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Beginnings: Pregnancy, Birth & Beyond

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Giving birth: Managing
pain video series

Video transcript: Preparing for birth
Video transcript: Coping with labor
Video transcript: Recovery in the hospital
Video transcript: Recovery at home

Giving birth: Techniques for pushing and birth

Wait to start pushing until you feel the urge to push or until your health care provider asks you to push. Sometimes your body will rest after your cervix is fully dilated. This resting phase may last several minutes to an hour. It is usually all right to wait.

Positions to try

Your health care team will suggest positions and ways to adjust the bed that can make your pushing most effective.

If you need to start pushing before you have an urge to, try squatting, kneeling or sitting on the toilet. As the second stage of labor progresses, your urge to push will probably get stronger.

Many women feel the urge to push as a need to bear down or to a have a bowel movement. When you push, direct your energy toward your perineum, the area around your vagina.

If you need some help directing your pushing, ask. Your nurse or health care provider can hold a warm washcloth on your perineum. Or, that person can put two fingers in your vagina and press toward your rectum.

Some women don't feel a strong urge to push. Pain medicines may sometimes reduce the urge. Your nurse or health care provider can tell you when to start pushing and help you.

How to push

  • As the contraction builds into an urge to push, take relaxing breaths.
  • When you have the urge to push, take in a full breath and hold it. Then relax your perineum and push with your abdominal muscles. It's all right if you make sounds during the push.
  • Continue taking new breaths every 5 to 6 seconds until you no longer feel an urge to push or you are told to stop pushing.
  • When the urge to push is gone, take a full relaxing breath and return to a resting position until the next contraction.

Positions for pushing

Your nurse and health care provider will suggest positions and ways to adjust the bed that can make your pushing most effective. There is time between contractions to change positions or add and arrange pillows to make you more comfortable. This may help your baby move lower and improve your own comfort.

standing position squating position sitting position side-lying position

Here are some positions to consider:

  • Upright positions use gravity to help your baby move through your pelvis.
  • Squatting or sitting helps widen the pelvic outlet.
  • Pushing on hands and knees can help your baby turn to a better position.
  • Lying on your side may help your baby turn and reduce pressure if your baby is coming too quickly.
  • Holding your legs or pulling back on them can be helpful when pushing in a semi-sitting position. However, be careful. Pain medicine can make you less aware of how far you are stretching your muscles. Don't pull your legs farther back than you normally can. Ask your nurse for guidance.

See Positions for Labor and Birth charts for more information about these positions.

Tips for pushing

Relax your perineum and pelvic floor. This makes pushing more effective. It also reduces the chance of tearing and the need for an episiotomy. An episiotomy is an incision (cut) made to enlarge the vaginal opening just before your baby is born. Warm washcloths on the perineum may increase your comfort. Relax your jaw and mouth — this helps relax your pelvic floor.

Direct your pushing downward. Don't strain. Straining makes your face red, your eyes bloodshot, and your neck muscles taut. These are signs that some of your pushing force is going up rather than down. Straining is also exhausting. Instead, focus on using your abdominal muscles to push down, out, and away. This is what you do when you are trying to urinate faster.

Make some noise. Pushing is hard, physical work. You don't have to do it quietly. Grunt, moan, make I'm-working-hard-to-get-this-baby-born noises. High-pitched noises and screaming do not help your pushing effort. They show your energy is moving up, toward your face. Instead, make low, deep sounds that help "aim" your pushing downward.

Use your labor companion. Take encouragement from your labor companion's words of support. Let him or her know what words and actions encourage you. In addition, this person can help physically support you. Look at Positions for Labor and Birth charts and show how your partner can help.

Touch your baby's head. As your baby's head begins to appear at the vaginal outlet, you can reach down and touch your baby's head. This may help direct your pushing. You can tell that your baby will soon be born.

Tip

Your ability to relax is as important as your ability to push. Your uterus can push your baby out. Don’t strain.

Focus on relaxing your lower body so your baby can be born.

Birthing your baby's head

When your baby's head reaches the vaginal outlet and is about to be born, you may feel burning or stinging. Your health care provider may ask you to stop pushing to allow your perineum to stretch gradually.

If you are told not to push, put your head back and breathe lightly and quickly. This does not take away the urge to push. However, it does stop you from pushing forcefully. That allows your baby's head to be born more slowly, reducing the chance of a tear.

Reducing the need for an episiotomy

There are things you can do to reduce the need for an episiotomy or reduce the size of a needed episiotomy. Talk with your health care provider about his or her preferences.

  • Relax your pelvic floor and perineum every time you push.
  • Use perineal massage. Gentle perineal massage by your nurse or health care provider can help stretch your perineum.
  • Use positioning. When you push while squatting, kneeling or sitting on the toilet, your baby's head presses evenly all around the opening of your vagina.
  • Squatting can strain your knees and hips if you are not supported. Use the bed, a squatting bar, or your labor companion to help support your weight.
  • Squat only during contractions. Between contractions stand, sit or rest on your hands and knees.
  • Let your uterus birth your baby's head. Stop pushing as your baby's head is born. Follow your health care provider's directions.

 

Source: Allina Health's Patient Education Department, Beginnings: Pregnancy, Birth and Beyond, sixth edition, ISBN 1-931876-14-2

First published: 10/04/2002
Last updated: 08/15/2011

Reviewed by: Allina Health's Patient Education Department experts