It’s crunch time! That sweet baby is nearly here. Are you ready?
Take a deep breath; you’re going to be a mother.
Of course, when it’s time for your little one to arrive, you’ll have a support team around you but, at the end of the day, you are the one who has to push (or not push) that baby out.
You shouldn’t wait until the end of your pregnancy, when you are about to give birth, to learn about pushing in labor.
It’s something you should discuss much earlier – in antenatal classes, with a childbirth educator.
Do you really need to push during labor?
The answer is: yes and no.
Women have birthed without coached pushing (when someone is telling the woman to push) for many years.
That’s because a woman has an innate fetal ejection reflex. For you, that means the baby will exit the cervix whether you push or not.
Even so, at times you will need some assistance to push and to get the baby out.
Sometimes things make pushing difficult.
For example, you might have an epidural. You might be totally exhausted. Or perhaps you’ve had another intervention that has interrupted the natural process, and the fetal ejection reflex might not work as expected.
Talk to your midwife or care providers. Discuss your expectations of pushing in the labor stage.
Read Is Pushing During Labor Necessary? for more information.
What muscles do you use to push during labor?
Your glutes and lower abdominals should be relaxed, and you should have tight contracted transverse abdominals.
This combination of a relaxed pelvic floor and tight abs is the most effective way to push a baby out.
These are the muscles you use:
- Rectus Abs. Most people think rectus abdominals are the only abs you have. These are at the front of the torso and are commonly referred to as the ‘six-pack’. This is the muscle group targeted in sit-ups. When you push and your spine is curved forward, your rectus abs are engaged
- Transverse Abs. These make up the interior layer of the abdominals (the inner abs). They are the most important in pregnancy – both for posture during pregnancy and for pushing. These are the muscles that are engaged when you suck in your belly.
Lamaze International, founded in the 1960s, published and taught a series of co-ordinated pushing classes, which use breathing and muscle techniques as described above.
What does pushing a baby out feel like?
This is a question women ask each other all the time. The answer is different for everyone. Your birth, and your journey to get there, are unique to you.
Most women explain the feeling as a burning sensation, as the perineum stretches, and the baby’s head appears at the opening of the vagina. This is referred to as ‘crowning’.
The most common expression women use is ‘It feels like you’re having a big poop!’ The bowel is very close to the vaginal wall, so this makes sense.
You might even have a bowel movement, because of the close proximity and the pressure from your baby’s head. This is quite common, so don’t be alarmed, or embarrassed.
Some women don’t recall having this feeling at all.
As long as the rhythm of birth has been allowed to go ahead naturally, however, almost all women feel an overwhelming urge to push.
This is the fetal ejection reflex at its best.
In any case, as many childbirth educators and other mothers will tell you, you’ll quickly forget the whole pushing situation as soon as you see your beautiful baby in your arms.
How do you push after an epidural?
Epidural anesthesia involves the insertion of a hollow needle and a small, flexible catheter into the middle or lower back. It goes into the space between the spinal column and the outer membrane of the spinal cord; this is called the epidural space.
The anesthesia might be given in early labor, in conjunction with an induction of labor, or in the active established stage of labor. This depends on what you choose to do.
The area where the needle is to be inserted is first numbed with a local anesthetic – see the diagram below:
The anesthetic stops the pain of the contraction and, if the procedure is done effectively, you might still be able to move and feel enough to push your baby out.
Unfortunately, epidurals can be hit-and-miss, in terms of how dense they are and the area they cover.
You could have an ineffective epidural or one that blocks all movement completely.
Having a spinal anesthetic will mean a longer pushing phase and an increased chance of an instrumental or a C-section birth.
Also to keep in mind that everything passes through the placenta to the baby, including the anesthetic from the epidural.
You are more likely to need to do some guided pushing, with your chin on your chest and using all your strength and breath to bear down and push the baby out.
How long is too long to push during labor?
The answer to this question really depends on the circumstances.
If you are a first-time mother, and your body hasn’t done this before, you can expect it to take up to a few hours for the baby to arrive at the second stage of labor.
On the other hand, if you have had babies before, your body will have muscle memory of labor and delivery.
You will feel the baby in the birth canal and feel the urge to push. The pushing might be much easier and faster, and the baby’s head will be on the way.
How long you have to push might also depend on the position of the baby during pregnancy and labor.
Babies can malpresent for whatever reason and sometimes it is tricky to get them into the right position to move into the birth canal.
In the end, it’s the baby’s call. If your baby shows signs of distress, then pushing might be expedited, or you could end up having an instrumental delivery.
What if I can’t push my baby out?
When the time comes for a baby to arrive, in the second stage of labor, there are several reasons why it just doesn’t seem to happen.
If you have had an epidural, you might have lost all sensation of where to push, and the guided pushing doesn’t seem to help.
Don’t despair. There are many situations – mainly involving mothers who have previously had babies – where the fetal ejection reflex is triggered, the body takes over, and the delivery of the baby happens naturally.
If this doesn’t occur, and if you also have maternal exhaustion from days of labor, you might need some help.
If the baby is close enough and in the right position, the doctor might be able to put a little suction cup on the baby’s head and gently pull on it to get the baby out.
If this method is not successful, the doctor might attempt a forceps delivery. This is done by inserting forceps on either side of the baby and pulling the baby out.
Obstetricians and gynecologists may advise a c-section at any time if the baby is distressed.
Do you push in the second stage of labor?
Yes. It is in the second stage of labor, the pushing stage, that your little one actually arrives.
This stage begins when the cervix is fully dilated and lasts until the delivery of your baby.
Your midwife will help you find a comfortable position – on your knees or on the bed. Many women prefer side-lying.
The midwife will also guide you when you feel the urge to push.
Safeguard your pelvic floor after pushing
The pelvic floor is a ‘sling’ of muscles – a bit like a small muscle hammock – that runs between the pubic bone in the front, and the tailbone at the back.
A woman’s pelvic floor muscles support her womb (uterus), bladder and bowel (colon).
Don’t forget to do your pelvic floor exercises after you have pushed your baby out. This is the best way to make sure your pelvic floor works in the future.
How to push without tearing
There is always a chance you might have perineal or vaginal tearing during the birth.
The best ways to minimize your risk of tearing are good preparation, and education.
A couple of tips:
- You can do perineal massage to stretch this area if it suits you.
- Make sure you use warm water for birthing, in the shower or pool, and for compresses on the perineal area.
At the time of baby’s arrival, provided the baby is happy, take your time. Allow the baby’s head to progress gradually, and slow the crowning and delivery, if possible.
If the baby flies out too quickly, you are more likely to experience tearing. Admittedly, this is easier said than done.
The urge to push is overwhelming. It can be difficult to take a deep breath and slow the pushing down.