Until recently, women have been asked to start pushing as soon as the cervix has dilated to 10 centimeters, but as long as you do not have a fever and your baby's heart rate is normal, there are many benefits to waiting to push until you feel the need to push.
In Nancy Tsao's research on this topic she concluded that 'Pushing with the early urge before full dilation did not seem to increase the risk of cervical edema or any other adverse maternal or neonatal outcomes'.
The urge to push is initiated by the position of the baby's head within the pelvis (Roberts et al 1987). Therefore, the cervix can be fully dilated without the baby descending deep enough to initiate an urge to push. Alternatively, spontaneous pushing can begin before the cervix is fully dilated.
The cervix must be 100% effaced and 10 cm dilated before a vaginal delivery.
Stage two: full dilation and pushing
Once the cervix has reached 10 cm, it is time to push the baby out. Contractions continue but also produce a strong urge to push. This urge might feel like an intense need to have a bowel movement. This stage can last anywhere from a few minutes to a few hours.
Getting up and moving around may help speed dilation by increasing blood flow. Walking around the room, doing simple movements in bed or chair, or even changing positions may encourage dilation.
Your cervix needs to open about 10cm for your baby to pass through it. This is what's called being fully dilated. In a 1st labour, the time from the start of established labour to being fully dilated is usually 8 to 12 hours. It's often quicker (around 5 hours), in a 2nd or 3rd pregnancy.
-If women aren't too tired, allow them to push at least two hours if they have delivered before, three hours if it's their first baby. They may push longer if they had an epidural as long as the doctor can see progress.
Laboring down is the practice of not pushing for one to two hours immediately after the second stage of labor begins. It may help your baby descend into the birth canal more naturally and reduce the overall time you have to push.
Pregnancy lasts for about 280 days or 40 weeks. A preterm or premature baby is delivered before 37 weeks of your pregnancy. Extremely preterm infants are born 23 through 28 weeks. Moderately preterm infants are born between 29 and 33 weeks.
Pushing sooner during childbirth is just as safe for most women and babies as pushing later, researchers report. The best time to start pushing during labor has been a matter of debate. Many U.S. hospitals recommend delaying pushing, but evidence has been inconclusive.
According to Meehleis, some providers might tell a laboring person to slow down or stop pushing to help prevent perineal tearing. Or, sometimes, the cervix isn't dilated all the way.
Three to four pushing efforts of 6 to 8 seconds in length per contraction are physiologically appropriate (AWHONN, 2000; Roberts, 2002; Simpson & James, 2005). When the time is right for pushing, the best approach based on current evidence is to encourage the woman to do whatever comes naturally.
Pushing Can Feel Like Relief
Your baby's head may press on nerves that desensitize the pelvis, and many people report feeling a numb sensation before the "ring of fire" (when the baby's head begins to emerge from the vaginal opening, a stage known as "crowning"). Some even say it feels good, similar to orgasm.
What is the fetal ejection reflex? The fetal ejection reflex, also known as the Ferguson reflex, is when the body “expels” a baby involuntarily — that is, without forced pushing on your part.
When your baby is ready to begin the journey through the birth canal, your cervix dilates from fully closed to 10 centimeters. This process can take hours, days, or even weeks. But once you hit active labor – about 6 cm dilated – it's usually just a matter of hours before you reach full dilation.
The most common description of the level of pain experienced was extreme menstrual cramps (45 percent), while 16 percent said it was like bad back pain and 15 percent compared it to a broken bone.
Delayed pushing had some adverse consequences. Four percent of women who waited to push had excessive bleeding after delivery compared with 2.3 percent who pushed right away. The delayed pushers had more bacterial infections: 9.1 percent versus 6.7 percent of the women who pushed immediately.
Now, a multicenter study led by Washington University School of Medicine in St. Louis and involving more than 2,400 first-time pregnant women, shows that the timing of pushing has no effect on whether women deliver vaginally or by C-section.
Because first-time C-sections often lead to C-sections in future pregnancies, a vaginal birth is generally the preferred method of delivery for first pregnancies. About 2 in 3 babies in the United States are born via vaginal delivery, according to the National Center for Health Statistics (opens in new tab).
The second, pushing phase of labor continues after the cervix is fully dilated (open) to 10 cm until the delivery of your baby. It averages 4 to 8 hours but can be as short as several minutes.
If your water (aka “amniotic sac,” “bag of waters” or “membranes”) hasn't broken on its own when you arrive at the hospital, and you're five or more centimeters dilated, your OB might recommend bursting the bag by hand—especially if your cervix seems to be making slow (or no) progress.
Deliver in an upright, nonflat position.
There are a number of delivery positions that might reduce the risk of a vaginal tear during childbirth. Rather than lying down flat during delivery, deliver in an upright position. Your health care provider will help you find a comfortable and safe delivery position.
Try being upright
One of your biggest allies is gravity. When you are upright—standing, sitting or kneeling—the weight of your baby presses on the cervix, encouraging it to open. An upright position may also help get your baby into the best position for birth.
It may be hard to talk or move easily. At this point, your cervix will be dilated 3 to 10 centimeters. (Dilating one centimeter an hour is textbook, but like in early labor, it's different for everyone.) If you're opting for an epidural, the time is…now!