In a previous post, we explored the emotional signposts of a typical labour:  what happens during the first stage, while your cervix is opening and thinning to allow the baby to descend into the birth canal.  Once that process is completed, the second stage begins, and soon it will be time to push that baby out!

The first thing to know about pushing is that it doesn’t have to begin the instant dilation is complete.  Many people experience a pause in the rhythm of labour between the first and second stages – which can be particularly welcome if your experience of transition was intense!  This happens because once your baby’s head is able to start moving down through your cervix, it leaves some space at the top of your uterus (the “fundus”).  Throughout the first stage of labour, the contractions have not only been dilating your cervix, they have been drawing the muscles of the uterus up toward the fundus, creating a thick, strong “launching pad” of muscle to push the baby down.  When that downward movement begins, leaving room for the baby to stretch their legs, the uterine muscles are able to relax a bit before tightening up again to keep the baby moving downward. 

If this pause happens to you, go with it!  It will allow you to rest and gather your strength for the pushing phase.  Your body is still doing its job, gathering itself to push your baby out smoothly and efficiently.  Letting the baby “labour down” during this pause is much easier for everyone than immediately starting to push.

Once the uterus has begun to contract again as the baby moves down the birth canal, you may feel a powerful, irresistible urge to push.  Many people find that the pushing phase of labour is significantly more straightforward and satisfying than the first stage.  This is not everyone’s experience, however.  Cynthia Gabriel, author of Natural Hospital Birth:  The Best of Both Worlds, estimates that about one out of every four birthing people finds pushing harder than dilation. (I was one of them. Pushing sucked.)

Many hospitals still practice “directed pushing,” in which the person in labour is encouraged to hold their breath for a count of ten while bearing down as hard as they can, at least twice during each contraction.  Most of the time, if you have a strong urge to push and each push is moving the baby down, directed pushing is not necessary.  Arguably, it could even limit the baby’s oxygen supply, since you are being encouraged to hold your breath.  If you feel that you are pushing well on your own and there is no concern about the baby’s condition, feel free to ask your nurses to let you push when your body tells you to.

Contrary to what you may see on TV, lying on your back in a hospital bed is not usually the best position for pushing, if you can possibly help it.  After all, your baby is trying to move down, so work with gravity if you can!  Many hospitals nowadays have a birthing bar that can be attached to the bed, so you can be supported in a squatting position, which will open your pelvis and allow as much room as possible for the baby’s head and body to move through.  If you are giving birth at home or at a birth center, your midwives may have a birth stool that you can sit on to push. 

In real life, people who are pushing out babies generally don’t look quite this calm, nor are they probably wearing pants.

I know doulas who have attended births where babies were born while their parents were standing up, squatting on the floor, any number of positions that were not “on your back in bed” but which worked for that person’s body and their baby!  (Footnote:  in some specific situations when your baby’s head needs to move around your pubic bone, lying on your back curled around your belly, with your elbows hooked under your knees, can be very effective – even if it seems hopelessly retro!)

On the other hand, if your baby is coming very quickly, a different set of positions may be helpful.  Although it’s much preferable to getting stuck, a baby coming too fast can damage the perineum and cause temporary difficulties with the baby’s heart and lungs immediately following birth.  If this happens to you, moving into a position such as side-lying or hands and knees – which reduces the effect of gravity while still allowing your pelvis to open – will help the baby to come out in a smoother and more controlled way, while your nurse or midwife supports your perineum to reduce tearing.

And what happens if the pushing phase is slow and the baby isn’t moving down much?  In that case, changing positions often may be the key to getting the baby unstuck.  (I pushed for three hours and in pretty much every imaginable position.)  If spontaneous pushing isn’t doing the job, or the laboring person is tired or not perceiving the urge to push, this may be the time for the kind of directed pushing described above.  And if it just isn’t happening, other strategies may be called for – episiotomy, use of the vacuum, or an epidural to allow swollen cervical tissue to relax – but only with your informed consent!

Regardless of whether pushing takes five minutes or five hours, whether baby comes in the squatting, side-lying or any other position, the moment when it’s over – when your baby emerges into your care team’s waiting hands and they scoop them up and drop that warm, squirming, slimy, new little person on your chest – will be a moment of intense physical relief and overwhelming emotion.  Enjoy!

One of the questions doulas hear most often from prospective clients and other people curious about our work, is “But what about the partner?”

There are plenty of blog posts that give the basics of the answer to that question.  But it recently occurred to me that there’s a very simple metaphor that sums it up.

