After a short break, we are back with our Hormones and Healthy Birth series! This week we're talking all about "second stage," more commonly known as "pushing." In the Lamaze "Healthy Birth Practice 5: Avoid Giving Birth on Your Back and Follow Your Body's Urges to Push," we learn that giving birth lying down flat on your back is not usually the best position to push and give birth. Similarly, it is better for you, your baby, and your body to follow your body's urges to push instead of the holding your breath as long as possible and pushing as hard as possible ("purple pushing"). The Hormonal Physiology of Childbearing report from Childbirth Connection shares with us the importance of the body's natural hormones that are produced during the pushing phase of a physiological birth (a birth that begins and proceeds normally, without the use of synthetic hormones or pain medication), and how certain interventions can prolong and interrupt that process. Let's look a little further.
For the most effective pushing phase, your body needs the hormones oxytocin and catecholamines (epinephrine and norepinephrine), both of which are produced throughout labor. A lack of oxytocin and catecholamines can prolong the pushing phase, making it longer and more difficult to push out your baby, and increasing the possibility of an intervention like forceps or vacuum extraction to help birth your baby. The best ways to ensure you have sufficient, naturally produced hormones for pushing is to avoid the use of Pitocin (for induction or augmenting/speeding up your labor) and epidural. Learn when induction is medically necessary, and if Pitocin is suggested during your labor to speed things up, find out why. Ask if you can try other alternatives first, like walking, getting into a shower, or nipple stimulation. In order to increase your chances of avoiding an epidural, learn plenty of pain relief methods and coping skills in advance or labor, and consider hiring a doula.
To learn more about pushing positions and pushing according to your body's urges, watch this short and informative video from Lamaze:
Have the Most Optimal Pushing Stage: Here's How
- Discuss early on with your care provider that you would like to do what comes naturally when it comes to positions and pushing during birth. If your care provider reacts negatively, this could be a red flag that she does not support evidence-based practices.
- Take a good childbirth class to learn the many ways in which you can push out a baby, and in particular, the many positions you can push in/on/around a hospital bed that does not involve lying flat on your back. Also learn about how to avoid induction and alternatives to an epidural.
- Avoid interventions that restrict your mobility so you can easily move in any way you feel comfortable, including positions for pushing, like on all fours, standing, squatting, and side lying.
- If interventions become necessary, involve your labor support team to help you remain as mobile as possible and get into upright positions for birthing.
- Learn the difference between directed pushing and pushing with your body's natural urges.
- Include details in your birth plan about your preferences to push in a position that is most comfortable to you and to follow your body's natural urges to push (ie, please don't count or coach for pushing). Share your birth plan with your care provider during your pregnancy, and bring a copy of your birth plan to your place of birth to share with your nurses/attendants.
- Consider "laboring down" to shorten the amount of time spent actively pushing and to provide you with more energy to push in upright positions.
- If you are birthing at a hospital, ask your nurses in advance of pushing about using the squat bar. Nearly all maternity beds come with a squat bar attachment, but staff may need some time to locate it and bring it to your room. The squat bar is an excellent tool that can help support your squatting position in labor and birth. It can even be used for women who have an epidural.
- You may find that pushing on your back and/or pushing with the encouragement or coaching of your labor support team is actually helpful -- and that's ok, too! Labor and birth is about what works best for you and your baby to have the most healthy and positive experience.
- What is the evidence for pushing positions? by Evidence Based Birth
- Pushing in Labor by About.com
- Why You May Want to "Labor Down" Before Pushing in Birth by Giving Birth with Confidence
Buckley S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care. Childbirth Connection, Washington, DC.
Childbirth Connection. 2015. Pathway to a Healthy Birth: How to Help Your Hormones Do Their Wonderful Work. National Partnership for Women & Families, Washington, DC.