Pushing vs Pooping

Actually, instead of putting them up against each other, we should probably be putting them side by side since pushing out a baby and having a bowel movement are oddly similar. We are going to walk you through what it looks...and sounds like...when it's go-time, as well when it's time to wait a little longer before pushing (even though some well-meaning people in the room may be encouraging you otherwise). Pushing is natural and moms should be able to tune into their bodies and babies, medicated or unmedicated, and allow the process to happen naturally.

There are 2 main approaches to pushing:

1. Birth team directed. 

PROS: May be helpful for moms who have had an epidural and aren’t feeling any fullness, pressure, or when/where to push. A little coaching from the birth staff may benefit them. You may like the coaching!

CONS: It can too often lead to “purple-faced pushing”. We’ve known women to get busted capillaries in their eyes and this is caused by exerting way too much energy in your face. Women are often told to hold their breath for some arbitrary number, and this can interfere with oxygen for mom & baby, and blood pressure for mom. This kind of pushing has even led to women popping a hemorrhoid! Mom may not be ready to push & this can lead to hours of exhausting, ineffective pushing. The birth team may put mom in a position that hurts her back, causes pelvic floor damage, or leads to tearing. 

2. Mother directed. 

PROS: We feel this is ideal most of the time! When you are able to pick WHEN you push and HOW you push, following your body’s natural urges (and everyone in the room is encouraging you to do this), it is naturally going to lead to better outcomes- effective, more efficient pushing, less or NO damage to your pelvic floor, less perineal swelling, allows for a more natural flow of oxygen for mom & baby. All of these things often lead to you have more energy with which to greet your baby.

To help illustrate the differences between birth-team directed pushing and mother-directed pushing, let's use an example from the perspective of something we’ve all experienced- pooping!

Have you ever been in a situation when you’re like, “I need to make it into a bathroom in 10 seconds 'cause stuff is about to go down?” haha! You can’t help it, your body is going to poo. That would be like waiting for an overwhelming, "I can’t help it my body is doing this", kind of an urge to push during birth.

The opposite of that would be if you are constipated or don’t need to poop and someone tells you to poop. They can coach all they want to, but it’s really just going to lead to lots of straining, exhaustion, and little to show for it after some time. That’s akin to a birth team-directed pushing stage where they tell you you are 10cm and to starting pushing without considering baby's position and if you're actually feeling the urge to push. 

Just because you are 10cm dilated does NOT mean it’s time to push. Why? You can be 10cm and still have baby at a higher station (position).

So, assuming mom & baby are doing fine, it’s best to wait! Let your body do the work of moving baby further down & into the birth canal! If you did NOTHING to help with pushing, your body would still birth your baby all on its own. In fact, your body is pretty amazing at this without a lot of outside interference. An example of this would be a mother who has had her baby in the car. I’m sure she did everything possible NOT to push...and yet baby arrived all on their own.

There will come a point where you can’t help it- your body is pushing at the start of each contraction, not just at the peak of contractions. Moms who are having an unmedicated birth will experience this fully. Moms with an epidural (especially and hopefully if you’ve let it wear off a bit) will often notice a feeling of fullness or pressure. 

Rest until you’ve reached that point! Keep a peanut ball between your legs. Once you’ve reached that point, here are our tips for pushing- and really, they’re quite simple:

1. Choose a position that allows your tailbone to move freely. It creates a lot more space and it’s way better on your back, hips, pelvic floor, and perineum. This can be in a squat, asymmetric squat, on your side, on hands & knees, leaning over something...and what’s cool is that EACH of those positions can be done on a hospital bed. *Make sure you have a provider that’s on board with delivering in a position that’s NOT your typical semi-reclined-on-your-back position. That said, if a classic position feels best for you, go for it! Just make sure you’re more upright and not leaning back on your back. Also, try to keep your ankles wider than your knees- this helps your muscles and bones to be rotated in a safer position for you.
2. When you feel that urge to push at the start of a contraction, take a couple of deep breaths, and then push! We often get asked, “should I hold my breath?” And the answer is: it’s up to you! I found that I naturally held my breath a bit, exhaling a little as I pushed, and the advantage to this is that when you hold your breath it creates a more forceful push- this can be useful in moving baby through the birth canal. (Test this next time you are on the toilet! Does your push feel more forceful when you hold your breath a bit vs exhaling + pushing?)  But you can also continue to let your body do the work, breathing normally and giving those instinctive pushes and “umphs” as needed. 
3. The same muscles you use to poop are the exact same muscles you use to push out your baby. Everything else though, even while pushing, try to keep completely relaxed- particularly your hands and face.
4. REST completely in between contractions! Get water, cool washcloths, chapstick, etc from your partner.
5. When baby is crowning, this is when you really want to ease their head over the perineum. Little pushes and light exhales can help. You’ll feel the “ring of fire”...which can give a burning sensation only because those tissues are stretching so beautifully & tremendously. If you were to open your mouth right now as much as possible, you would start to feel some tightness and pulling at the corners of your mouth. It's a similar sensation & concept! A warm compress applied by your provider to your perineum can help encourage those tissues to stretch. 

SO! You may be wondering what can you do now to prepare.

1. Be dead-set on LISTENING TO YOUR BODY.

2. Learn everything you can about this Second Stage of labor! Practice all the different pushing positions NOW. We teach all of this in more detail in the My Essential Birth course- come join us! Your partner needs to know them too so they can suggest & help you into different positions during birth.

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