Labor has been exhausting but with your birth team you're almost through the hardest part. The lights have been low, you brought your favorite essential oils, you've used the tub, birth ball, and shower for pain relief, and NOW THE TIME HAS COME. You start feeling "pushy". Finally you know what that means. The sharp pull at the peak of contractions begins to be replaced by a totally different, nearly unexplainable feeling. You have to get that baby OUT.
The nurse rushes in, pages the doctor, the lights come on (ESPECIALLY the big one pointed at your vagina), the bed is broken down, and you are instructed to 'HOLD YOUR BREATH AND PUUUUUUSH. COUNT TO 10 WITH US!' And now you start to understand why they call it "purple pushing". It isn't pretty or fun. The whole energy of the room has changed, and you're not sure that you like it. (DISCLAIMER- this doesn't happen at ALL hospital births. But it is VERY COMMON due to how most doctors and hospital staff have learned to manage the pushing stage. Listen to women tell their birth stories...you'll see the trend).
I love to discuss the benefits of physiological pushing. What does that mean exactly? It's letting the birthing mother decide when and how to push her baby out. It doesn't mean:
I always bring a copy of this lovely blog post by Rachel Reed of MidwifeThinking with me to prenatal visits with families that I'm working with, because it really emphasizes how the mother is the expert in pushing out her baby. Risks of "purple pushing" or directed pushing include:
Even though study after study has documented the risks of directed or purple pushing, the physiological pushing has been slow to take hold in most hospitals. This survey from 2005 documented that only 21% of women pushed when they felt like pushing. Over 90% gave birth on their back or semi-reclining. Some reasons for this likely include the fact that upwards of 60% of women in most areas choose an epidural, which leads to more management of pushing, but also it's just a fact that most birth professionals are taught directed pushing in their trainings, and they rarely see or experience anything else. Humans are creatures of habit, and we tend to fall back on what we know.
This study review has a great overview of the differences between physiological and directed pushing. Women who are pushing instinctively often push only for 3-5 seconds and then take a short breath, before pushing again. They tend not to close their mouths or clench their jaws. The mother often will chose a position such as kneeling or hands and knees. She might not put her chin to her chest and push "down" to the baby. I very often see women wanting to arch back and do just the opposite! There really are no "rules", and a position that works for all women. Remember: a woman's body knows how to give birth! Listen to it.
Now that you know that it's evidence-based and healthy for a mother to push when she feels like it, and in positions of her choosing, what can you do to maintain your physiological birth even if you are being encouraged to do something different? I love this article about saying "no" to purple pushing, but I've found that it's really not that simple when that moment comes. So here are my tips for saying 'no' and being successful at mother-directed pushing no matter where you are.
Strategies for Physiological (Mother-Directed) Pushing in the Hospital
The bottom line is that mother-directed pushing is safe for the mother and her baby. If you discuss this with your care provider and they are unwilling to consider this option, you might want to think about finding a care provider who will work with you, and the birth that you would most like to have. Or, you can share some of the linked studies with him or her and ask them to reconsider.
I've said it before, and I'll say it again. You can have a great birth no matter where you choose to be! Hospital, home, birth center...but it never hurts to know what you want, to communicate those wishes clearly, and to bring a supportive team who knows you well to help you achieve that goal.
A supportive birth partner, and a doula, can help to remind you of the plans that you made before you reached a point in labor where it's easy to think that 'those details weren't important, so let's just get this over with.' But you might feel differently once the hormones wear off. (I speak from personal experience when I say this, can you tell?) It's normal to feel like you need reassurance and guidance during this phase of labor, but remember that YOU are the only one giving birth to your baby, and your body knows what to do! Have your birth partner remind you of that! It's not the last time that you'll need to lean on your instincts as a mother to do what's best for your child.
What was your experience with pushing your baby (or babies!) out? Do you have any other suggestions for supporting mother-directed pushing? And thanks to the mothers who shared their beautiful birth pictures to show the various positions that women can choose for pushing!
Google Maps, GPS, Garmin...as someone who has always been missing that "internal compass" that I've heard wonderful things about, I am very grateful for their existence. I depend on them (probably way more than necessary) whenever I need to go somewhere unfamiliar. And 95% of the time, the ETA on the GPS is right on. I have no idea how it can be so accurate, but I'm sure it involves lots of technology and maybe invasions of privacy. Who knows. But I can have the confidence that if Google Maps tells me that "your route is clear and I should reach my destination at 5:00 pm", that I almost certainly will arrive at 5:00, or within a couple of minutes of that time.
There is something SO reassuring about that certainty. I can plan my day around it. I can schedule an appointment and not worry about getting lost for 20 minutes. I can tell my kids that I'll be back at a certain time.
In our modern lives, we are now accustomed to being able to schedule most things. We like to have the assurance that we know what's happening and when. How long events will last. It is likely this desire to know WHEN labor will start and how long it might last that drives the routine measuring of cervical dilation before and after labor begins. But guess what?
YOUR CERVIX IS NOT LIKE GOOGLE MAPS. Any measurement only tells you where you ARE. Not where you were, where you are going, how you'll get there, or how long it will take.
What if the cervix WAS like Google Maps? Well, a cervix at 3cm dilation with regular contractions would give baby and ETA of about 8 hours. 7 cm? Baby's ETA= 4 hours. And in reality, this mindset is common! Here's an example:
I really cannot stress this enough, because this confidence in the predictive power of the cervix is now ingrained into how we think about birth in the United States. So, what's a better illustration for the cervix? I think I've found one.
The cervix acts more like a TARDIS.
Sometimes you might feel like you are stuck in the present dilation, with no end to labor in sight...
Or maybe you are feeling like labor will never begin, even though the cervx is "ready"...
You might feel that your cervix skipped past early labor straight to the really difficult part and didn't even ask permission.
Did you know that your cervix can UN-Dilate? Yep. I've seen it happen. But it doesn't matter! Because it can dilate again faster than it did before!
Or maybe you feel that you missed labor completely and jumped straight from pregnancy to motherhood.
AND THAT'S PERFECTLY NORMAL
So please, please...don't think of your cervix like Google Maps. So much more is involved in the labor process than dilation. The cervix has to soften, your baby signals that he's ready, the uterus has to contract, baby has to rotate and descend, ligaments need to stretch, etc. Try to remember that even if you read a hundred birth stories, that yours will be unique. Gather a great, positive birth team, trust your intuition, take every contraction one at a time, and enjoy your ride on the labor TARDIS.
What do you think?
I look at birth from the perspective that our bodies are wonderfully made, and if we really believe that and work with the birth process and nourish our bodies properly, they will function optimally, most of the time!