When to Push??

“How will I know when to push?”

Okay, so I know that many of my clients read this blog – heck, some of you chose to hire me BECAUSE of this blog! And I am sorry, but many of you will recognize yourself in this particular blog post and think I’m speaking directly and specifically about you. Let me assure you….this post was inspired by a great many “you’s” and if you recognize yourself in this, you are not alone!

Other than a first time mom who asks “How will I know when I am in labor?”….probably the most common question I get asked is, “how will I know when it’s time to push?” Those that ask this question are often first time mothers, or mothers who have only given birth with epidurals in the past. In other words…many many many mothers!

Here is my answer: You don’t have to!

Think on that for a moment and let it absorb. In a world that has taught us that birth is something to be feared, it has also taught us that it is something to control. We must know when you are fully dilated so we can tell you when it’s time to push.

OH REALLY?? Let me break this down into all of the ways in which it is wrong. First and foremost: just because you are fully dilated does not mean it’s time to push. Did you know that the US is one of the ONLY countries who have decided that the second stage of labor (called the “pushing stage”) begins at complete dilation?

The moment you are 10cm dilated it begins…I always imagine an OB in scrubs with a gun filled with blanks pointed towards the sky while the poor pregnant mother dressed in a hospital Johnny is in starting position – the OB fires the gun! GO!! The race has begun!! Ready or not, you better run your little heart out because if you don’t cross the finish line in a predetermined amount of time the OB will disqualify you and take you out of the race. Your punishment? A c-section.

Your body is not always ready to push at 10cm! Sometimes there’s a lull that happens…it has become known as the “rest and be thankful” phase. Mother’s body and baby have done a lot of work to become fully dilated and there is a lull in the labor that gathers energies and strength before the big race begins. There is absolutely NO reason to push during that stage and doing so can waste your energy as well as put unnecessary stress on the baby.

Okay….so how will you know when rest and be thankful is done and you should push?

Again, you don’t have to know! You would think it’s silly for a mother to ask, “So how will I know when the next contraction should be so I know when to contract?” You don’t have to, your body does it. Your body will know when to contract. And your body will know when to push.

Do you really think that if nobody told you when to push…if we dropped the ball on this one and just didn’t tell you that you should push…do you really think you’d be pregnant forever?? That this baby can’t exit your body without instruction?

When you were not pregnant did you ever ask the following questions…?
How will I know when I need to eat? How will I know when I need to go to the bathroom? How will I know when I need to throw up? How will I know…..

Do those seem like silly questions? Good…then you can understand why I smiled at you when you were in labor and asked me, “How will I know when I need to push?”

You don’t need to know…your body will know and your body will tell you louder and with more clarity than I could! This is different if we interrupt the signals with an epidural and it makes a lot of sense that a woman need to be told in that instance. She will also have a urinary catheter because she doesn’t know when to pee. Fortunately, I am not dealing with THOSE births…I see unmedicated mothers who (I hope) are fully in touch with the signals her body and her baby liberally throw her way.

So I sit and witness…as she flows through labor…waiting for it…waiting…watching…listening…watching and waiting…until…

Mother HEAVES, grunting as her body bears down with a force unimaginable to her before that moment, and she looks up at me with that look of, “Whoah!” And I smile with joy as a mother gets the opportunity to see how perfect her body can be and prepares to welcome her baby earthside.

19 Comments

  1. Kelli wrote:

    Even after my first unmedicated birth I questioned my pushing urge…it came so soon, but I remember being told “Just do what doesn’t hurt” when I asked repeadedly “Why am I pushing!?!” and really I’d been pushy for about 15min before that but denied it. I thought it was too soon to push up until Kate looked and said “Kelli, I see a head you know.” Even with the most faith in my body I questioned it because I doubted the speed of my labor. No harm done, but really, the doubts come even to the most prepared, thanks for the reminder that our bodies work and we aren’t alone in wondering, this is what I wanted a doula for and a midwife…I think its really whats needed from a midwife while she’s life-guarding, just reassurance that all this intensity is still alright and normal. Thanks for the great post!

    Wednesday, October 27, 2010 at 2:48 pm | Permalink
  2. Laura wrote:

    I didn’t know I was pushing, it just happened. I thought it was just a different type of surge or contraction. I compared it to a sneeze, it just came on and happened. The body is so cool!

    Wednesday, October 27, 2010 at 4:07 pm | Permalink
  3. Rosie wrote:

    As a doula, I need to know what I could have done to help this mama. I have a feeling the answer is time. Although it seemed like she was complete or almost complete for a long time. Maybe she needed even more time. I felt baby may have had a nuchal hand but we did not see it at birth. Just a cord, kinda tight. Perfect tones the whole way.
    My doula mantra goes, “Birth is Life and Life is Birth. Keep living life until you get the urge to push.”

