a few piles too! So rest and be thankful....... If you've had an epi you'll often still feel an increase in pressure (you'll feel it mostly in your bum) so even though you may not have the intense urge to push you can let your body do the work which means you're not exhausting yourself and your baby. So back to the title of this post - learning how to push.....you don't learn - your body already knows what to do far better than we can imagine! This is a great article about the 2nd stage. So how did that stage of the birth process feel for you? What were your experiences? Tracy
GentleBirth Posts: 750
Bump! Tracy