Pregnancy
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Labor and Delivery

How to Push during Labour & Delivery

Pushing in Labour & Delivery forms the second stage of labour. This phase occurs after the cervix dilates completely and the head is ready to exit the birth canal. A well-synchronised pushing effort by the mother enables a smooth passage of the baby.

This article shall help you understand the science behind pushing during labour and things to be careful about.

How to know when to push during a delivery?

Complete cervical dilation marks the end of the first stage of labour, and with this begins the second stage, wherein you are ready to push your baby out. The baby’s head when ready for delivery at the vaginal canal can be perceived as a natural indicator for a woman to exert pushing force in her lower body region. The urge is so strong that pushing becomes a natural and necessary response for relief.

Increased pelvic floor pressure, heaviness in the genital region, amplified blood circulation together trigger the active.

Contractions while pushing

In the active(pushing) stage, the fully pregnant uterus contracts strongly every five minutes, each lasting for 45 to 90 seconds. It might not be easy to identify true contractions. Contractions are usually forceful and may or may not be associated with a desire to push. It certainly feels different when your baby travels down the birth canal. At this moment, stay calm and let nature welcome your baby into the world.

How Do You Feel When Your Body Urges You To Push?

With the baby’s descent, mothers’ feel the weight and a strong urge to push sometimes even before they are fully dilated.

It is important that your baby gets delivered safely rather than quickly. Each stage of labour takes its own time and is necessary for nature’s process to complete. Usually, women in the pushing stage may feel various types of urges:

Strong urge: An uncontrollable urge, a feeling like your body is experiencing the baby coming. It is hard to resist. A gravity neutral position may be helpful in this situation.

Normal urge: Women may feel like pushing with every contraction or at the peak of contractions. It can be best controlled by changing the position and breathing until you feel a strong urge.In selected cases, the baby may just move down easily and you will not experience any strong pains.

Absent urge: It is possible that a woman may not feel any urge to push. Time and position are critical here. If dilatation is complete for more than 30 minutes following which, one may consider an instant urge to push by herself or direct pushing that is directed by another person.

How Long Does Pushing Take During Labour?

The pushing stage lasts up to a few hours in women giving birth for the first time. And in those who are giving birth for the second or subsequent times, the pushing stage can last for as less as 10 minutes. In general, it can take a few minutes to some hours. The pushing time varies depending on the following factors.

First delivery or subsequent delivery:The pelvic floor muscles are tight if they have never been stretched to accommodate a baby. Stretching is slow and steady, and therefore takes time. If it is a subsequent delivery, it will take lesser time to push out your baby. Women who have had multiple deliveries can push just once or twice because the muscles have already been stretched out previously.

Pelvic structure: The anatomy of the pelvic apparatus varies amongst different women. An ideal shape is an oval-shaped pelvis. Some pelvic outlets are small but most babies manage to pass through them. In rare cases, the pelvic outlet is too small for the baby to get delivered. Such cases of disproportion usually prolong the delivery and might be associated with birth complications.

Baby Size:A few babies have large heads, with oversized cranial bones which overlap on each other during delivery to accommodate through the birth canal. In such cases, the baby’s head may be elongated and termed as a “caput”. This usually normalizes sometime after birth.

Alignment of foetal head and the pelvic apparatus: The normal position of the baby during a vaginal delivery is head as the presentation, with face towards the mother’s back or the sacrum. This is termed as the anterior position.

In certain cases of vertex presentation, the baby may be facing towards the pubis, the posterior position, which requires manual rotation of the baby while delivering.

Labour force: It is the effort with which the mother pushes the baby out. Uterine contractions are vital for cervical dilatation. Without any of the two, delivery isn’t possible naturally. Synchronized contractions with adequate dilation facilitate a smooth delivery.

How to push during labour?

push during labour
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1.Coached Pushing: Coached or directed pushing is where you are directed how to push during the delivery by your health attendant or midwife, once your cervix is fully dilated. It is carried out irrespective of whether you feel any urge to push or not. Few experts believe that coached pushing may be hazardous to both the mother and the baby.

Pros and Cons of coached pushing

According to a 2006 study, which assessed about 300 women undergoing normal delivery without epidural anesthesia, found that there wasn’t any significant difference in the pushing stage of both, coached versus spontaneous pushing groups. Neither the mother nor the baby had any significant benefits according to the study.

A higher risk of urinary problems was reported previously by the same research team in women who were offered coached pushing. Spontaneous pushing did not have any adverse effects reported.

Coached pushing was also associated with one or more of the following:

  • Higher likelihood of episiotomy or perineal damage.
  • Mothers’ had a higher risk of damage to pelvic tissues and/or urinary apparatus.
  • Exhaustion and malaise in mothers – the push takes up plenty of energy needed later when you have an urge to push.
  • Features suggestive of foetal distress.
  • Higher requirements of C-sections and assisted deliveries.

1.Coached Pushing: Coached or directed pushing is where you are directed how to push during the delivery by your health attendant or midwife, once your cervix is fully dilated. It is carried out irrespective of whether you feel any urge to push or not. Few experts believe that coached pushing may be hazardous to both the mother and the baby.

2.Spontaneous Pushing: This is considered to be a safer and more natural way of pushing during labour. In this method, the mother starts pushing only after she feels the urge to push out the impending baby through her vaginal canal for relief. This method is advised and preferred by doctors, and it is also documented to be safe by various competent authorities.

How is coached pushing done?

The second stage of labour begins when the cervix is fully dilated to 10 centimeters and goes until the delivery of the baby. This phase may go on for hours and this is when the coaching takes place.

  • Taking a deep breath before each push or contraction, you should bear down the pressure, keeping the muscles of your abdomen taut. The effort is similar to that felt during hard stools.
  • Pushing can be done to a count of ten. Two to three pushing efforts for each contraction may be adequate and fruitful. It is important to coordinate pushing with the baby’s descent in order to prevent tearing.

Why is coached pushing done?

A prolonged second stage of labour might be detrimental to the baby’s survival. Coached pushing helps reduce the duration of the second stage. Hence in indicated cases, it is now widely applied in deliveries around the world.

Prolonged second stage of labour can be estimated as per the guidelines of the American college of obstetricians & gynaecologists. It states that a second stage more than three hours without epidural, and two with epidural is prolonged for primi mothers. While it is 2 and 1 hour respectively for multigravid mothers.

There are recommendations to go for a C-section, assisted labour techniques like vacuum or forceps if the second stage is prolonged. It may be managed without intervention if both the mother and the baby are comfortable. However, coached pushing is advisable in order to avoid intervention and a prolonged second stage.

Pros and Cons of coached pushing

According to a 2006 study, which assessed about 300 women undergoing normal delivery without epidural anesthesia, found that there wasn’t any significant difference in the pushing stage of both, coached versus spontaneous pushing groups. Neither the mother nor the baby had any significant benefits according to the study.

A higher risk of urinary problems was reported previously by the same research team in women who were offered coached pushing. Spontaneous pushing did not have any adverse effects reported.

Coached pushing was also associated with one or more of the following:

  • Higher likelihood of episiotomy or perineal damage.
  • Mothers’ had a higher risk of damage to pelvic tissues and/or urinary apparatus.
  • Exhaustion and malaise in mothers – the push takes up plenty of energy needed later when you have an urge to push.
  • Features suggestive of foetal distress.
  • Higher requirements of C-sections and assisted deliveries.

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