Hey there guys it is Alice here. I am a doula, a childbirth educator and I spin the big wheel
of birth to see what topic we're gonna talk about today. Let's do it! Today we're talking about an
important phase of labor and that is pushing. So, pushing technically is called the second stage of
labor. So real quickly, the first stage of labour is the dilating and the effacement of the cervix.
So, the cervix getting out of the way and then the baby has descended and so, the second stage
of labour is pushing the baby out. Now after that is the third stage of labour which we have a video
on here and that's the delivery of the placenta. So, second stage of labor is pushing and pushing
is really the time that instead of working through the contractions and trying to just get get over
them (get through them, get by them), pushing is where we can give effort to really work with our
contractions. Now one of the questions that is so common in my class and people didn't don't
realize sometimes is that you only push with the contractions. So, when it's time to push your baby
out you aren't doing this continuous pushing over and over again like the show in TV and the movies.
They get it all wrong. Pushing is just done during contractions. So, a contraction starts that's
when you push and bear down with the contraction and then as that contraction ends you rest. So,
you still have that rest time in between. Now, pushing can take a long time and it really depends
on if it's your first baby or whether you have had a vaginal birth before. So, if you've had a
vaginal birth before usually the second, a second, third, fourth ,baby the pushing phase is going to
be a lot shorter. So, the first time you push a baby out generally the pushing phase lasts
between a half an hour until two hours, three hours and it's not uncommon for first-timers
to push for two hours. Now, you might be thinking "oh my god that's a long time to push" and it is,
but sometimes it goes by fast. So, I have heard a lot of people say, "I can't believe I've been
pushing for two hours, it doesn't seem that long." That is very common. No it's hard work and so if
you are supporting someone who's pushing, one of my favorite favorite things to have
ready to go is a cool washcloth. And I go into detail on washcloths, it's a topic on the wheel
in this video and I'll put a link down to below - the washcloths video having a cool washcloth
ready to go and a cool drink some water to sip on some kind of juice an electrolyte drink something
like that both of those are really important to have nearby. If you're the support person,
put helping someone pushing. Now, the act of pushing can kind of differ depending upon if you
are pushing with an epidural or pushing without an epidural. So, pushing without an epidural you
have the ability to change positions and push in different positions. And as a Lamaze educator,
I like to encourage upright pushing positions. Upright positions might include pushing while
standing, pushing while in an upright kind of seated position, pushing on the toilet,
pushing in a squatted squatting position. Even hands and knees its considered more of an upright
position for pushing and the easiest way to talk about why upright positions are good for pushing
is just to think about gravity. Right? That was me dropping my imaginary ball... gravity. So, working
with gravity, working with the way that our pelvis is designed. So, when we're pushing upright,
the sacrum has the ability to move out of the way and if we are flat on our back our sacrum doesn't
it doesn't have the ability to move out of the way and just open up that pelvis some more. So,
alternative positions if you have an epidural and you aren't able to get upright a great position
is a side lying. So, on your side with one leg up sort of being held up that way your sacrum
has the ability to move even if you don't lie all the way on your side. If you just tilts a
little bit that can help the sacrum have that movement and your pelvis have that increased
space to help with pushing. So, depending upon how strong your epidural is or how much numbness
you're feeling in your legs and if you're able to support yourself with your legs can have an
effect on your options for pushing. Now, that's those were pushing positions. Let's talk a bit
about pushing style. So, there are sort of two schools, two ways of pushing. One would be to go
with the body's natural urges and the most the easiest way for me to describe this is when I
compare it to having the urge to poop. Having the urge to have a bowel movement, where you
are maybe driving in a car you're looking for a bathroom and stop on the side of the road and you
feel like you are about to go to the bathroom in your pants. That is that desire to push and it's
very strong but it's usually not strong unless you don't have an epidural. So, if you have an
epidural you might not feel that natural urge to push very strong but if you don't have an
epidural generally there will come a time after you're dilated that you will start the contraction
will start feeling less like contractions and more just like pressure and an urge to bear down. So,
that is a sensation that with an epidural sometimes people will start feeling pressure. So,
instead of the and I've also experienced where people feel like their epidural might be wearing
off because they're starting to feel that pressure and that can be mean time to push. So, if you have
an epidural and you're starting to feel that pressure sensation come on it's great to notify
your nurse. They might check your cervix at that time and see if it actually is time to push. So,
the two types of pushing one would be to go with your natural urgent urges and to work with them.
