Pushing happens during the second stage of labor, once your cervix is completely dilated (open). By pushing, you're moving your baby down the birth canal to the outside world. Your provider, nurses, or labor coach will help you know when and how to push – this can be more difficult if you've had an epidural.
The most common reason for telling a women not to push is that her cervix is not fully dilated. Often when a baby is in an occipito posterior position the woman will feel the urge to push before the cervix is completely open.
As of 2019, the American College of Obstetricians and Gynecologists (ACOG) no longer recommends laboring down for people who've had an epidural. They recommend that people should begin pushing once the second stage of labor begins, even if they don't feel a natural urge to push.
If you're having your 1st baby, this pushing stage should last no longer than 3 hours. If you've had a baby before, it should take no more than 2 hours. This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you.
Stopping your Pushing
There may come a time when you may be asked not to push with a contraction. This is for reasons such as the cervix is not fully dilated or the baby is crowning and the perineum needs to stretch gradually. Usually these situations require you to stop pushing for a short time.
But if you're close to 10 centimeters dilated the research suggests it's not an issue. Evidence suggests it's more of a theoretical fear that just adds additional stress and in some cases results in an epidural (or a higher dose of epidural) to mask that urge.
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.
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.
Discourage more than three to four pushing efforts with each contraction and more than 6 to 8 seconds of each pushing effort (avoid counting to 10 with each pushing effort). Take steps to maintain a reassuring fetal heart rate (FHR) pattern while pushing.
Mammals, including human beings, have the ability to give birth while completely unconscious – even during sleep. This is due to something called the fetal ejection reflex (FER). The FER occurs when a woman's body spontaneously, and with no effort, pushes a baby out quickly and efficiently.
With no epidural or narcotics on board, most birthing parents rate active-phase labor a 10 on the pain scale of 1 to 10. With pain management techniques taught in childbirth education, however, laboring parents can greatly reduce the intensity of the pain they experience.
If the FTP continues, then a doctor may use a vacuum or forceps to assist the baby through the birth canal to be delivered or perform a cesarean delivery (c-section).
Transition to the second stage of labor
This can be the toughest and most painful part of labor. It can last 15 minutes to an hour. During the transition: Contractions come closer together and can last 60 to 90 seconds.
There is a growing understanding that in the majority of cases it is not really necessary or helpful to push the baby out. Pushing can cause vaginal and labial tearing as well as damage to the pelvic floor, whereas focusing on the breath and relaxation allows the body to birth the baby when it is ready.
Pushing can be one of the most intense and exhausting parts of the labor and delivery process—and it can take anywhere from several minutes, up to a few hours to push your baby out.
Some doctors will request that the epidural be turned off or down during the pushing phase to allow mom to feel the pressure of baby's head, which creates an urge to push, says G.
During active labor, your cervix will dilate from 6 centimeters (cm) to 10 cm. Your contractions will become stronger, closer together and regular. Your legs might cramp, and you might feel nauseated. You might feel your water break — if it hasn't already — and experience increasing pressure in your back.
You can still push in all sorts of positions even with an epidural! At a minimum, you can push on your side or with support under your back to still make space for the sacrum. If you can move, you can even try all fours or kneeling, using the back of the bed as support!
Purple pushing, coached pushing, holding your breath, all mean basically the same thing. Mothers being instructed on pushing causes them to hold their breath and push down into their bottom. Another more normal and less exhausting option would be “breathing or bearing down” working with the contractions.
An overwhelming urge to push (some women don't, however) "The ring of fire," a burning, stinging sensation as your baby's head crowns and your vagina stretches for your baby to emerge. The burning doesn't last long – soon there's a feeling of numbness instead as the vaginal tissue stretches thin, blocking the nerves.
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.
When your baby's head crowns, you will experience a burning or stinging sensation, often referred to as “the ring of fire,” as your baby stretches the vaginal opening. As soon as you feel this sensation, stop pushing!
Doctors have to wait until the cervix is at least 4 centimeters dilated before doing an epidural. Otherwise, the epidural will slow the process down too much. However, once the cervix becomes fully dilated it is too late for an epidural to be given.
You may feel pressure and the urge to push. Your doctor or midwife will let you know when to start pushing. How Long It Will Last: On average this stage can last 1 ½ to 2 hours with your first baby. However, you only push when you are having a contraction and you can rest in between.