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Spontaneous Pushing 

  1. What is spontaneous pushing ?
  2. How do we know that it will happen that way?
  3. How is spontaneous pushing better?
  4. What if I don't get an urge to push?
  5. Does this mean that the labor partner is out of a job?
  6. What does this have to do with pelvic support?

What is spontaneous pushing?

When the "transition" stage of labor ends and the rhythm of the contractions slow again, the caregivers wait with the woman until she feels an urge to push.  Sometimes there is still a little bit of cervix, but it's going to go away with the beginning pushes.  sometimes the cervix is out of the way for a little while before she get any urge.

A big part of finding out how her body will push best is discovered by changing positions and moving around until the woman finds the position that works best for her.

She usually will hold her breath only briefly, if at all, so her throat is open.

She usually will make low-pitched noises, like a grunt or sigh, so her mouth and jaw are relaxed and open.

Contractions vary in intensity, so she will feel a need to push gently or not at all with some, while others will "carry her away" into strong bearing down efforts.

She usually will feel the need to bear down only after the strength of the contractions has built to its peak and she cannot resist the urge to add her effort to the work of the muscles.

She usually will give four to six short bearing down effort per contraction with good breaths between pushes.

The emphasis in this part of labor is on letting go and going with the urge to push with short efforts.  The effect is that of the woman "opening to let the baby out".

The sense that the uterus is working hard and the woman is going along with the labor, letting go and adding bearing down efforts, leads to a more relaxed atmosphere and a more relaxed body, including the perineum.  When the vaginal opening is relaxed, the body does not need to work  as hard because it is bringing the baby down onto muscles and skin which are more yielding.

It is each woman's own body which is leading the way, so she pays attention to her own sensations and follows the lead of her uterus. 

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How do we know that it will happen that way?

Our culture has taught us to "plan" for birth, to "practice breathing" so we will be "ready" for labor.  But birth is not really a mental even.  It is a physical one.  Perhaps the most important preparation is not to try to "learn" what to "do".  It may be more valuable to develop confidence that your body will tell you - that you will know - how to let go and add your effort to the work of the contractions at the right time.

Birth is not a mental even, and it isn't one that we have complete control over.  A lot of built-in reflex activity is involved, processes which will unfold without conscious effort, like yawning and stretching when you are tired.  Just think for a minute how hard it is to keep from yawning and stretching when you have the urge to to do so - and how good it feels to do it when you can.  Birthing is a complex and powerful process that your body knows will how to perform.  You will want support and encouragement, but there is no need to worry that you won't know how  to give birth.

When the time comes, you and your caregivers will work together to give you and your baby safe passage.  It is good to have a birth plan which will help you tune in to your body and push on your own.  It is also good to remember that you will not be alone.  Your caregivers will be helping you the whole time.  Let them know what you need.

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How is spontaneous pushing better?

Research has already demonstrated several benefits to spontaneous bearing down efforts.

Better flow of blood and oxygen to the baby, so less fetal distress.
Better stretching of the perineum, so less need for episiotomy and fewer tears.
Better chance of birthing without needing assistance with vacuum for forceps.
Better sense of satisfaction and accomplishment.
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What if I don't get an urge to push?

Every woman's labor follows its own timetable.  Many of us are out of practice at listening to our body's signals.  The hospital setting and staff routines - or just having people you don't know well around you - can disrupt efforts to "tune in" and wait for the urge to push.

Remember that after the difficult time in the transition phase of labor, for many women there is a "rest and be grateful" period while the uterus - and you - get ready for the baby to come down the birth canal.  So don't worry if things seem to slow down and you don't feel a need to bear down yet.

If you have a waiting time, use it to rest and make yourself more comfortable:  empty your bladder, get something to drink, get into an upright position or walk around in the room for a few minutes.  Upright positions use gravity to help bring the baby down.

You may also just need to soothe out any last minute worries you are carrying around with your.  Ask yourself what you need to feel ready.  Are you afraid of the birth?  Are you not feeling ready to be a mother?  See if you can take a minute to deal with these very reasonable fears!  That's part of letting go.

Know that if there is a reason why you should not wait, your caregivers will tell you.  so don't worry that you need to make that decision.  You can always change to directed pushing if you have to - everyone knows how to help you do that.

Of course, you may not have to wait for the urge to push at all.  You may be one of those women whose baby comes quickly.  It that's the case, you'll need to go along for the ride. 

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Does this mean that the labor partner is out of a job?

Definitely not.  Your labor partner is there to support you as you listen to and follow the urgings of your body.

Your partner may need to think up a new "script" since "Hold your breath and push" is not what you'll need to hear!  Some phrases that may be helpful include:

"listen to your body;
find your rhythm;
go ahead and make noise;
good, low noises;
lean on me;
here's a sip of juice;
 you're doing so well;
let the contraction take you with it;
let yourself open;
 you look powerful;
you look like you need to change position; 
you are birthing y/our baby;
your body is so strong;
this baby has hair!;
you are doing what you need to do;
it looks overwhelming now; you must really be moving that baby well;
that's it!;
all is well;
rest now;
you can touch the baby's head now if you reach down;
this is incredible;
you are incredible".

Your partner can remember to help you keep drinking and changing positions.  Or you may need to rest in between.  the people helping you should take cues from you if you want lots of verbal support or if you prefer quiet moments.

You may decide ahead of time that your support person will pay attention to what is going on in the room (Is everything going normally?  Is the baby okay? Who is in the room?). This will free you to concentrate on what is going on in  your body.  Between the two of you, you can put together the whole birth story later: how it felt to you and what everyone else was doing.

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What does this have to do with pelvic support?

One major goal of the PERL Project is to find out if there is another important benefit of spontaneous pushing.  We know that women who have borne children have more problems with uterine prolapse and urinary incontinence.  Does spontaneous bearing down help preserve the integrity of the pelvic support structures?  it makes sense that it would.

The pelvic supports include muscles, ligaments,  and connective tissues which hold our reproductive and urinary tract organs in their optimal places.  Strenuous pushing may overstretch, tear, or weaken these fibers.  Long, hard, pushing while holding the breath may also cause harm to some of the nerves which prevent unexpected leaking of urine when we lift, laugh, cough, or run.

We think that these are some of the differences that occur when women push with spontaneous pushing.

Short breath holding keeps oxygen flowing to the muscles and nerves (and to the baby!).
Short, repeated pushes allow a gradual stretching which may preserve nerves and connective tissue and muscle fibers.
Waiting to push near the peak of the contraction assures that the urinary structures are pulled up out of the way of the head.
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University of Michigan, School of Nursing.
Copyright 2000.  Regents of the University of Michigan.  All rights reserved.
Revised: February 07, 2001 .