Ah push it...push it real good!

When it comes to pushing the key common questions we as birth doulas often hear are:

• How will I know when it is time to push? 

• How long does pushing take?

• How will I know if I am doing it correctly?

• Am I going to poop on the table?

If these are questions you have asked yourself or your birth team then you are NOT alone.  Anxiety around the thought of this part of labor is very common but we are here to help you along the way so you can feel confident bringing your baby into the world.  So let's get to it!

After hours and sometimes days of labor, reaching push time is a time that marks great accomplishment.  You are finally 10 centimeters dilated and ready to meet your baby - you did it!  But then it hits you...you have to push your baby out of your you know what and you realize this may be a little more difficult than you originally imagined.  Breathe...we've got you girl!

Before we jump into the nitty gritty let's talk about what this moment in labor normally looks like in a hospital setting.

In most birth settings in the US, once moms reach full dilation the nurses will step in immediately  to begin to "coach" the mom on how and when to push.  They have them lie flat on their backs, grab onto the backs of their thighs, curl their torso up as if in a crunch position, and hold their breath.  While at the same time they tell them to push into their bottoms like they are having a bowel movement.  They then add to the moment by yelling PUSH, PUSH, PUSH!  Whew...that sounds exhausting doesn't it?  Talk about confusing and stressful all at the same time!  

All your anxiety about this moment begins to slowly resurface.  The thought of birthing your baby and having a bowel movement are not exactly two things you want to think about at the same time.  The chaos and yelling is driving you crazy and you are certain that if the nurse yells  to push one more time you may throw something at her.  So what can you do to ease the stress, and how will you know what you are doing is right?

How will you know it is time to push?

Pushing is an involuntary response and the easiest answer to how will you know it is time to push is you will just know.  Your body will naturally have the urge to bear down and it is usually very difficult to fight against this urge.  Void an epidural, there is often the feeling of pressure in your rectum as if you have to take the biggest poop of your life and your body naturally follows this urge to push your baby out.

What if you don't get the urge to push?    If at first you don't succeed...brush yourself off and try again...or try something new.  Change your position!  Try multiple positions to get baby into an optimal position.  If you have been laying down, try standing up to allow gravity to work with your labor.  If you are standing up try squatting.  Squatting can actually open your pelvis by up to 30% to allow your baby more room to come down and apply pressure.  There are so many positions that one could try but here are a few to consider: sit on the birth ball, child's pose, side-laying release, all fours.  Talk to your doctor, midwife or doula about trying these positions if pushing doesn't come easy.

If you have an epidural, however, it can be difficult to feel the sensation to push.  In this case direction from the nursing staff may be necessary.  They will follow your contractions and direct you when it is time to push.  If this happens, simply ask them to do so in a low tone and to allow you to rest in between the time you reached 10 cm to the time they start directing you to push.  This time in between is called the resting phase and normally occurs naturally with mothers before they feel the urge to push if they didn't have an epidural.  Taking your time in between will allow the body a chance to "labor down".  This simply is giving your body the chance to do most of the work for you.  Each contraction will bring the baby further down the birth canal without you having to do much.  This will decrease the amount of time spent actually pushing.

How long will pushing take?

We have all heard the stories from our friends..."I pushed for three contractions and my baby just shot out!", or, "I pushed for four hours - it was exhausting!"  Yes, it is true pushing can vary in time but on average it takes between 30 minutes to 2 hours.  The longer push times are usually seen in first time mothers as their bodies have to create space to pass the baby through the birth canal.  As we mentioned above, by allowing your body to labor down and using different positions that work with your body and not against it, you can reduce the amount of time you have to do most of the work.

TIP: Try upright positions and stay off your back.

How will I know if I am doing it correctly?

Let's first get one thing clear...we ladies push babies out of our vagina, not our butts!  Big surprise right?!?  Remember when I told you that nurses tend to coach moms to push into their bottoms like they are having a bowel movement?  Well this is actually not the muscle group you want to engage.  While the muscles are physiologically close together they are not one in the same.

So what should you be doing?

You first want to find the proper muscle group.  It is the same muscle group that you engage and relax while doing kegel exercises or to stop the flow of urine.  Still confused?  Let's walk through a few little exercises to help you find it.  

• Lie on a your back on a flat surface.
• Place your feet flat on the floor and spread your knees slightly.
• Take a small object (i.e. a slipper, flip flop, light phone) and place it on your stomach near your belly button.  
• Now contract the muscles you would use to have a bowel movement...nothing.  You should not see any movement in the item on your belly.
• Now (bear with me this may seem a little weird) visualize engaging the muscles that you would use to push a tampon out.  
• If done correctly, you will see the object on your belly move.  That's right you did it!!

Another great way to test out the right muscle is to...

• Sit in a V position (bottom on floor, legs out in front of you in a V shape) with your partner.  
• Each of you take a hold of one end of a scarf and have your partner tell you when to push.  First have him/her tell you to push into your butt (but be careful, not to hard).
• While pushing each of you pull the scarf as if you are playing tug of war.
• Next, do the same thing but have them tell you to push into your vagina.  You should experience a different sensation this time.  That is what we want!! 

 So now the answer we have all been waiting for...

Am I going to poop on the table.

Yes, it is highly likely.  The reality is shit happens...literally.  Once you get to this phase of labor it is also likely that having this occur is the least of your concern.  By now you have likely expelled other bodily fluids so why not add one more to the experience.  And trust me, it is nothing to worry about.  Medical practitioners and nurses are amazing at scooping up these little pellets so fast that you and your partner will likely never even realize it happens.

Ah push it...push it real good!  You've got this girl! 

- Latina Baxter, Doula

Enjoyed reading this blog?  Let us know below.  You may also feel free to leave comments below about your experiences with pushing.  What did you do to ease the stress of push time?