How about stories from people who have urinary incontinence for months after birth?
Both of these can be side effects of something referred to as Purple Pushing
Purple Pushing known by the medical term Valsalva maneuver or closed glottis pushing
It is a style of pushing during labor where direct
coaching is done by your care provider (usually your labor and delivery nurse).
The good news is that there are other options for pushing. We are going to cover your options
AND make sure to stay until the end for the exact phrases you will want to include on
your birth plan when it comes to pushing. Let’s walk through what purple pushing or
directed pushing looks like. Direct Coach pushing generally looks like the
nurse instructing you to take a deep breath in, putting your chin to your chest and bearing down
(pushing) and holding your breath often while they are counting to 10. That strenuous process
is repeated through the length of the contraction which is usually 3-4 pushes per contraction.
You’ve experienced this if you have had a nurse saying words like “Hold Your Breath” “Push Harder”
As you can imagine, this directed pushing style that includes holding your breath can be really
intense and can cause your face to turn purple. You might even end up
with bloodshot eyes the next day due to tiny capillaries bursting while pushing.
There are two other options for pushing that I want to make sure
that you are aware of before you are 10cm dilated. Open Glottis Pushing – This is a technique where
take a deep breath in, but this time you slowly exhale while you bear down.
It helps to visualized directing your breath towards your rectum and your vagina. Because
pushing a baby out is so similar to pooping, you can actually practice open glottis pushing next
time you are on the toilet having bowel movement. Did I just suggest practicing pushing while
pooping? Yes, I did. It's a great time to practice.
So what it looks like is a deep breath in and then a slow exhale. So it could look like this.
It could also look like .
The other option is to take a deep breath in and make a grunting or groaning sound
as you push towards the feeling of pressure in your vagina or your rectum.
Something like that. To recap that is two other options, a deep breath and a
slow exhale or a deep breath and a grunting noise. Now, research done on purple pushing
has shown that it can decrease the pushing phase of labor by around 5-15 minutes on average, but
the American College of OB GYNs give clear recommendations to doctors to support the options
that are working for the woman giving birth. Their exact recommendation is “When not coached
to breathe in a specific way, women push with an open glottis. In consideration of
the limited data regarding superiority of spontaneous versus Valsalva pushing,
each woman should be encouraged to use her preferred and most effective technique.”
In addition to the leading OBGYN group, the leading group of labor and delivery nurses, AWHONN
instructs the members of their organization to “In order to support the woman during the second
stage of labor, the nurse will promote mother initiated pushing and open-glottis pushing,
assist the woman to maintain upright, gravity neutral positions,
and encouraging grunting, groaning, or vocalization during the push
in response to contractions” And finally ACNM (the American
College of Nurse Midwives) have also supported a person’s right to spontaneous pushing.
What this means for you is that you should have the option to push how you want. Now I
said “should”, because not all doctors, midwives and nurses are following these recommendation.
If you would like to avoid purple pushing in labor I recommend talking to your care
provider prenatally about your preferences AND expressing these preferences on your birth plan.
You could use this exact phrase on your birth plan “I would like to work with my body’s own
urge to push and prefer not to be direct coached during pushing unless necessary.”
And because there is research that says changing positions while pushing can also be effective at
shortening the length of pushing you might also consider adding this to your birth plan as well.
You could also add “I am interested in changing position while pushing and would
like to sidelying and upright positions.” If you are interested in shortening the time
that you are in labor, then I recommend you checking out this video right here
where I share my favorite positions for speeding up labor. And if you like this video, go ahead
and hit that subscribe button for more videos just like this and I'll see you next time. Bye.