sHey friends, glad to have you back for part three of this series! If you stumbled across this post first and haven’t yet read the first two parts, you should go back and read them now. In part one, we discussed that there is more to contractions than dilating your cervix; contractions are also about building your fundus. And in part two, we talked about the pushing, specifically feeling the urge to push and/or what is called the fetal ejection reflex. Check them out!
Today, we are continuing our discussion about the second stage of labor, otherwise known as “pushing.” Yesterday, we covered the uncontrollable, involuntary, powerful urge to push, the fetal ejection reflex. But, what about those moms who reach complete dilation and then don’t experience that urge?
If mom has an epidural, she either begins to feel a lot of pressure “down there” and then her cervix is checked and if she’s found to be completely dilated, will be coached in pushing her baby into the world. Or, mom may have her cervix checked during a routine check (usually scheduled for every hour or every couple hours) and is found to be complete but, mom’s not feeling any pressure so she is left to “labor down” for another 30min or even more than an hour before the pushing commences. If mom does not have an epidural, either that uncontrollable, involuntary urge to push takes over and the fetal ejection reflex kicks in and she births her baby, or she is found to have a completely dilated cervix during a routine check. In that case, most providers will coach mom to push her baby out. But some providers….the smaller few will wait. They will grab a chair and wait patiently for the fetal ejection reflex to kick in. The main factor to remember in all of those scenarios is that some moms experience an urge to push/fetal ejection reflex soon after their cervix reaches full dilation and some do not, regardless of whether an epidural is being used or not.
So what is the difference? Does it matter whether you feel the urge to push and just go with it or whether you are coached to push before/without feeling that urge? I believe it does matter. You see friends, our bodies know how to birth our babies. There is this phase of labor that is often not recognized or talked about and not every mom experiences it. It’s called the “rest and be thankful” phase. This occurs when a mom’s cervix has fully dilated but she’s not yet experiencing an urge to push. This is when she should REST AND BE THANKFUL. Labor is seriously hard work. And sometimes our bodies need to take a little break between doing all the work of dilating the cervix (and building the fundus!) and pushing our baby out into the world. This phase is good. Its purpose is to build up energy to finish its work. It may also be allowing baby some time to rotate to better fit through mom’s pelvis. But, mom isn’t allowed that rest (and baby the time to rotate) very often. Our maternity care system is impatient. Providers are taught that there is something wrong if anything takes "too long." And the results of not allowing that rest are that it then takes mom much longer to push her baby out that it would have if we had waited for the urge to push. And because our maternity care system is impatient, mom may even end up with a cesarean after doing all of this work and going this far because of that training that something is wrong if it takes "too long." Or mom just ends up being much more exhausted and sore than necessary once baby has emerged, making recovery harder. Also, it has been shown that coached pushing often results in more occurrences of tearing and more severe tearing than in mom-lead, instinctual pushing (aka the fetal ejection reflex!) which also makes recovery more difficult than it needs to be.
With my first VBAC, I experienced a rest and be thankful phase. My midwife knew I was complete. It had been a very very long labor (54 hours) and my baby was possibly, probably not positioned perfectly. I am so thankful that she trusted the birth process and my body’s ability enough to just patiently wait for my body to begin uncontrollably, involuntarily pushing on its own. While we waited, I actually fell asleep. Contractions faded and I napped for I believe around 20min. Then I pushed my daughter out in less than 20min, without any coaching and only experiencing a small tear. With my second VBAC, my water broke as we were on the way to the hospital and then the very next contraction, my body gave a little heave downwards at the peak. He was born just 8 min after we pulled up to the front doors of the hospital. I’m very thankful for that midwife as well, who trusted the birth process and my body enough to just stand back and let me push my baby out without making me submit to a cervical check first. She knew that if I was pushing involuntarily, then my body was ready to birth my baby. And that time, I experienced no tearing. They were both wonderful births.
I’d love to hear about your experiences, too!
Amber Piller - Professional Birth Doula and owner of Agape Birth Services. Serving Northwest Houston including Jersey Village, Cypress, Tomball, Spring, and Katy Texas.