For many women, the second stage of labour is hard work.
It looks a lot like what you see in the movies – a sweaty, exhausted woman being told to hold her breath and push, push, push into her bottom.
Eventually, sometimes after many hours, a baby emerges from her body. Often by this stage, mama is starting parenthood feeling physically depleted, and most likely with stitches in her vagina.
Is Pushing During Labour Necessary?
Before the advent of obstetric hospital care, women weren’t told to push their babies out during labour. How were babies born then, if not pushed out?
Mammals, including human beings, have the ability to give birth while completely unconscious – even during sleep. This is due to something called the fetal ejection reflex (FER).
The FER occurs when a woman’s body spontaneously, and with no effort, pushes out a baby quickly and efficiently.
You can read more about this in Fetal Ejection Reflex – What Is It And How Does It Happen?
So What's With Pushing?
Forced pushing came into vogue in the 1920s, when maternity care moved out of the home and into the hospital.
Doctors decided the second stage of labour was dangerous for babies, so it should happen as quickly as possible. Women were often told to push from the start of labour, exhausting themselves unnecessarily in trying to force their baby out before the cervix had dilated.
It took 50 years before research caught up, and realised the second stage of labour had very positive benefits for the baby. In fact, it stimulates the respiratory and digestive systems, and allows the baby to be colonised by beneficial bacteria. You can read more in BellyBelly's Natural Birth – 5 Huge Benefits For Babies.
Pushing during the second stage of a normal labour has no positive benefits for either mother or baby. When the mother is pushing forcefully, she is holding her breath and bearing down. When she holds her breath, she temporarily stops the oxygen flowing around her body, and to her baby within. This can lead to events such as decreased fetal heart rate, and to interventions to ensure the safe birth of the baby.
Pushing also increases the force placed on the pelvic floor of the birthing woman. The vagina and perineal tissues will stretch to accommodate the baby’s head, but pushing places more pressure on these tissues to stretch before they are ready, and increases the chances of tearing.
What If Women Don’t Push?
One hospital in the United Kingdom has implemented a small change in its maternity care and, as a result, rates of perineal trauma have been dramatically reduced.
The Medway Maritime Hospital in Kent implemented a program to stop telling women to push during labour. This came after the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives called for action to stop the increased rise in severe perineal tearing which, over 12 months, affected almost 14,000 women.
The new program at the Kent hospital included a number of measures, such as: staff not telling labouring women to push; encouraging them to breathe through contractions; using upright positions; and supporting the perineum by not pulling the baby out after the shoulders emerged.
In the 12 months after the program was implemented, there were almost 4,000 births and a significant decrease in the rate of third and fourth degree tears. Before the program was implemented, perineal trauma had been experienced by almost 6% of women; afterwards, it was just over 1%.
The program has been so successful the results were published in the European Journal Of Obstetrics & Gynaecology And Reproductive Biology and there are plans to bring it into hospitals across the United Kingdom.
What Does This Mean For Birthing Women?
Until now, perineal tearing has always been considered a complex problem of vaginal birth. Maternity experts suggest tearing occurs because of many factors – such as higher maternal age for first births,and increased maternal weight – and do not focus on poor quality care during labour.
Women who give birth in midwifery-led models of care might be less likely to experience tearing, for a number of reasons.
- Midwives focus on normal physiological birth, and support women to labour and birth in the positions which feel most comfortable.
- Women are also more likely to have an undisturbed labour, which increases the likelihood of the fetal ejection reflex occurring.
- Continuity of care from a known midwife creates a relationship of trust, allowing the birthing woman to give birth instinctively, rather than rely on her care provider to tell her what to do.
The program and research in Britain won't come as a surprise to advocates of normal physiological birth. However, it is hoped more hospital awareness and engagement will help promote a safer approach to labour in obstetric settings, and encourage women to seek care providers who will support a positive birth experience.
Women who do have the urge to push should be supported to work with their bodies gently. Those women who need to push to ensure their babies are born quickly and safely should also be supported to do so, in a way that reduces the possibility of perineal trauma. You can read more in Tearing During Birth – 9 Ways To Help Prevent Tearing.