    I went to a hospital birth with this lovely girl on Monday night. She had the closest thing to a homebirth type labor at a hospital that I have seen. The nurses pretty much left her alone to labor, minimal intervension. Most impressive was that their attitude and WORDS were encouraging, never negative.

    Then, why did her baby get vacuum assisted?

    7PM 3 cms.
    11PM 5 cms.
    7AM 9 cms. with lip (Yay!)
    10AM 9 cms. persistant lip
    AROM
    Pushed four hours
    Mom tires out, asks for help
    Doc comes in and uses vacuum.
    1st degree tear.
    8lb.6oz. baby girl
    2:45PM
    10/27/10

    Wednesday, October 27, 2010 at 4:50 pm | Permalink
  4. Rosie wrote:

    Oops! I mean baby was born Tuesday, 10/26/10

    Wednesday, October 27, 2010 at 4:52 pm | Permalink
  5. Darnell Walls wrote:

    I couldnt agree more! With Lilly I pushed for 2 1/2 hours and was in labor for 10 hours she was 8lbs 14oz…….very hard work! But with Royce-Jay his labor and delivery was so different! I was in labor for 5 hours and I went from 6 centimeters to “oh my I NEED to push NOW” in about 10 minutes, I was confussed and dazed. My midwife (Nancy Spencer) just told me to not push ( we werent quite ready for him, she needed to get ready fast!!) and I told her I am not pushing he is just coming and she told well that is what contractions are for this is what your body is made for just breath. I did and he was in my arms within about 5 minutes and I might have really push twice. It smiply amazes me what our bodies can do on there own! Royce-Jay was born 10/19/10 weighting 9lbs 10oz.

    Wednesday, October 27, 2010 at 6:55 pm | Permalink
  6. Sharalyn wrote:

    Oh, this was the very thing I was *so* frustrated with at my son’s birth! I did not want to be yelled at or told what to do. It was in my birth plan that no one even looked at (pre-eclampsia at 34.5 weeks).

    I was “naughty” and pretended to push when they told me to so they wouldn’t yell more, but I only really pushed when my body told me to… Funny, I “pushed” for 15 minutes, and I think in reality I pushed a total of 3 times.

    Also, at that burning ring of fire stage, I automatically stopped and panted. They started yelling that I had to push through it to get him out. Wanna bet? Panting allowed my uterus to do its work without extra strain, and the OB was surprised that I barely had any “skid marks” and no tearing whatsoever. Course that was after she had gone for the scissors, and I yelled, “NO EPISIOTOMY! I WANT TO TEAR!” Lol. She was startled.

    Despite everything that happened that was not how I had envisioned it, there is still that sense of empowerment in that moment. 🙂

    BTW–we’re planning a homebirth this time. 🙂

    Wednesday, October 27, 2010 at 7:05 pm | Permalink
  7. Trena wrote:

    Indeed, those seem like silly questions – the body knows (as Rose worded it last night) how to “throw-down”, just as it knows how to “throw-up”, right?! I have about 8 weeks to go and I’m scared as it’s my first birth, but also SO excited to experience my first time too. Funny how you can feel both at the same time. :0) Thank you Stephanie for the constant reassurance that this all will come naturally. I trust that, and yet I can’t be reminded enough!

    Thursday, October 28, 2010 at 2:10 pm | Permalink
  8. Amy Lynn Drorbaugh wrote:

    So true! Pushing is never a choice for me…it’s just something that happens and I love it! Because that means my baby is almost here. 🙂

    Thursday, October 28, 2010 at 3:26 pm | Permalink
  9. Mama&Ellie wrote:

    I ENJOYED pushing. My body told me when to push…I was sleeping through contractions at the time and was certain that I couldn’t be ready to push (so much so that I didn’t help my body push at all and the head still came all the way down.) Letting my body do the pushing didn’t wear me out. The only part of the pushing stage that hurt was the “ring of fire”. I can’t wait to do it again. Btw, we had a wonderful homebirth!

    Friday, October 29, 2010 at 10:47 pm | Permalink
  10. Desiree wrote:

    I never had “the urge” to push. Instead, a force took over my body and my uterus just did it, ejection reflex at it’s finest. I think *I* actually pushed once to get out my vbac baby’s hips after my body pushed out he rest of him. Our body is an amazing thing!

    Tuesday, November 2, 2010 at 12:04 pm | Permalink
  11. Sara wrote:

    Pushing was such a relief for me- not nearly the horrid screaming fit that you see so often in movies and birth shows. It was a real shock to be pushing after only 4 hours of labor, though! (1 hour of painful contractions).

