STAGES OF LABOUR: THE ‘PUSHING’ PART? – WHAT, WHEN, WHERE, HOW?

8 Jul, 2019

LittleBirthCo

When describing what the second stage of labour is, one of the easiest ways to keep it in someone’s memory is to tell them it is the part where the ‘pushing’ bit happens. Though you might be surprised that the ‘pushing’ we talk about isn’t like what you may have seen on programmes like OBEM or in the movies. We will chat about this in a bit.

It is so much more than that! Understanding your body is crucial to trusting in its ability to birth your baby, so here is some key information about the second stage of labour.

What?

The Second Stage of labour is when your cervix is 10cm dilated, or fully dilated, to the birth of your baby.

In order to birth your baby, you will continue having surges, although they can often be less frequent and slightly longer in length than they have been in earlier labour. This is a clever mechanism, to provide you with a bit of a rest period in between each surge.

I like to imagine it as more of a transition from the first to second stage, as opposed to a start and end, labour is not black and white, there isn’t an absolute moment where you know you have passed into the second stage of labour.

The process of birthing your baby is not just about ‘pushing’ either – as with the entire labour process, there is more to it than that, it can take time and energy. Being aware of your position and keeping active and mobile can be hugely beneficial.

When?

As with all of our previous stages of labour posts, it is hard to predict at what point you will enter the second stage of labour.

There are often some common signs that this stage may be approaching, these include:

Feeling pressure in your bottom or the need to open your bowels
Feeling nauseous or vomiting
Feeling the baby move lower into your pelvis
Mentally, you may feel a sense of being out of control
A rhombus shape may appear on your lower back, this is known as the Rhombus of Michaelas and is a sign that your pelvic bones are adapting, to make way for your baby
The purple line – this is a line which appears between your buttocks and can indicate that your labour is progressing
The instinctual urge to bare down, this may be something you have control over, or alternatively may be a sensation which is out of your control
The need to be in a private place
There may be physiological changes in the baby’s heart rate, due to compression of their head
You may also be offered a vaginal examination, which could confirm your cervical dilatation at that moment. This is not always necessary if other signs are present and is your decision at all times.

Where?

By this point in your labour, it would be brilliant if you were in your chosen place of birth, with your care provider present. This could be at home, in a midwifery led unit or in a hospital environment.

However, there are occasions where you may be entering the second stage of labour and are not where you have chosen to give birth, for example, if you are in the car on the way to your chosen place or have remained at home during the majority of your labour.

The important thing to remember is that wherever you are, you are capable of birthing your baby. The tools and techniques you will learn in your hypnobirthing class will be so beneficial now to support you in remaining calm and relaxed.

If you are experiencing the common signs of entering the second stage of labour, it is advised that if you feel you can safely make your way to your chosen place of birth, then do so, alternatively, you could remain at home and call 999, asking for a paramedic ambulance. Always call the maternity triage number provided on your notes for further support in this scenario. Of course if you have chosen to birth your baby at home then hopefully by this point your dedicated Midwife will have arrived and will be ready to support you.

How?

I want you to close your eyes, lets do some imagining.

Your baby has a journey to go on, when they are being born. Your body has already done a lot of work, in opening the cervix and moving your baby into the optimal position for birth by this point.

When you enter the second stage of labour, the baby must move even lower into your pelvis and navigate the birth canal, which is comparable to a U bend.

Remember, that if this is your first baby, your body has never done this before, so the process can be more gradual. If you have had previous vaginal births, your body has carried out these changes before, so it can be swifter. Again, just generalisations! It is never the same for any two births.

When you are in the second stage of labour, you are likely to begin to feel the urge to bare down, or a significant amount of pressure. Follow your body, do what it is telling you to do. Some women hold back due to fear, but this is counterproductive at times – your baby wants to be born!

You have probably seen women giving birth on the TV, laying flat on their back on the bed, being told to hold their breath and push push push. Again, some women may need this, for example, if they have had an epidural and are unable to feel their surges. However, that is not the ideal way to do it.

At this point in labour and when your body is given the time required then it will produce the sensation and power to ‘push’ your baby out with no conscious effort at all. At this point we often say to women, just follow your body, follow its lead, breathe your baby down. This has been referred to as the fetal ejection reflex, as you body switches to the surges that will move your baby down. Surrender to it and just go with your body. It’s fine to feel like you are ‘pushing’, the difference being that you are pushing with your body, with the instinctive bearing down that you body is doing, NOT because you are been instructed to push when maybe your body isn’t ready.

Remember our U bend? This is obviously going to be more pronounced if you are laying on your back. If you move into a more upright, forward and open position, the U bend is reduced, and you will likely need to put in less conscious effort to birth your baby. You may also feel more comfortable breathing deeply, instead of pushing. Pushing tenses your abdominal muscles, which are not involved with birthing your baby, whereas breathing can be a gentler and less exerting way of birthing your baby.

Your baby will move round the U bend when you are having a surge, due to the pressure, and swiftly retract back when it ends. It may feel like you are not getting anywhere, but with each surge, your baby is moving further into your pelvis. This process is also important as it allows everything to stretch and release gently. And just like magic, your baby will eventually stop moving back. The babies head should be born shortly after this point. Keeping your breathing slow and controlled, can help to reduce the chance of any damage to your perineum.

Once the head is born, you should feel your baby rotating. This is to support the shoulders to be born. On your next surge, they should be born, and your baby will be passed on to your chest. We will continue with what happens next, in next week’s post!

In some circumstances, medical support may be required in the second stage, such as instrumental birth (forceps and ventouse). In these cases, continue to follow your body, as every surge is bringing you closer to meeting your baby.

Other things that can support you in the second stage, are:

Eating and drinking
Emptying your bladder
A fan, flannel or water spray to keep cool
Positive affirmations
Your partner encouraging you
Changing position and keeping active
Believing in your body
If you have any questions, please get in touch and if you would like to take a hypnobirthing course with one of our wonderful instructors, visit our instructor page ????

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