Doctors decided the second stage of labor (the pushing stage) was dangerous for the baby, so it should happen as quickly as possible. Women were often told to start pushing from the beginning of labor and coached pushing became the norm.
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.
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.
If you're 4cm dilated and feeling a strong continuous urge to push (very unlikely) - then that's not ideal…often any pushing urge this early passes if you change position. But if you're close to 10 centimeters dilated the research suggests it's not an issue.
It's standard advice in so many delivery rooms: don't push until it's time. Usually, mothers giving birth are told to wait until the midwife, doctor or delivery nurse says it's time — usually about an hour after the cervix is dilated to a certain diameter, often 10 centimeters.
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.
Pushing your baby out
You may not feel the urge to push immediately. If you have had an epidural, you may not feel an urge to push at all. 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.
You can still be in control when pushing with an epidural!
You have so many options with positions, feedback methods, and tips to push. If you need more support, ask for it! Your team is there to help you meet your baby. If you feel confident to do it with less help, let your team know!
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.
The second stage of labor starts after your cervix has dilated (opened) to 10 centimeters (about 4 inches), and it continues until your baby finishes moving through your vagina and is born. During this time, you will push or bear down (like you do when you have a bowel movement) to help your baby come out.
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.
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.
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.
It may feel like: A strong urge to have a bowel movement. An increase in pressure on your pelvic floor. Feeling heaviness and pressure in the vagina.
Other emergency treatments
Another option is for you to have an emergency caesarean under general anaesthetic. Once the anaesthetic has taken effect, your baby will be pushed back into your uterus and delivered through a cut in your tummy. Both of these options are emergency treatments.
According to a survey conducted by the American Society of Anesthesiologists, around 50% of birthing parents between 18 and 39 said that contractions were the most painful part of labor and delivery. But 1 in 5 had a different take and said that pushing and post-delivery were the most painful.
The “push” phase of your delivery depends on many different factors, including what kind of shape you're in, how big the baby is, if you've received an epidural, and so on. Some women push for as long as four hours straight, and some deliver baby on their second push.
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.
For some women, they say there's actually a huge sense of relief when they finally push their baby out, while others describe the sensation of pushing a baby out as the most excruciating pain they've ever experienced (again, we really don't want to scare anyone!
While it sounds scary, it doesn't last long, and it's a good sign that your baby's almost here. Some women don't experience the ring of fire. If you have an epidural, you may not have this sensation, or you may have a dulled burning sensation.
Hospitals and doctors have their own individual policies for epidurals. In most cases, however, an epidural will not be given until the mother is at least 3-4 centimeters dilated. Once the mother is fully dilated most doctors and hospitals will consider it too late for an epidural to be given.
Pushing itself can be extremely tiring physically, like an incredibly physically demanding workout requiring intense focus. And despite the great deal of discomfort many people experience before getting ready to push, often the pushing can feel like it brings some relief.
Dr Han How Chuan, an obstetrician and gynaecologist from Mount Elizabeth Novena Hospital, said decapitation can happen during breech deliveries, especially when the baby's head is “too big - bigger than the maternal pelvic bone”.
For first-time moms, it can last from 12 to 19 hours. It may be shorter (about 14 hours) for moms who've already had children. It's when contractions become strong and regular enough to cause your cervix to dilate (open) and thin out (efface).
How many hours is considered prolonged labor? Prolonged labor is when labor lasts: 25 hours or more for those having their first baby. 20 hours or more for those who've had at least one baby in the past.