    Our bodies are made to do this! Why don’t more people realize that women are MADE to GIVE BIRTH. It’s such a simple truth, but so powerful once it is realized.

    Thursday, November 11, 2010 at 11:10 am | Permalink
  12. Charlotte wrote:

    I just knew when it was time to push because I could feel it in my muscles. I was in the hospital and they had a catheter in me. It was just me, my husband and mother in the room as another mom on the floor was in a critical situation and they had all run to help her. I looked at my husband and said “You need to get SOMEONE in here to get this cath out or I’m taking it out myself. I NEED to push right now.” Sure enough, they came in and took the cath and as soon as I relaxed for a minute my body started pushing the baby right out.

    Saturday, November 13, 2010 at 10:30 am | Permalink
  13. I wish I could say that it was like that for me, but it was not. after 24 hours of unmedicated labour, my body finally started pushing of its own accord, and it took my breath away and i hated it! I had a nurse next to me yelling that she needed to check me before i started pushing and not to push (yea right! i’ll stop pushing when you stop breathing and blinking). But after 4 HOURS of pushing as my body told me, she was NOT coming out. She was crowning for an hour or so. sooo exhausting. Every time i pushed and she would not come out and just slide back in i would throw myself back and cry. I didn’t get a rest between contractions, with constant pain for about 12 hours. At the end of 4 hours, i welcomed the coaching and the episiotomy, and she was finally in my arms and I could rest.

    Saturday, November 13, 2010 at 10:32 am | Permalink
  14. Christy wrote:

    Another great post! My last 2 babies (homebirths) came out on their own in 3 contractions as my body pushed them out. I exerted no pushing effort at all. My first (birth center) was a different story. I was very comfortable on a toilet when my water broke. I am convinced that if they would have left me alone (what a concept!) I would have birthed fine. Instead they wanted me to lie down on the bed (which I hated). I wound up pushing with great effort for maybe an hour and was then told I needed an episiotomy due to baby’s heart rate getting low. He shot out with the cut, but I blame all that on me being interfered with. Pushing while lying on my back with my legs up in the air was not what my body wanted to do.

    Saturday, November 13, 2010 at 6:30 pm | Permalink
  15. I recently witnessed a birth where a mom was not told to push and afterward she said she had never known that a woman didn’t have to be told to push in order to have a baby! What a nice surprise for her.

    Saturday, November 13, 2010 at 9:57 pm | Permalink
  16. Melissa wrote:

    Wow, this is a totally great post!! I wish I was more prepared for my homebirth (had my water broken too) because I felt so scared as a first time mommy. I pushed because I wanted her out but I wasn’t getting the urges. I probably was in that ‘lull’ but didn’t realize it at the time. I was told to push when I felt the urge but still wasn’t told about the fact that I could have waited. I did get an internal tear too. But after it all I am still very proud of myself and my hubs and baby girl. :o) But I do know now that next time I can let my body do it all. :o) The weird part is I never got but one urge to push the whole time! I guess some women just go through that. But your body will still do what it has to do, I know that much. :o)

    Sunday, January 23, 2011 at 3:12 pm | Permalink
  17. Tirzah wrote:

    That last paragraph hit home w/me because it took me back to that exact moment. My firstborn (1 on the way) I had at home. I was in the tub, never asked many questions, didn’t even take any birth classes to know what to expect, why ~ I guess I just thought that I would figure out what to do & learn how to handle labor when it came. The only thing I read was to make sure you breathe through contractions for a smoother, quicker labor & that was the only thing I concentrated on. Anyways, I just remember that moment when I felt that unimaginable push from my body & exactly,, I said WHOAH!! LOL..good stuff right there!! Totally made me just smile & remember so clear!

    Sunday, February 6, 2011 at 2:01 am | Permalink
  18. Avani wrote:

    I do wish I could have you as my midwife!

    Sunday, February 6, 2011 at 5:20 am | Permalink
  19. Chelle wrote:

    Yes, the body is designed in a magnificent way for birthing. I too didn’t have to push, but was coached to push although I had no urge at the time. At crowning I was told to stop, I did, but my son flew out and I had a 3rd degree tear, after such a wonderful drug free home-birth. I’m still trying to find answers as to why I tore, was it the coached pushing? It was only for around 5-10 mins I pushed at different intervals. My second home-birth, no pushing and again a 3rd degree tear! Baby no.3 now- I’m bring recommended a hospital birth and an episiotomy away from my scar, will this actually help though? I have no idea…

    Wednesday, June 5, 2013 at 3:43 am | Permalink

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