Imagine a stool with two legs.  It wouldn’t be very sturdy, would it?  You wouldn’t want to sit on it, and if you did, you would have to be constantly bracing yourself with your own legs to avoid falling over.

Now add a third leg, and suddenly, you have a solid, comfortable place to sit.

Each leg is essential, but there need to be three of them for the piece of furniture to be useful.  A dyad – a pair of two – is inherently unstable.  Add a third, and it becomes a firm and solid triad.  The doula, with their experience, knowledge, and handy bag of tricks, provides this third leg.

After all, you’re having a baby because your family didn’t feel complete with just you and your partner.  Our partnerships are stronger when, instead of trying to “go it alone” as a couple, we welcome the support of positive influences in our lives, whether friends, family, health professionals, clergy, or any others. 

Any doula worth their fee will enhance, not hinder, the dynamic between you and your partner as you both play your essential roles at the birth.  They will support you – literally, like the third leg of a stool – and help provide a solid foundation for the birth experience you hope to achieve.

I’m sure I’ll have more to say soon about the partner’s role, but this image is a good place to start!

Emotional Signposts in Labour

When you’re expecting, especially for the first time, you often spend a lot of time reading books and attending classes to learn about what will happen within your body during the physical process of birth.  But have you learned about what happens emotionally?

There  are three stages that many people go through between the beginning of labour and the moment of birth.  Not everyone experiences all three, but knowing what the stages are and their typical order will help you to understand what is happening and, hopefully, be more relaxed and empowered during your birth.

Stage 1:  Excitement

The first emotional stage begins when you get the first indication that your baby is really on the way – the initial contractions, the breaking of your water, or perhaps the loss of your mucous plug.  At this stage, you feel thrilled, because things are getting under way!  The long-anticipated birth is imminent, and you’ll be meeting your baby soon!

It’s great, at this stage, to make sure that everything is ready, double-check that your bag is packed, and be in touch with those who may be caring for your pets or other children.  But bear in mind that, especially with first babies, it may be many hours, or even days, from the first twinges until things really get going.  As much as possible, as long as contractions are manageable, go about your business as usual. If you think there’s a reason you might need to go to the hospital (for example, if your water breaks before contractions begin) contact your provider.  But otherwise, relax, bake something to eat after the baby is born, watch a movie, or try to get some sleep while you still can!

And some people skip this stage entirely and wake up in the middle of the night to find themselves clearly in active labour, also known as –

Stage 2:  Focus

When I was a first-time mom in early labour, my midwife came over to check me and, as she was getting ready to go, said, “Call me back when the contractions are demanding your full attention.”  The need for complete focus is what defines the second emotional stage.  It’s no longer possible to talk, or do anything else, during contractions; getting through them is doable, but it takes work and concentration.  They get longer, stronger, and closer together, and (although the precise timing depends on your history, situation, and the advice of your provider) it’s during this stage that you will call in child and pet care, contact your doula, and make the decision to go to the hospital or birth center (or call your midwife if you have planned a home birth).

The second emotional stage can last for less than an hour, or for 24 or more.  If a person in labour is well prepared and well supported, they can sustain the intense focus required for this stage and manage the contractions for as long as necessary.  But sooner or later, the intensity becomes overwhelming, which is when the parents and support team recognize the arrival of:

Stage 3:  “I Can’t Do This”

Those who attend births have seen it over and over again, but for the labouring person and their partner, it may take them by surprise:  someone who has been coping well with contractions for hours suddenly seems to lose control.  There’s writhing, yelling, swearing.  The labouring person goes into the corner of the bathroom and refuses to come out – or plants themself on the bed and won’t move.  They flatly inform the medical staff that they’re done with this baby-having thing; they intend to leave and come back tomorrow.  And they holler the trademark phrase of the third emotional stage of labor:  “I can’t do this anymore!”

Far from being a sign that everything is going wrong, this kind of meltdown actually indicates that things are progressing very well.  It means that the phase of labor known as “transition” is under way – that complete dilation is very close, and pushing is just around the corner

It can be extraordinarily difficult for the partner, especially, to witness the “I can’t do this” stage. This is where the support of a doula can be essential, both to alleviate the pain and panic as much as possible until dilation is complete, and to reassure the partner that, alarming as it all is, nothing is actually wrong, and that the labouring person’s emotional response is actually a sign that baby’s arrival is very close.

For most people giving birth – but not all – the pushing phase is an improvement over the intensity of transition.  For more on that, stay tuned for my next blog post!