It’s like pushing a flaming watermelon out a fleshy hole the size of a baseball. Just kidding. Actually, this experience is completely different for each woman. I’ll give you a couple of examples.
My client Chelsea had taken my HypnoBirthing class and was a devout believer in breathing her baby down (an alternative to pushing). For weeks beforehand, she practiced the birth breath every time she was having a bowel movement, and in her regular meditation practice she envisioned successfully helping her baby emerge in this gentle way. When she went into labor, the midwife and I were called to her house and she began a very long journey through labor.
Tired but determined, Chelsea worked her HypnoBirthing tools, continuously focusing on surrendering and expanding. Twenty-four hours later, the midwife said the head was almost out. Chelsea began doing her birth breathing, and ten minutes later the midwife said, “Give me one big push.” And just like that, her baby was born. I was shocked. Almost every birth I’ve attended consisted of a big announcement when the mom was fully dilated, and everyone getting in position to help her push. A nurse or midwife would then loudly coach the mom to press her chin to her chest and push like her life depended on it. It was usually a long process. But not this time.
My birth, on the other hand, was the epitome of the classic pushing you see in the movies. My feet were in those scary-looking metal stirrups, I had a spotlight on my vagina, a nurse was nervously watching the monitors, my husband looked like he was about to faint as screams, blood, and probably some poop came out of me, and the doctor kept telling me to “Push harder! Harder! Harder!”
I did as I was told. I wailed like a banshee and worked so hard I spiked a fever. I pushed for three hours before Hudson came out. When he arrived, his hand was pressed against his face (something called nuchal hand), which is likely what made the pushing such a long, hard process. But I don’t think that was the only reason. Even though I knew about the birth breathing technique I hadn’t really believed in the power of it , and I didn’t have a doctor who supported it. But who knows, even if I had Chelsea’s unwavering belief in breathing the baby down, I might still have needed to push harder harder harder, whether because of the nuchal hand or just the structure of my body.
I share these stories to make the point that the experience of pushing (or breathing) a baby out can range from gentle to super-duper intense. So much of it depends on the woman and the baby. And while how the pushing process unfolds is mostly out of your hands, there are ways you can prepare yourself for the experience, which I cover in the “What to do” section. Before we get to that, let’s look at the questions about pushing I get most often.
What does it feel like? For many women, pushing doesn’t feel nearly as uncomfortable as they think it will, even if they don’t have an epidural. Because of the pressure of baby’s head on nerves in the vagina, a numbing sensation is often present during pushing. This numbing is usually accompanied by intense pressure — essentially, it feels like you’re about to take the biggest poop of your life. Some women report a “ring of fire,” an intense burning sensation, when baby’s head is crowning. But most women I’ve worked with (myself included) said they never felt it. As strange as it sounds, I found pushing to be the most comfortable part of childbirth, albeit the most exhausting.
What can make it harder? A baby in the posterior, or “sunny-side up,” position is one of the most common situations that can make their emergence trickier. In this position, baby’s face is pointing toward the front of your body, which can make it challenging for them to get past your pubic bone. It doesn’t make vaginal birth impossible, just harder. There are tips for repositioning a posterior baby in the “What to do” section. You’ll also find a link for the video “How to Reposition a Posterior, or Sunny Side Up, Baby” in the book’s “Recommended Resources” section.
Numerous other circumstances can complicate pushing — here are the ones you can actually do something about:
Lying on your back: This position doesn’t utilize gravity and can narrow the birth canal. Being on all fours, lying on your side, or squatting are all preferable for most women. If you have an epidural, ask if you can lie on your side while pushing.
An epidural: As an epidural can make it difficult to feel and coordinate the birthing muscles, pushing when you have one can be tricky, but not impossible. I’ve witnessed many midwives tell moms with an epidural who had fully dilated to not push, and let contractions do the work instead. In many of these cases, the mom didn’t have to push until baby was almost out. Some call this delayed-pushing technique laboring down. You can also ask if the epidural can be turned down when you’re ready to push, so some sensation returns.
A tired uterus: If you’ve had an incredibly long labor, your uterus might get tired, and tired uterine muscles can complicate baby’s descent because they may not be able to contract as effectively as needed to push baby out. Some care providers recommend Pitocin if they suspect the strength of contractions is waning, as it can give the uterus a much needed pick-me-up.
How long does it take? Unfortunately, there’s no answer for this one. Some women push for ten minutes and the baby is out, and others push for hours and still need the support of forceps or vacuum. Following the tips in the “What to do” section can increase your chance of shortening your push time.