Generally that is breathing when you need to, doing more of a grunt kind of a push. And a grunt
like that during that contraction. The second school of pushing way of pushing is directed
pushing which that would mean a lot of times the nurse would sort of be leading you're pushing,
sort of be directing the pushing by saying "take a deep breath in and then hold down bear down for a
count to ten" and then take another deep breath in bear down and do that three times during the
contraction. So, often we see that the directed pushing is done with people with an epidural and
sometimes with an epidural you don't really feel a need, feel a desire to push. And you might not
even feel any sensations knowing that you're having contraction would just make pushing a
little bit challenging and sometimes our nurse has to let us know. Okay, "contractions are starting
begin the pushing process." So, there and then in between the two of the going through our own urges
and the directed pushing you can be somewhere in between. Where maybe you are breathing with
your contractions and pushing and not holding your breath. Holding your breath has been shown
to have adverse effects on pushing. Results of pushing and on the baby as well though,
it's still done. I would say a lot, like a significant amount and with epidurals but it's
something to think about. How you want to push and what feels good to you and and maybe something to
do a little bit more reading into as well. Which I can put some good links down below if you want to
dive into this type of pushing. Now, when you have an epidural if you don't --aren't able to feel it,
sometimes can be a little hard to get the hang of how to push especially if you're a first-timer. A
couple things that can help: one is if you have a mirror set up so that you can see your perineum.
Now, some people might say "no, I don't want to see a mirror" but even a mirror for a little
while so you can see the progress of baby's head when you are pushing. The baby does a lot of like
two steps forward one and a half step back. So, the babies-- the babies motion is very in comes
out a little comes it comes it so you can see a little bit of head and then you can see a little
bit of head and then you can't. And that's very normal, that's as the baby is being pushed through
the vagina down through passing through the very last part of the pelvis their head is molding and
they are making their way they have to be guided out gently. And sometimes that takes time. So,
sometimes putting a mirror up can help you train your body to know okay that's what it
means to push. The other thing that sometimes will happen is your care provider (your nurse)
will put two fingers with consent in your vagina so that you can feel where you need to be pushing
to. And sometimes that just is a way to sort of connect your head with where you're supposed to be
pushing and make pushing more effective because it does take sometimes some time. A little learning
process to get the pushes in the right area and to be effective to not hold a lot of tension in
your legs, hold a lot of tension in your butt but in instead direct the attention towards your
uterus and pushing that baby down and out. So, the fingers in the vagina and a mirror can sometimes
help with pushing. Now, if the baby's heart rate is going low during pushing or they're a
little bit worried about baby during pushing they might suggest that an oxygen mask be added. So,
that you would use that in between contractions and take it off between that can sometimes be
something that happens during pushing or if there is too much if the baby is needs to be
born immediately if we're seeing anything that is worrisome about the baby there might be the
talk of an episiotomy or an assisted birth which would be done with a vacuum or with forceps. So,
both of those are tools to help assist pushing. If there is a need for the baby to be delivered
immediately then there is usually a discussion about both of those. So, pushing is a important
phase that second phase of labor and though it might not come naturally, when it does get going
generally you can get the hang of it. Now, support team one thing I need to be super aware of,
besides having your washcloths, and your sips of water is make sure that you're not yelling. It's
so tempting to want to yell "PUSH" and "STRONGER" and you can kind of get caught up where you don't
even realize you're yelling and you're actually yelling. Yelling it's not helpful to the person
giving birth. Saying things like "you're doing a great job" "that was a good one",
"oh I saw a big change at that one push", "just like that" or "the third push was the best of
them all" or "the second push was your best push." Those kind of more specific, positive things are
so much better than just yelling "push and push harder" because you know the person giving birth
is probably pushing very hard and it's it's not very helpful to have that yelling. Especially
if the nurse is yelling and you're yelling, and doula is yelling and everyone's yelling. I don't
suggest it. Some good feedback is really helpful. To say "that was a great push", the nurses can do
this as well and then if you hear the nurse say "that was your strong work, strongest push",
you can say "you just gave your best push". You don't have to really know. You could just echo
what they say. So, just little hints for partners. It can be very exciting and easy to want to get
in there and start screaming but not very helpful. So, let me know your thoughts about pushing and if
you have questions about pushing as well you can put them down in the comments below. And if this
help video was helpful to you hit the like button. If you are not in the free course BirthAtoZ.com,
why don't you give that a look. That is all of our previous spins that have been
organized into really easy to use free program. Called birth a to z. And hope to see you there
or see you next time on the big wheel of birth. Thanks for joining me today guys see you soon!