I'm glad your back for part two! If you haven't read part one of this series, you should hop over and do so real quick. We talked about how contractions have more of a purpose than to just dilate the cervix.
So what happens once the cervix has opened fully at the bottom of the uterus and the fundus has built into this beautifully thick an strong muscle at the top of the uterus? Pushing! The baby will be born!!!
Pushing is what is known to be the second stage of labor. Some refer to this as the fetal ejection reflex. I can certainly understand why it would be considered a reflex. I like to compare the urge to push as sort of like throwing up, but backwards. It is an involuntary, uncontrollable, heave downwards that your body does all on its own (if left alone). It is that strong fundus that has been building up as your cervix has been opening, pushing downwards and expelling the baby. Have you ever known of a woman’s body to begin involuntarily, uncontrollably pushing and then mom’s cervix was checked and found to not yet be 10cm so she was told not to push? I have. I’ve watched it as a doula. And I really don’t like it. And I won’t participate in coaching mom not to push. I used to, but I won’t any longer. I have full confidence that our bodies are not making a mistake when that pushing urge kicks in. Now, if mom is feeling a lot of pressure in her bottom and is reacting to it by forcefully pushing with that pressure during a contraction, that is different. That can mean things like a swollen cervix. And we don’t want that. In those instances, we (her birth team) help mom to find other ways to cope with that pressure than by bearing down and pushing. But, if that fetal ejection reflex has kicked in and it is truly an uncontrollable, involuntary, and strong pushing urge, I believe in letting her body do its thing, no matter what her cervix dilation was at her last cervical check. I think that telling moms to resist and try to control that urge (although, as I said, it really is not controllable…her body still pushes on its own whether she is consciously pushing along with it or not.) is detrimental to the process. To explain my thinking on this, let’s visualize a baby learning to walk. You notice your baby standing next to the couch and trying to take a step away and then successfully taking two whole wobbly steps unassisted. Now let’s imagine that the “experts” have declared that babies should walk at 12 months old and not any sooner or later. So when you see your baby that is “just” 11 months old taking these couple steps, you decide to not allow him to be free to move about any longer, because babies simply cannot begin walking at any time other than 12 months old; they are not ready! You now confine your baby to a small playpen or a crib all day to discourage him from walking. He will still stand and take tiny wobbly steps in that crib. You can’t stop it, you can’t control it. His body is ready. But, you’ve slowed it down and he is not free to just do what he is ready to do. A few weeks later, after that baby reaches 12 months, you declare he is ready to walk now and let him freely move around again. But, suddenly he’s not interested. He’s lost the confidence he had a couple weeks ago. He’s now scared and unsure of himself and his abilities. His muscles have been temporarily stunted in their growth and development. And then it takes him months to gain that back. He is 16 months old before he is able to walk unassisted. And in those 4 months since his first birthday, everyone has been fretting and worrying and wondering what’s taking so long and offering advice and interventions and help of all kinds because this is not normal.
Can you relate this to the mom whose body was involuntarily and uncontrollably pushing and then told that it wasn’t yet time and she’s not allowed to push yet? What happens to that mom? She loses confidence in her body. She becomes scared and unsure of what to do or how to do it. That beautiful and strong fundus at the top of her uterus that is pushing her baby down and out has been stunted in it's growth and development. And then pushing can take much longer and be much harder than it needs to be, than it would have been if she had just been left alone.
And let’s explore another facet of this. What if……just what if not everyone dilates to exactly 10cm before their body is ready to push their baby out? What if all of our cervixes were not created perfectly equal and alike? What if our babies’ heads were all different shapes and sizes and had different abilities to mold and squish? Can you imagine? Perhaps this one-size-fits all definition of completely dilated being 10cm is a bunch of phooey because we were all created differently.
So now what about those moms that are fully dilated and then that fetal ejection reflex doesn’t kick in? Those moms whose cervixes are 10cm yet they are not feeling an urge to push? Let’s talk about that Thursday.
*Updated to add a link to Part 3.
What happens during labor? Your uterus contracts. And what is the purpose of those contractions? To open your cervix.
Well yes, but no. Contractions are less about a hole opening up and more about a muscle being built. Stay with me, here. I’ll explain. Let’s start with the fundus. The official definition of fundus is “the part of a hollow organ that is farthest from its opening.” So the fundus is the top of the uterus, farthest from the opening, the cervix, at the bottom. Got it? Good. Now, the uterus is an organ made up of muscle fibers. It is a big mass of muscle fibers all crisscrossing over and under and between each other; some running up and down and some running around it side-to-side. During a contraction, these muscle fibers…..well, they contract, pulling the cervix up and out causing the cervical tissue to thin and then open. As this happens, these muscle fibers start building up at the top of the uterus, the fundus. They are slowly moving from the bottom of the uterus, to the top with each contraction. As they do so, the cervix thins and opens at the bottom while the fundus is thickened and strengthened at the top of the uterus. And with each contraction, the fundus pushes down on the baby. As the fundus gets bigger, the push gets stronger. Once the cervix has finished opening, the fundus has also finished growing and now is a very large, very strong muscle that expels the baby from the uterus.
Pretty cool, right?
Let’s not stop there, though. Let’s talk a bit about pushing.
But, let’s do it Tuesday. I’ll see you back here Tuesday.
*Updated to add links to Part 2 and Part 3
Amber Piller - Professional Birth Doula and owner of Agape Birth Services. Serving Northwest Houston including Jersey Village, Cypress, Tomball, Spring, and Katy Texas.