Pushing during labour and delivery is often portrayed in movies and TV as an intensely painful and dramatic experience, with mothers screaming at the top of their lungs while they bear down with all their might. But is that accurate? How hard should you actually push during labour?
The pushing stage is when the baby moves through the birth canal and is delivered. This phase is also called the “second stage” of labour. For first-time moms, it can last anywhere from 30 minutes to 3 hours. For women who have given birth before, it may only last 5-30 minutes.
Pushing effectively helps guide your baby through the birth canal. But pushing too hard or too soon could lead to problems. Here’s what you need to know about when and how to push during labour.
When to Start Pushing
Your body gives cues when you’re ready to start pushing. Pushing before you’re fully dilated and effaced can cause the cervix to swell. It may also increase your risk of perineal tears.
Here are signs that you’re ready to push:
– You feel rectal pressure. This may feel like you need to have a bowel movement.
– You have an overwhelming urge to push. Your body will naturally start pushing downward.
– Your contractions feel different. You may feel them more in your rectum.
– You’re fully dilated and effaced. Your cervix is 10 cm dilated and completely thinned out.
Don’t start pushing until your doctor or midwife confirms it’s time. They’ll check your cervix. Once you get the go-ahead, you can start using contractions to push the baby out.
Proper Pushing Techniques
Pushing requires physical and mental effort. But you don’t have to push as hard as you can. Here are some tips for pushing effectively:
– Take a deep breath as the contraction starts. Hold your breath and push for a count of 10.
– Focus the push down into your vagina and rectum. Avoid pushing with your face or throat.
– Push with your abdominal muscles like you’re having a bowel movement.
– Tuck your chin to your chest. This helps align your spine and pelvis.
– Relax your mouth and jaw. Keep your face and neck loose.
– Rest between contractions. Recover your energy before the next one starts.
– Change positions if needed. Upright positions can make pushing more productive.
– Follow your care provider’s guidance. They may have you modify your technique.
Pushing takes practice. Don’t worry if you don’t get the hang of it right away. Keep trying different positions and techniques until you find what works for you.
How Hard Should You Push?
You may feel an overwhelming urge to push with all your might. But pushing too forcefully can cause problems, including:
– Fatigue. Pushing at 100% effort is exhausting. You’ll wear yourself out quickly.
– Holding your breath. Aggressive pushing often involves holding your breath and tensing up. This limits oxygen flow.
– Increased risk of tears. Straining too hard can cause vaginal or perineal tears.
– Fetal distress. Intense pushing can reduce blood flow through the placenta.
– Hemorrhoids. Pushing extremely hard raises hemorrhoid risk.
– Pelvic floor damage. Overstraining the pelvic floor muscles can weaken them.
Pushing as gently as possible is ideal. Your care team will guide you on when to push a little harder. Some key points:
– Push just hard enough to make slow, steady progress.
– Gradually increase effort as the baby descends.
– Stop pushing if you feel lightheaded or exhausted.
– Allow your body to push naturally as much as possible.
Stay in tune with your instincts. Avoid actively pushing during parts of contractions when you don’t feel an urge.
When Hard Pushing May Be Needed
While gentle pushing is generally better, there are some cases when more forceful pushing is appropriate:
– The baby needs to be delivered quickly in an emergency.
– You have an epidural. The medication can make pushing less efficient.
– You’re exhausted. Stronger pushes may help avoid a long second stage.
– You need extra force to deliver the shoulders.
– The baby is in an awkward position. Pushing hard may help rotate them.
Talk to your provider about when and why to push more assertively. They’ll ensure it’s safe and necessary.
What If You Can’t Push Effectively?
It’s normal to have trouble pushing effectively at first. But if you continue struggling, your provider may recommend interventions to help, like:
– Changing positions to ease pushing. Squatting may help open your pelvis.
– Using a birthing bar for leverage while pushing.
– Applying fundal pressure. Your care team gently presses on your abdomen.
– Using forceps or vacuum extraction to guide the baby out.
– Episiotomy. This makes space by cutting the vaginal opening.
– Cesarean delivery if the baby doesn’t progress. This is very common with epidurals.
Keep communicating with your care team if pushing feels impossible. Be open to suggestions to help move things along.
