Let's move to Stage 2. Pushing and Birth.
Turn to page 24 in the manual. Take time to read the text on this page. (READ)
There is sometimes anxiety about pushing and the delivery of your baby. It is hard to believe that a baby is able to come out of what you perceive as a pretty small space, but take heart! Your baby and you are set up to deliver this way. There is an outlet, after all, and a hormone present that allows soft tissues as well as the pubic bone and pelvis to relax a bit. The hormone is called Relaxin. Also the baby’s head “molds” to fit better. Go to the boney plates video in Chapter 2 and see how the baby is designed to make the process of birth possible for both him and his mom. (WATCH)
The manual points out that pushing and birth may take 20 minutes to 2 hours or more. Contractions are now 3-5 minutes apart. -Nature’s way of allowing you to rest and breathe between contractions. Lasting 60-90sec.
If you are feeling the urge to push, always call for the nurse before you bear down or tell your midwife what you are feeling. If you are feeling a strong urge to push and are only 9cm, then exhaling short breaths or blowing raspberries may help distract you and prevent you from taking a deep breath in and bearing down like you would to have a bowel movement.
It is possible that you are completely dilated, and you aren’t feeling the urge to bear down just yet. This would likely be because the baby is not down in the pelvis very far. (See the pelvic station image on page 24.)Your provider may allow you to "labor down" or rest while your baby descends with the force of uterine contractions for a period of time before starting to push.
Another reason that you may not feel an urge to bear down may be a result of anesthesia. A heavier epidural may make it so the feeling is simply not perceived. You may or may not feel abdominal tightening to know when to push. Your nurse will let you know when you are having a contraction and will coach you when and how to push.
See the video from the manual in chapter 2, entitled, Pushing. (WATCH)
You will deliver in your labor room if you have a vaginal birth. Most hospitals are set up this way. Timpanogos and American Fork are both set up where the laboring mom delivers in the same room. The bed is pretty awesome, and has the capacity to change for 2nd Stage. (Pay attention to this in the videos)
As a general rule, your doctor won’t be there for the bulk of your pushing. Your nurse will be with you throughout the duration of your pushing efforts and your birth. The doctor will come in as you are getting closer to birth, or when the baby has descended well and near crowing. If you are using a Certified Nurse Midwife, she may be there the entire time you push.
Turn to page 37 in the manual and look at the different positions available to you (VIEW). Now see the video in chapter 4, entitled Pushing Positions. (WATCH)
This next video shows real women pushing in labor. Most are pushing with their urges and do not have an epidural.(WATCH). Keep in mind that when you are pushing in labor, you only push with contractions. You will probably only give 3 to 4, 8-10 second pushes during each contraction. You will rest and breathe between contractions.
As the baby's head emerges, and no longer slips back, this is called crowning. Within a minute or two after crowning, your baby will be born.
With crowning and birth, there will be burning and stinging in the perineum if you have an un-medicated birth, there will also be rectal pressure. You may feel some degree of this stinging or pressure with an epidural, or you may not feel any discomfort at all.
Husbands/partners can be active participants in this stage as you have seen on the videos. You (partner) will help her to focus, provide encouragement, and assist her into positions that she may desire to try. You may support her physically by holding her leg.
What if pushing isn’t progressing well? If it has been 30 minutes and your pushing efforts aren't moving your baby further down into the pelvis, you may want to try another position. Also, if you are trying a position that is uncomfortable to you, then stop using that position. Also requesting a mirror can be helpful to see your baby's head with your efforts. Reaching down and touching your baby’s head can also be surprisingly encouraging.
Keep in mind that first time moms may push for between 1 and 2.5 hours.
Turn to page 25 in the manual. Read the text and view the yellow box. (READ)
This is a short video of the birth of a baby delivered in the hands and knees position. Go to the videos in chapter 2, select the Birth video. (WATCH)
The efforts of pushing are rewarded with the birth of your baby!
As you are holding your baby, ideally skin to skin after birth, you will deliver your placenta. This usually happen 5-20 minutes after the birth of you baby.
Read the right hand side of page 26 and watch the video entitled, Placenta.
For your assignment:
1. Practice some pushing positions. You should never actually push while practicing. Remember that pushing is similar to having a bowel movement, and it is not unusual to have a small BM with your pushing efforts. This is normal and discretely taken care of by your nurse. You may not even know that it happened. An enema before labor is not necessary.
2. Go to page 32 and 33 in the manual. Read the text, watch the video and practice breathing together.
3. Email me any questions and let me know that you have completed Unit 4.
