Pushing during childbirth can be one of the most intense and painful experiences for a woman. The contractions during labor cause the cervix to open and the baby to descend into the birth canal. Once fully dilated, a woman starts actively pushing the baby out. This involves bearing down with each contraction and using abdominal muscles to expel the baby. Many factors influence whether pushing will be painful or not for the mother.
What causes pain during pushing?
There are several reasons why pushing can hurt:
Stretching of the vaginal opening
As the baby’s head passes through, it stretches the vaginal opening significantly. This intense stretching of the sensitive tissues around the vagina and perineum is often described as a burning or stinging sensation. First-time mothers in particular feel this stretching acutely as their tissues have not undergone this expansion before.
Pressure on the pelvic floor
The pressure of the descending baby on the muscles and nerves of the pelvic floor can cause aching and soreness. Pushing requires the strongest contraction of these muscles, which can be painful.
Perineal tearing
The perineum (area between vagina and anus) often tears during delivery as the baby’s head stretches it. This can cause a sharp, burning pain. Severe tears may require stitches after birth.
Fatigue
Pushing can last anywhere from minutes to hours. As the mother becomes exhausted, the process often becomes more painful and difficult. Fatigued muscles can increase irritation and discomfort.
Baby’s position
If the baby is posterior (facing forward) or in an awkward position, pushing the hard head against the mother’s tailbone or spine can cause tremendous pain. Malpositioned babies often require longer pushing.
Use of forceps or vacuum
Assisted deliveries with forceps or vacuum devices make pushing more painful. The pressure and pulling on the baby’s head causes intense perineal pain.
Factors that influence pain
Several factors impact how painful and difficult pushing will be during labor:
Medication use
Epidural analgesia can take away pain but make pushing less productive. Narcotics cause drowsiness and difficulty pushing effectively. Natural childbirth avoids medications, but the mother feels the full pain of contractions.
Coaching and support
Continuous emotional support and coaching on pushing techniques helps distract from pain and speeds up labor.
Delivery position
Upright positions take advantage of gravity and open up the pelvic outlet more. This often makes pushing easier than lying on the back.
Hydration and stamina
Remaining hydrated and keeping up energy levels can help maintain strength for the pushing stage.
Conditioning
Exercises during pregnancy like Kegels help strengthen pelvic muscles and increase endurance for pushing for longer periods.
Previous vaginal deliveries
Women who’ve delivered vaginally before usually have less painful, easier pushing experiences in subsequent pregnancies.
Baby size
Larger babies require more intensive pushing and cause greater perineal stretching.
Mother’s pelvic dimensions
A wider pelvic outlet makes passage easier. Contracted pelvis can obstruct labor and cause more pain.
Pain relief options
There are some methods that can help reduce pain and difficulty when pushing:
- Hot compresses on the perineum
- Perineal massage with oil to gently stretch tissues
- Warm bath submersion for buoyancy
- Calm, focused breathing
- Soothing music in the delivery room
- Acupressure and visualization
- Changing positions frequently
If the sensations become overwhelming, pain medication can be requested. Options include:
- Nitrous oxide gas for relaxation
- Pudendal nerve block injections for numbing
- More epidural medication, if already administered
- Local anesthetic injections at perineum
How to make pushing more effective
Proper pushing techniques can hasten labor and minimize unnecessary exertion and discomfort:
- Start pushing only when there is an urge or contraction
- Keep chin tucked to chest while pushing
- Push for 8-10 seconds per contraction
- Take rapid breaths in between pushes
- Have support person count out loud
- Stay focused and aware of body
- Conserve energy in between contractions
- Push with contractions even if baby is crowning
- Avoid prolonged straining
Using these optimal techniques, instead of holding breath and straining for long durations, can speed up labor while reducing fatigue and tissue trauma.
Positions to aid pushing
Being upright and mobile in the pushing stage can facilitate the baby moving down without extra strain on the mother’s body. These positions open the pelvic outlet more effectively:
| Position | Benefits |
|---|---|
| Squatting | Widens pelvic diameter, uses gravity, opens outlet |
| Kneeling on all fours | Uses gravity, takes pressure off back |
| Sitting on birthing ball | Uses gravity, feels less restrictive |
| Supported squat with partner | Good leverage, partner can lift and support |
| Side-lying | Restful, can help rotate baby |
| Hands and knees | Rotates pelvis, aligns baby |
Changing positions every 20-30 minutes prevents exhaustion and varying orientations can assist labor progress.
When to stop pushing
Pushing for too long without progress can be detrimental for mother and baby. It’s important to recognize when to stop actively pushing:
- Baby becomes distressed seen on fetal monitor
- Pushing over 2-3 hours without progress
- Mother is too fatigued to push anymore
- Increased swelling or bleeding occurs
- Baby’s head delivers but body is stuck
In such cases, it’s critical to stop aggressive pushing. The team will assess if assistance like vacuum, forceps or a C-section is required for the safety of both.
Special cases
Some specific situations need extra precautions and assistance during pushing:
Breech presentation
With the baby’s buttocks or feet positioned to deliver first, pushing requires extra control and gradual maneuvers by the clinician. Pain management is very important.
Precipitous labor
Very rapid labor may not allow time for anesthesia. Intense, unavoidable sensations need managed breathing.
VBAC (Vaginal birth after Caesarean)
Previous uterine scars increase chances of rupture or bleeding which require close monitoring when pushing.
Multiple births
Pushing out more than one baby requires pacing oneself and stamina. Birthing positions and epidural adjustments need proper planning.
High-risk pregnancies
Medical conditions like high blood pressure or gestational diabetes necessitate careful monitoring during active pushing.
The ring of fire
Many women describe the burning, stinging sensation of the baby’s head crowning as the “ring of fire”. This is caused by extreme perineal stretching and is often the most painful part of pushing. Some ways to manage this include:
- Slow, controlled breathing and relaxation between contractions
- Warm compress on perineum
- Perineal massage and oil to gently stretch tissue
- Allowing head to deliver slowly, pausing contractions
- Imagery, hypnobirthing techniques
- Medication if unbearable
This intense phase often passes quickly once the head delivers fully. The burn subsides immediately after birth.
Does pushing hurt the baby?
The contractions and active pushing do not directly hurt or harm the baby. In fact, pushing helps propel the baby out of the birth canal. However, distress can occur if:
- Labor stalls for too long without progression
- Cord becomes compressed preventing oxygen
- Baby’s head size is disproportionate to the pelvic outlet
- Poor maternal positioning inhibits descent
- Prolapsed cord occurs from premature pushing
Fetal monitoring during the pushing stage helps immediately identify any emerging problems. As long as there are no complications, the baby remains safe through the process.
Conclusion
Pushing during labor can involve significant pain and exertion for the mother. However, it facilitates the satisfying completion of their journey to birth. Awareness of techniques, positions and breathing can help manage the intensity. While challenging, women draw immense strength during active pushing. Support and reassurance help endure the temporary discomfort to meet their babies. The joy of this moment far surpasses the fleeting struggles of labor. With proper guidance, the pushing stage can be streamlined and smoother. After bringing new life into the world, the mothers feel empowered by the challenges they overcame.