Coaching Is For Football, Not Labor
During the second stage of labor — after your cervix is 10 centimeters dilated and your baby rotates and descends further into your pelvis, you will feel the urge to push. Don't worry if you're not ready to push immediately after your cervix is fully dilated — your baby may still need time to rotate and descend further into your pelvis.
Amy Romano, midwife and co-author of Optimal Care in Childbirth: The Case for a Physiologic Approach, explains, "The urge to push is one of the most intense physical urges a woman will ever experience. When the urge comes, the woman will tend to bear down and exhale at the same time, only holding her breath for a few seconds at a time or not at all — this is the healthiest and safest way to push."
Although we see a lot of "purple pushing" and counting to 10 in the movies, some research shows this type of pushing is not usually ideal.
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Romano explains, "This research shows directed pushing decreases oxygen flow to the baby, causes the mother to be more exhausted after giving birth, and causes weakness in the pelvic floor muscles that can last for months after giving birth. It may also lead to more tears in the vagina and perineum."
Still, sometimes a little guidance can help.
If you're not sure how to push, you're not alone
"Some women don't get a strong urge or have trouble knowing what to do even though they feel an urge, so they naturally turn to their support team for help. The nurse and midwife or doctor can give her guidance and feedback, like praising her when she pushes well and moves the baby down, telling her when the baby's head is visible, or gently pressing inside the vagina to help her get a sense of where to direct her pushing effort," Romano says. "It is particularly important to wait for the urge to push when the woman has an epidural. Pushing before the urge increases the chance of a vacuum- or forceps-assisted delivery, which increases the chance of injury to both the baby and the mother."
So, what's the best way to push?
Like many things in labor, choices can't be made until you're in the moment. When you're in the second stage of labor, your doctor or midwife will assess how far your baby has descended in the pelvis and what position she's in. You can also try different positions for pushing — like squatting, kneeling, side-lying, semi-sitting or using a squat bar — and find what's most effective for you.