When to Push During Labour

'OK, push!' are the two words that signify your baby's journey into the world has really started, but knowing when to push and when to save your energy can make a lot of difference to your birthing experience.

Before any woman goes into labour, she will hear and read plenty about the different stages of childbirth. Some worry that they will not be able to tell when one stage ends and the next one starts. This article should explain how to identify the different stages of labour and when you should, or should not, be pushing.

Much has been written about the pain of contractions and a long labour can be extremely tiring. While a cervix which dilates slowly is said to be less painful than one which moves rapidly, the many waves of contractions makes it impossible for the mother to rest and can leave her exhausted before it is time to push.

Therefore, no matter how impatient you are to see and hold your baby, conserving energy during childbirth is essential. The doctors, nurses and midwives will all be able to guide you through when to push and when to conserve your energy.

Pushing during the first stage of labour?

During the first stage of labour, the cervix thins and dilates, making the transition of the baby possible. The next phase is when the baby travels down the birth canal. This is when you need to push to help them along their journey.

For women who have not given birth previously, the pushing stage normally lasts between 90 minutes and two hours; in women who have delivered vaginally before, it tends to be quicker. This is because their tissues have already stretched to accommodate one baby (or more) before. If the second stage of labour lasts longer than two hours, then doctors may intervene to help your baby along by other methods, such as by using forceps.

Two hours is an incredibly long time for a woman to push and using too much energy early on can leave you shattered at the crucial point. It is therefore a good idea to save your exertions for when it will have an impact and let nature take its course in between.

The pushing stages

The pushing stage is split into three sub sections; latent, active and perineal phases.

The latent phase is the most comfortable of the three and the urge to push will be weak, if present at all. Contractions will also be much less intense, so now is a good time to take a well-earned break and try to relax. Pushing during this phase will achieve very little and will only frustrate and exhaust you. This part of labour should last between 20-30 minutes; if nothing is happening after this, it is time to give nature a helping hand, either with the assistance of your midwife, or by moving into an upright position and letting gravity take control.

The next part is the active pushing phase. This is one of the toughest phases to get through as your contractions come hard and fast and the urge to bear down is difficult to resist. The best way to push is through your bottom, as if you were having a bowel movement. Some women try to separate the sensation for fear of actually passing a movement but this will hamper the delivery and prolong labour. At this point, the baby's head will be putting pressure on your rectum as it passes along the birth canal and this in turn sends a message to the brain that the bowels need to be opened. Emptying your bowels is a very common occurrence during childbirth and one which the midwives will have seen countless times before. They will simply clear up whilst you get on with the more important business of having a baby.

Most pushes last between three and six seconds and are timed to coincide with the contraction. On average, around three to five pushing motions can be squeezed in per contraction.

During the active phase, remaining upright can be a big help to both you and your baby. There are many different positions that can be adopted during contractions so you are supported. One option is to lean against a birthing partner's shoulders while standing and pushing. Other women prefer to either kneel on the bed, or to use a birthing ball. Squatting is a particularly good position as it opens the pelvis up, making it easier for the head to pass through.

The last phase of the pushing stage of childbirth is what is known as the perineal, or transition stage. This is where the baby's head starts to emerge from the vagina, a process known as crowning. The sensation to push will be overwhelming at this point but the midwife will ask you to try and resist. This is so that the tissues have time to gently expand to accommodate the baby and reduces the chances of you tearing. It is common to feel a burning sensation at this point.

Alternatives to the urge to push?

Of course, not every woman will feel the urge to push, especially those who have had an epidural and cannot feel the contractions. In these cases, the contractions will be monitored via a device strapped to your tummy and your midwife will be able to tell you when to push.

There is another alternative to pushing during childbirth, known as labouring down. This involves no pushing from the mother until the baby is crowning. Instead, it relies upon the baby to travel using the contractions of the uterus alone. Understandably, this takes much longer, but studies have shown that not only does the mother experience far less fatigue, but there are fewer cases of assisted deliveries, such as the use of forceps.

Understanding when to push and when to rest are two of the most important things a woman going through childbirth can equip herself with. Practicing breathing beforehand may seem tiresome, but will help you cope with the pain as well as resist the urge to push when you need to wait. Many women start labour fearful of embarrassing themselves or appearing undignified, but there really is nothing you can say or do that the medical staff will not have seen or heard before, so focusing all your efforts on yourself and the imminent arrival of your baby is all you need to worry about.