Birth Plan Options for Pushing
<Directed or Purple Pushing
Directed pushing is the most difficult and tiring for the mother. It involves being told to push while someone counts (usually to 10), then being told to take a breath and push again. Using directed pushing will require pushing through the entire contraction, regardless of desire or urge to push. This style of pushing can be helpful it there is concern for your baby's health because directed pushing does decrease the amount of time spent in second stage labor. However directed pushing does increase the chance of a tear, increases the mother's fatigue and can decrease oxygen levels for both mother and baby.
Spontaneous or Mother Directed Pushing
Spontaneous pushing refers to the pushing efforts that a mother makes on her own as she feels the urge from her body. Using this style of pushing is generally easier on the mother and reduces the risk of tearing. Spontaneous pushing takes longer to get the baby out than directed pushing, however many women feel that the benefits of not wasting energy, ability to breathe when necessary and allowing the perineum to stretch make the longer pushing time worth the wait.
Exhale pushing can be used to decrease the strength of a push, or to release some of the tension the mother feels. Using this style of pushing promotes a gentler, slower pushing phase which may be easier on the mother and baby. To exhale push, the mother will slowly let the air out of her mouth while she pushes instead of holding the air in. Some women find that this pushing style helps them stay relaxed and focused during second stage. Other women find that it is difficult to coordinate exhaling with pushing when their urge to push is overwhelming.
- Laboring Down
Laboring down is the term given to the process of letting the body push without the mother adding extre effort. It can be helpful when a woman is using an epidural for pain relief, especially if she is unable to feel when she is having contractions. The body slowly moves the baby lower without the mother actively pushing. When the mother begins to feel pressure of the baby's head on the perineum, she begins to push with the contractions (pressure). This decreases the amount of time the mother needs to actively push, allows the mother to maintain an epidural during pushing and has not been shown to increase risk to mother or baby. Becuase this process is slow, it may not always be appropriate.
What options are available for pushing position?
This is the classic or traditional American hospital pushing position. Some women find that this position is helpful because it allows them to use their arms to hold their legs. Other women like the way this position allows support persons to assist them. Many women use this position because it is the position they are most familiar with from TV and movies.
Some experts feel that a reclining position increases the length of the second stage by causing the woman to push "uphill." Others are concerned that reclining positions may cause unnecessary pressure on a mother's back.
Squatting is the position the body is designed to use to eliminate and give birth in. It opens the outlet of the pelvis to allows for an easier passage of the baby. It also helps to prevent perineal tears. Some women find that using an upright squatting position helps them focus their efforts to push with the right muscles. Other women feel that being upright makes them more in control of their pushing.
Some mothers find that a squatting position is uncomfortable because their bodies are not familiar with it. In that case, tools or props can be used to help the mother maintain a squatting position, such as a squat bar on a hospital bed, a birth stool or a handle or counter that the mother can hold onto for support while she squats.
Hands and Knees
For mothers who are experiencing back pain during labor, a hands and knees position can help to relieve some of the back pressure. It also uses gravity to help encourage the baby to turn to an easier position. Some care givers are uncomfortable with the hands and knees position because the "upside down" view is unfamiliar to them, and that makes it difficult for them to assess progress.
Some mothers find it difficult to isolate the muscles necessary to push effectively. Other mothers are embarrassed by the sensations of pushing, concerned that body fluids may be excreted. In these case, sitting on the toilet to push may allow the mother to feel more free with her pushing efforts. By imitating the pushing she does for a bowel movement, a mother can improve her pushing technique. Having the toilet to catch body fluids can make the mother feel more comfortable with the effects of her pushes.
Studies have found that episiotomy is not an effective way to prevent a tear, and may increase the likelihood of a deeper tear. On average an episiotomy takes 3 months to heal.
There are two types of perineal massage. One type, done during the month before labor, helps the mother to learn to keep her pelvic floor relaxed during the stretching of crowning. The other type is done by a health care provider during pushing to gently stretch the perineal skin around the baby's head. This may be done with an oil or other lubricant to help the baby slip through the stretching skin. Some health care practitioners will provide perineal support, a type of counter pressure to the stretching from the baby's head, to help prevent a tear. To have perineal massage during your labor will require hiring a health care provider who is familiar with this technique.
Hot compresses soften the perineal skin allowing for more stretch in the tissue. This is what all the hot water was boiled for in the old books and movies. Some experts have expressed concern that hot compresses can "over stretch" the perineal tissues. Many women find the compresses to be valuable for comfort as well as to promote stretching of the perineum.