Many pregnant mothers-to-be wonder what the second stage of labour (pushing) will feel like.
They wonder if they'll know how to do it.
They also wonder if they'll be able to do it.
Birth is a normal bodily function. When women are given the space, many instinctively know what to do.
Many new mothers report their body just progressed as if it knew exactly what to do.
Of course, even the most natural of bodily functions can occasionally veer from normal or be impacted by outside interventions.
So, how will you know when to push?
In short, when you feel the urge — it's a sensation that you will distinctly feel (unless you're numb from an epidural or block). However, lots of variables can impact when and how you push.
Pushing During an Intervention Free Birth
Lets take a look at birth when it's allowed to unfold without any interventions or medications. One where mother and baby is healthy and there are no complications.
How will you know when to push? After transition (the final few centimetres of dilation), you'll likely have a pause in contractions – the ‘rest and be thankful' phase! Then contractions begin to pick up with a strong urge to push.
It may feel like:
- A strong urge to have a bowel movement
- An increase in pressure on your pelvic floor
- Feeling heaviness and pressure in the vagina
- A rush of adrenaline or intense hormonal shift
- When no matter what you do, your body simply pushes – this is called the fetal ejection reflex.
Pushing With An Epidural
Having an epidural can really impact a mama's ability to push. If all or most of the sensation is lost in the pelvic area, it can make it difficult to feel the urge to push. Pushing with an epidural can be more difficult, as you are unable to work with your contractions. This is especially true for a first time mama, who has not given birth before and is unfamiliar with how to push and what it should feel like.
How will you know when to push if you have an epidural?
- Your midwife/doctor will likely perform a vaginal exam to confirm that you are fully dilated — if so, he or she will recommend that you try to push
- If you have some sort of feeling back in your body, you may notice increasing vaginal or pelvic floor pressure
- A midwife (nurse in the US), or other staff will watch the monitor you're connected to. She or he will watch for the intensity of contractions, and will instruct you to push so you can make the most of the contractions
- Your midwife or doctor will gauge babies position and station, and recommend you try to push
- If your epidural wears off or is turned down, you may feel an intense urge to push and/or an urge to have a bowel movement
Here are 4 things to consider when it comes to pushing:
#1: What Do I Do If I Feel The Urge To Push Before 10 Centimetres (Fully Dilated)?
Sometimes women feel the urge to push before fully dilating. This can be physically and emotionally challenging. Fortunately, if they can pinpoint why, there are things that might help stop this urge, and help labour continue to progress.
Two possible causes of this are:
The Baby's Positioning
Babies descend easiest when they are head down, facing mama's spine and with their back to one side of the front of mama's tummy. In this position, they can easily flex their head and navigate the birth canal. This is known as ‘occiput anterior' or OA for short and is considered as optimal fetal positioning. If baby is in another position, especially occiput posterior, the head can cause an increase in rectal pressure causing the urge to push. OP babies are facing mama's tummy instead of her spine.
What can you do if baby is not OA? Remaining upright, mobile and frequent position changes can help facilitate space for baby to switch positions. Walking up and down stairs (if you've not had an epidural of course!) is a great help — it moves your pelvis and helps baby wriggle down (ask the labour ward where the nearest stairwell is). Some mama's find success having their doula or midwife use a rebozo to help facilitate fetal movement. If baby still does not turn, using coping techniques and remaining mobile can help the mama cope, and the baby to navigate the birth canal.
Depending on what source you look at, cervical lips may or may not be considered a problem when it comes to early urges to push. Ultimately though, listening to your body, staying upright and frequent position changes can help. Frequent position changes and remaining upright can help reduce any swelling and help you reach full dilation.
#2 – If I'm 10 Centimetres Must I Push Immediately?
If you have ever watched a movie with a birth scene chances are you saw something that went like this:
“Okay, you're 10cms! You can push now.”
*Mama begins pushing*
“PUUUUSHH! 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Breath. Now PUUUSH! 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.”
It leaves you with the impression that as soon as you're 10 centimetres, you're ready to push. It also implies you must be coached and push as hard as you possibly can. Rarely are either of these things necessary.
If you have not had the epidural, you will eventually feel the urge to push. Sometimes as soon as you are 10 centimetres, and sometimes not for several minutes later. Sometimes our body knows we need to rest and recoup after all the work of dilating. It gives us the ‘rest and be thankful' stage. A chance to breath and regain our strength to give birth.
You can certainly try pushing at 10 centimetres without the urge, but often mamas that do so find they've exerted or wasted extra energy. If you're healthy and baby is doing well, evidence supports waiting until you have the urge and continuing to push only with the urge. There's no evidence to support directed pushing in the absence of an epidural or medical complications.
For most, waiting for the urge is the most effective way to push.
#3 – How Will I Know When To Push With An Epidural?
Pushing can be more difficult if you are unable to feel the urge, but it is definitely still doable! If you have an epidural you will likely need some direction when it comes to pushing. You might also need more time to push.
Your midwife/doctor or a nurse will likely let you know when you have reached full dilation. At this time, depending on baby's station, they may suggest trying to push. Watching the contraction monitor can help in knowing when your pushing can work with your contractions to make pushing more effective.
If you're progressing slowly or having difficulty pushing some midwives/doctors will turn down the epidural to allow more sensation. This can make it easier for some mama's to feel the urge and push more efficiently. You may need to also focus on comfort techniques during this time as contractions can feel very intense after an epidural.
#4 – What Happens If Pushing Isn't Progressing Quickly Enough?
In some circumstances, due to medical concerns or interventions, mama's struggle to push effectively. If you are being told you are not progressing quickly enough, here are somethings to consider.
- Did you begin pushing with the urge, or simply due to being filly dilated? If the latter, perhaps you started earlier than your body was ready. Not progressing quickly enough might simply be having started the clock to soon. Your progress might still be fine!
- Have you had an epidural? ACOG recommends giving mama's with epidurals a longer window for pushing. If mama and baby are tolerating labor well, sometimes they simply need extra time. With the epidural it can take longer to effectively push.
- What position is baby in? Might you need time to move, try different positions and try to facilitate fetal movement? Perhaps baby will be born occiput posterior but you both need more time to facilitate it.
- Are you and baby tolerating contractions well? No medical concerns? Perhaps you simply need more time. Maybe switching positions, moving and using gravity will help baby descend more.
In the event that your midwife or doctor recommends an assisted birth, you can use the acronym BRAIN'D to help you process the recommendation:
Benefit, what are the benefits for me? For baby?
Risk, what are the risks for me? For baby?
Alternative, what alternatives are available?
Intuition, what is my intuition telling me?
Nothing, what happens if we do nothing?
Decision: we'd like some privacy for five/ten minutes to make a decision.
Often you can feel immense pressure having to decide in front of doctors (white coat syndrome!). Being able to make a decision with your support team helps you to think more clearly, combine wisdom and ideas and also gives you some valuable information.
What information is that?
If a doctor is happy to leave you for five or ten minutes, it's obviously not an emergency situation. In this case, the least you can do is ask for a little more time. For example, you could say you've considered their knowledge and your feelings, and you'd like to wait 20 or 30 minutes (for example, your comfort level should dictate this — trust your instinct mama), and then you'll be happy to reassess the situation. If after that time everything is still okay, ask for another 20 minutes or so.
In short, your body will let you know when to push. In long, well as you see, there are some variables. But as one mother put it, “The answer to the question, ‘how will you know when to push?’ Well, all those experienced mamas are right when they say that you will just know – because your body will lead you.”
Also read: 8 Tips For A Slow or Stalled Labour.