Episode 19: Pushing

The truth is, the experience of pushing a new human out of one's vagina and into this world is hard to describe or practice for. Some excellent advice dispatched from this community was "push like you're pooping". Those muscles are the closest, for sure, and that advice is often helpful!

For some birthing people pushing is a reflex, more similar to vomiting if anything -- they can't stop even as they try to use all sorts of tricks to slow things down. For other birthing people, it takes an hour to find and coordinate their most effective pushing muscles. And then another hour or two to slowly move the baby down, invite the baby to find the proper rotations, mold the baby's head, and push the baby all of the way out. The longest few inches.⠀⠀⠀⠀⠀

Full Video Transcript

Welcome to episode 19 of the free Brave Journey Birth Preparation Videos. Today, we're talking about pushing and I have so much to say about pushing as you will be able to tell in this video, .As I've been mentioning these videos, I originally recorded them for a different purpose. I was recording them to be part of the full Brave Journey Birth Preparation Program. However, I've since completely reworked how I'm introducing concepts in that program. And I've changed the order that I'm introducing things. So these videos are no longer useful. So I split them all up and I'm releasing them weekly as free content.

I do want to mention, I may mention or reference things like in this lesson we talk about, but we're not going to talk about XYZ until a future lesson. And that is in reference to lessons and concepts that we will be discussing in the, the Brave Journey Birth Preparation Program, which is a paid program.

So, um, if that doesn't make sense, I'm sorry, but otherwise the rest of this information should be solid. So without further ado, let's talk about pushing.

Now let's talk about pushing. So the stages of labor we just talked about the phases of labor, early labor, active labor, transition. That is all part of the stage of labor, where the cervix opens, softens thins and the baby moves down.

Pushing is when the baby is traveling through the vaginal canal out to being born.

So during this stage, the baby's head is slowly molding to the shape of the birth canal as they find their way slowly through the birth canal.

Babies are born with this really fantastic design to their skull, where it is completely normal and expected for their head shape to change and mold as they journey through the birth canal.

And that's why babies are often born with these really, really cute and wonky heads. Sometimes where this part of their skull just really is elongated. Sometimes there's ridges where if during the pushing stage, the baby hung out at a certain place in the vaginal canal and there a Ridge may be formed there, but don't worry if your baby is born with a really funky shape to their head, that is normal for a baby that is born vaginally.

And over a few days, it will round. And if you're worried, you can talk to the pediatrician about it. Everyone will assure you it's totally normal.

Once the cervix is fully dilated the baby begins to descend even further. And because of this, sometimes there's a period of time where the contractions slow down and space out because the uterus is catching up with the baby that has dropped.

So if contractions were here and the baby was pressing against the cervix, the cervix opens the baby drops while the uterus may still be contracting up here. And it takes a minute for the uterus to catch up with the baby. So that stage there can be a little bit of a delay or a slowing down in a spacing out of contractions during this time.

So in the hospital, pushing is often done with, well, generally pushing is done with each contraction, usually two or three pushes per contraction in the hospitals, offices, Christians and midwives will often do care provider directed pushing, which is where care provider director pushing is, where they will coach the person birthing to push at certain times during the contract.

So what that will sound like, you're saying like push, push, push, push, push. Okay. Breathe in now. Push, push, push, push push. So that's most often at hospitals and sometimes birth centers, home births, and some midwives will do. What's called, um, and obstetricians when asked what's called mother directed pushing or birthing person directed, pushing where the birthing pushing person pushes.

Feel the urge to within their body. And they push with the pattern that they feel the urge come from their own body. Generally though it's two or three pushes per contraction through the pushing stage contractions as should be implied by what I just said, contractions continue the ebb and the flow of contractions for a minute or two, and then rest for a minute or two or three, and then contractions for a minute or two, and then rest for a minute or two or three that continues from early labor.

All the way until the baby is born. So through this pushing stage, pushing with contractions gives more power to the push. If a birthing person is to tries to push between contractions, it is more difficult. Sometimes the care provider will suggest that as a means of either guiding a gentle pushing stage, or if the baby has been partially born, their head is born and the care provider may instruct pushing, even when the contractions going away for the rest of the baby to be okay.

It's not unusual for the baby's head to be born and then the contraction to go away. And then for the care provider and the birthing person to wait for the next contraction to push again for the rest of the baby to be born. And that's because the baby is still receiving blood and oxygen through their umbilical cord.

So they're not breathing yet because they haven't fully been born. Their lungs haven't expanded yet. So they're had maybe. And then it may be a minute or two for the next contraction and then the rest of their body will be born with that next contraction.

It's also not uncommon for first time, birthing people to take about an hour to find the most effective muscles to push their baby out. So. Pushing is very, very different than the rest of labor. The muscles involved, the coping practices and the positions involved are very, very different.