What is it like for baby? While it’s impossible to know what baby is thinking during this process (I suspect it’s something along the lines of “WTF is happening?”), monitors tell us that many babies experience a dip in heart rate every time their mom engages in heavy-duty pushing, as there’s usually a drop in oxygen during this time. The heart rate usually bounces back up when the contraction and push are complete. This is another reason why the gentler pushing methods can be beneficial — they don’t require mom hold her breath. However, if there is a special circumstance requiring that baby come out as soon as possible, the more intense pushing could be worth it. Your care provider can help you determine what is safest for you and baby.
What to do
While there’s no way to know what type of pushing will be most effective for your body and baby, or how you’ll process that experience, these techniques will help you go into the event as prepared as possible.
Do the perineal tissue massage. This massage will prepare your perineum for baby’s head.
First, coat your pointer and middle finger, or your pointer and thumb, with an unscented, organic oil.
Then insert the fingers two inches into the vaginal opening, and move them in a U-shape along the inner edge of the perineum.
I recommend applying more pressure when you reach the tautest skin (area between the vagina and anus), as this is the skin most likely to tear during birth.
As you push to the point of discomfort, utilize pain-relieving techniques like deep breathing and facial relaxation. This makes the perineum become more elastic, and helps mentally prepare you for the vaginal stretching during crowning.
I recommend doing this nightly for about ten minutes, starting at around week thirty-four or thirty-five of gestation.
Get baby in the optimal position. Cephalic presentation (the best position for baby to be in) is when baby is head down, facing your back, with their chin tucked to their chest. Your care provider can help you determine if baby is in this position.
If they’re not facing your back, here are a few things you can do to give them the space to get into it, which they’ll usually instinctually do if they’re physically able.
Get into the yoga position called “child’s pose” and really stick your butt into the air. You can also gently sway your hips. Stay in this position for at least five minutes (unless you feel woozy), and practice once a day.
Get on your hands and knees and gyrate your hips.
As often as possible, sit in a position where your pelvis and belly are tilted forward. The easiest way to do this is to sit on a wedge cushion. If you’re sitting on a birth ball, make sure your knees are lower than your pelvis.
Sleep on your side instead of your back.
Avoid sitting in bucket seats, or leaning back into the sofa.
Prepare your pelvic structure. A deep squat (with the support of a spotter) or the yoga poses “child’s pose” and “cat-cow pose” can all help relax and lengthen your pelvic floor muscles.
Practice birth breathing while pooping. Because the “birth breath” stimulates the natural expulsive reflex, it can help you poop and get a baby out with minimal pushing. Many mamas don’t believe this until they experience its effectiveness while having a bowel movement. So . . .
While sitting on the toilet, take in a quick and strong inhalation through your nose.
As you slowly exhale, feel the power of the breath being pushed down the back of your throat, through the uterus, and out your vaginal opening.
While you exhale, you’ll organically create a low sound and gentle vibration in your throat. You’ll also feel your expulsive muscles bearing down.
Repeat until you expel that poo!
Ask your care provider how they typically guide women through baby’s emergence. Gaining an understanding of the instructions your care providers usually provide through this phase of birth helps you determine whether their process resonates with you. If it doesn’t, talk to them about how you’d prefer to navigate pushing.
Think of how you want to be guided through pushing, or breathing baby down, and add it to your birth preferences. After you’ve determined if you’d like to try birth breathing or want to go with more traditional pushing, add it to your birth preferences. I also recommend listing how you’d like to be guided through this experience. For example, women I work with often use the phrase, “I request calm prompts from only one person. No loud ‘cheerleading’ please.”
Utilize the “laboring down” technique. In laboring down, you allow the uterus to push baby out with only contractions, and not your pushing efforts, after you’ve fully dilated. This can conserve energy, reduce your chance of tearing, and provide a gentler experience for baby. Many women I’ve supported use this technique until they can no longer suppress the urge to push.
Choose a position that takes weight off the tailbone. Standing, kneeling, squatting, being on all fours, or lying on your side allow more expansion in the pelvis, potentially leading to an easier emergence for baby. Changing positions can also help if pushing progress seems to stall.
Apply a warm compress and oil. Help the perineum soften and expand (which minimizes tearing) by asking your care provider to place a warm washcloth on your perineum, in addition to massaging it with oil.
Go limp between contractions. Contractions and pushing can take a lot of energy. Allow yourself to recharge between push sessions by closing your eyes, going totally rag doll, and taking slow easy breaths. You can also ask that no one talk to you unless absolutely necessary.
Consider having a mirror held between your legs. Seeing the top of baby’s head between your legs can be an incredibly motivating visual. If you’re into this idea, bring a hand mirror to your birth, and ask someone to hold it between your legs when baby is crowning.