Pain Management Options for Pushing
Pushing can be challenging and painful, especially for first-time moms. Here are some options for making this stage more manageable:
| Method | How It Helps |
|---|---|
| Epidural | Provides effective pain relief but may prolong pushing |
| Nitrous oxide | Reduces pain without motor impairment |
| General anesthesia | Eliminates pain sensations but you’re unconscious |
| Local anesthetic | Numbs perineal area to reduce tearing pain |
| Sterile water injections | Relieve lower back pain between contractions |
| Acupuncture | Stimulates endorphins for natural pain relief |
| Massage | Reduces muscle tension and anxiety |
| Hydrotherapy | Warm water soothes pain during pushing |
| Breathing techniques | Distract from pain and improve oxygen flow |
Discuss your preferences with your provider ahead of time. Certain pain medications can make pushing more difficult.
When to Stop Pushing
As the baby moves down the birth canal, your care provider will coach you on when to stop pushing between contractions. This allows the perineum time to stretch slowly.
Other times you may be advised to stop pushing include:
– The baby’s head delivers but their shoulders don’t. Stop pushing while steps are taken to free the shoulders.
– You’re too exhausted or breathless to continue. Take a break before resuming.
– The umbilical cord slips out before the baby. Stop pushing to avoid cord compression.
– Pushing is ineffective after a reasonable time. Your provider may recommend a C-section or vacuum extraction.
– You’re at risk of severe perineal tears. Your provider may cut an episiotomy before the head emerges.
Listen closely to guidance from your care team on when to push, stop or slow down. This helps ensure a smooth, safe delivery.
How Long Should the Pushing Stage Last?
For first-time moms, active pushing typically lasts 1-3 hours but may be shorter or longer. For women who’ve given birth before, this stage usually lasts under 30 minutes.
Pushing longer than 3 hours if you’ve delivered vaginally before or 4 hours for first-timers can raise risks like:
– Maternal exhaustion
– Fetal distress
– Postpartum hemorrhage
– Infection
Factors affecting the length of pushing include:
– Epidural use – this lengthens the pushing stage
– Baby’s size – larger babies may require more pushing
– Baby’s position – posterior babies often take longer
– Shape of the pelvis – a narrow pelvis can prolong pushing
– Birth attendant’s guidance – their coaching style impacts duration
There are no hard rules on how long you should push. Focus on working with your body. Trust your care team to guide you if pushing drags on too long.
Recovery After Pushing
You’ll likely be exhausted, sore and swollen after labor. Here are some things that may help with recovery:
– Rest as much as possible. Let others handle baby care so you can sleep and heal.
– Use cold therapy to relieve swelling. Ice packs can help shrink hemorrhoids and ease perineal tears.
– Try sitz baths and numbing sprays for perineal discomfort. These can provide relief as tears and stitches heal.
– Use a squirt bottle or peri bottle to cleanse after urinating. This avoids irritation and stinging.
– Take over-the-counter pain medicine as needed. Ibuprofen or acetaminophen can ease postpartum aches.
– Do Kegel exercises to regain pelvic floor strength. Start once bleeding and soreness subside.
– Seek physical therapy if you have lasting pain or incontinence. PT can help rehab the pelvic floor muscles.
– Accept help from loved ones with baby care, meals and chores. Focus on healing the first few postpartum weeks.
Make sure to attend your post-delivery follow-up visits with your healthcare provider. Report any concerns about prolonged pain, bleeding or incontinence.
Frequently Asked Questions
How do I know if I’m pushing correctly?
Signs of productive pushing include feeling intense pressure and stretching in your rectum and perineum, progress in descending the baby with each contraction, and guidance from your care provider that pushing is effective.
Why do I feel like I’m constipated when I push?
Because the rectum and vagina are close together, you may feel rectal pressure, stretching or stinging while pushing. Using the same muscles makes pushing feel very similar to bearing down for a bowel movement. This is normal sensations.
Can I tear my vagina from pushing too hard?
Yes, straining too forcefully can potentially lead to tears in the vaginal walls or perineum. Your nurse or midwife will help guide your pushing strength to minimize this risk as much as possible.
How do I stop myself from pushing before I’m fully dilated?
Changing positions, focusing on your breathing, relaxing your pelvic floor and using pain relieving techniques can help overcome the urge to push too soon. Let your care team know if you feel constant, uncontrollable pressure.
Can I opt for a C-section if I’m struggling to push?
Yes, if prolonged pushing is putting you or your baby in distress, your provider may recommend an emergency C-section as the safest option. This would require your consent.
Conclusion
While depicted as extremely strenuous in media, pushing during labour does not have to be a dramatic or traumatic experience. With guidance from your care provider, focus on working with your body and following its natural urges. Avoid actively pushing when you don’t feel the reflex to do so.
Start gently, gradually increasing effort as needed and your care team advises. This helps make delivery smoother and safer for both you and your baby. Don’t hesitate to ask for help pushing or request pain relief measures as needed.