And really, there's no way to prepare for what muscles are required when pushing the closest thing to compare it to is pooping. And pooping is often the closest thing to remind birthing people have when they're learning how to push during the final stage of labor, but it's still not the same, so it can take an hour for birthing people to practice the different muscles and push in different ways.

Pushing requires a different set of muscles using them in a different way for a baby to emerge from a different place than pooping. So, yes, during the pushing stage, as a birthing person is trying to learn and find those muscles to push care providers, a birth doula, as I've said it before, think of push, I think of pooping use the muscles you're using when you bear down to poop, but it's just not quite the same.

So the only way that you can learn how to do it is in the moment, which is why it can take some time. So it's not unusual. And birthing partners -an hour may feel like a long time, but remember that for one thing, birthing people or only practicing, pushing during contractions. So there's usually a contraction for about a minute and then a couple of minutes of rest.

So it's just a few minutes of practicing. And then in addition, birthing people are hopefully still in that labor land that altered mind, state and time just means different things... it's something different to birthing people. So it may not feel like a long time to the birthing person, but to the birth partner, it can feel like, "oh my gosh, it's been an hour and she's, you can't even see the baby's head."

It's normal. Sometimes the care providers will place their fingers at the very base of the, of the vaginal canal and feel when the baby is moving. And also to give feedback, so they should ask permission before they do this, but it can be a really helpful biofeedback process for the birthing person to feel like, okay, if I push them to that point and then the care provider will be like, yes, yes, yes.

That moved that baby a little bit. Those are the muscles. And then that's when the birthing person learns, okay, those muscles move the baby. I can do that again. So after about an hour of that is when pushing really starts to get effective. And then that's when you start to see some more movement. Now when the baby starts to get lower and lower and they get low enough that you can start to see their head.

What it'll look like if this is the vaginal opening, and this is the baby's head during the contraction during the push, the push push push, you'll see the baby's head just a little bit. Those labia will part, and you'll see the baby's head. It'll look like a wrinkled. Sometimes you can see the baby's hair.

Frankly, it may look a little strange if you weren't expecting it. Wrinkled, because remember it's all compressed. So you'll see the baby's head. And then when the contraction releases and the birthing person stops pushing, the baby will go back up. So this is part of that gentle molding process. This is part of the baby's head molding, the vaginal canal molding the perineum slowly stretching.

This is very, very normal. At some point, the baby's head will emerge. Excuse me, then you'll be good. See just a little bit of the baby's head. And then between contractions while the birthing person rests until the next contraction, the head will stay and this is called crowning. So once the baby is crowning is usually when the care providers will then start to get the birth care ready.

So up until then. Care providers know it can take a couple hours. So, and up until then the care providers probably don't have all their birth garb on and all the birth kit ready when the baby starts crowning is when they'll call for maybe assistance to have a few more hands in the room because the baby's birth is much more we're imminent.

It's totally normal for first-time birthing people to push for three or four hours before the baby is born. Three hours is within the realm of normal for somebody without an epidural, four hours is within the realm of normal for somebody with an epidural.

Now epidurals do slow down labor and they can make it a little bit harder to push because all that, all that finding of the muscles and feeling the movement of the baby and figuring out how to push us a little bit. Sometimes a lot harder when you can't feel your body in the same way, we will talk a lot more about the pros, the benefits, the risks of epidurals and all other interventions during the interventions lesson.

So I mentioned that many birthing people, it takes them an hour to find the muscles it's unlike anything they've ever done before. And it takes a lot of practice.

In contrast for some birthing people pushing is such a strong urge that they couldn't not push even if they tried, it's almost like a reverse vomit. This is called the fetal ejection reflex. So some people, it takes them an hour to find these muscles and figure it out. And for some birthing people, they are pushing whether they want to or not. The urge is so strong. And for those people birthing and pushing the pushing stages often shorter.

So, um, you never know what it's going to be like for you. It can be. Two very different experiences that taking an hour to find the muscles and figure it out or pushing without even realizing you're pushing. Um, because the urge to push is so strong and both are normal.

In terms of pushing positions, we will talk about pushing positions in, uh, a lesson later on in the brave journey, birth preparation program, but often, um, in hospital.

Birthing people often are pushing on their side or on their backs and, um, in birth centers and home births, uh, birthing people often push in a more upright position, a squat or a kneel, but we'll talk about these positions in a separate lesson, and it is possible to advocate for freedom to move and push in lots of different positions within the hospital. It's just less common in the culture of the hospital

so whether pushing is a reflex and you couldn't stop it, if you tried, or it takes you an hour or two learning, which muscles have to use to effectively push that baby out, both are completely normal.

The next stage that we'll talk about is after the baby has been born and the third stage of labor, which is delivering the placenta.