Little Lamb Doula Care

Whether you labored naturally or had pain medication, pushing in the hospital often becomes coached whether that was the plan or not. Reasons this may occur include:

•    –   You don’t have an advocate for your birth plan.
•    –   You’re really tired and understandably ready to be done, and you’re simply listening to your nurses and OB.
•    –   You just had a vaginal exam, it’s discovered you’ve dilated to a 10, and the stirrups are snapped up. You find yourself on your back or in a semi-sitting position all prepped for coached pushing.

Coached pushing is what you usually see in movies; the mom grabs under her legs, tucks her chin, and holds her breath and pushes forcefully usually to a count of 10. This is often repeated 3 times during a contraction. It’s been associated with fetal bradycardia (baby’s heart rate is less than 110 bpm persistently), and increased instances of neonatal resuscitation and episiotomy (Caldeyro-Barcia, 1979, as cited in Davis, 2012). Blood vessels are likely to burst in the face from the efforts, and damage to the perineum and subsequent issues with incontinence are also increased risks. So is maternal fatigue (Frye, 2013, pp. 448).

That’s not to say there aren’t times for coached pushing. There are. You may feel that’s what your body needs to get the baby out, or you may have had a long pushing stage already and aggressive pushing is needed for the baby to be born. Perhaps you have an active epidural and need the direction.

Once you’ve dilated to a 10, coached pushing usually commences right away in the hospital. Oftentimes, in natural birth and especially with first-time moms, the body takes a short rest before pushing. Contractions space out a bit and the urge to push builds gradually. A form of pushing follows where a mom listens to the urges of her body in bearing down efforts. This is physiological pushing. It is also called spontaneous pushing or mother-led pushing, and the mom is encouraged to breathe or exhale while pushing and take her time.

So if you want to have a natural pushing stage in the hospital, how can you go about that?  Make sure that you, your husband, or doula will advocate for your plan to do spontaneous, mother-led pushing. Ideally, everyone on your birth team is on board and ready to say what you want, including you. Say what you want out loud. Be confident in yourself, your body, and your plan.

A few cues coached pushing may be in your near future are:

•    –   You’re a 10 and the staff tells you that you can start pushing.
•    –   You’re a 10 and they’re calling in other nurses to help with pushing efforts.
•    –   You’re on your back on the bed or semi-sitting, the stirrups are coming up, and nurses start explaining to you how they want you to do coached pushing.

This is your opportunity to say, “actually, I want to do a gentler pushing style where I follow my own instincts. I’m not feeling pushy yet, and I want to wait until I do to push.” This is also your opportunity to get out of the bed and keep moving around.

Here are some phrases to have in your back pocket to circumvent this situation and advocate for mother-led pushing:

•    –   I’m not feeling pushy/ ready to push yet. I’m going to get up for a bit.
•    –   I want to wait until I feel the urge to push to start pushing. I’ll let you know when I’m feeling more pressure.
•    –   I want to rest a little more before pushing.
•    –   I’m going to push when my body tells me to. Please support me in this.
•    –   I don’t want coached pushing at this time. I’m going to push with my body’s natural urges, even if it takes a little more time.
•    –   I want to let my epidural wear off so I can feel the urge to push better. Once it does, can you help me into a kneeling position?

Phrases to get out of the bed or an uncomfortable laboring/pushing position:

•    –   No, I don’t want this. [Beckon partner or doula over for assistance]. I’m laboring out of the bed.
•    –   I won’t/don’t want to push on my back [or x position]. I’m going to push in a position that feels better.
•    –   I’m getting out of this position. I want to try hands and knees or kneeling [or x position].
•    –   I’m going to try an upright position now.

So with mother-led pushing, how do you know when you’re actually ready to push? We’ll talk about that in Pushing Series pt. 2!

I hope these phrases help you during your pushing stage! I’m Emma Pence, a Birth Doula and Pediatric Sleep Consultant in the Lansing, MI area. I want to help you have your best birth! If you’re looking for a birth doula, please reach out today at emma@littlelambdoula.com!