Push It – The Second Stage of Labor
Editor’s Note: Happy Friday Morning! Through her extensive work as a nurse and a midwife, Deepa Upadhyaya has witnessed many beautiful birth stories. Today she’s discussing the second stage of labor – pushing - plus, the first of many international birth stories. Here she is:
For the longest time, whenever I was in the second stage of labor (pushing part) with a woman I got the Salt-n-Pepa lyrics “Push It Real Good” in my head.
“Da da daa da da daa da daa da daa da push it, p-push it, real good”
How irritating.
Usually you are completely in the moment when you are laboring with a woman. However, every once in a while you find yourself humming random 80’s one hit wonders in the final stages of labor or even planning dinner while inspecting a placenta!
This month’s article topic hit me as I was toilet training my youngest.
She just turned two, so it was time and she was more than ready. There she was on the toilet and I could hear and smell that there was a poo ready to make an appearance. So, I started to coach her on pushing it out.
My past and current lives were colliding.
How many times as a midwife had I stood there in the washroom encouraging a mom to empty her bowels, or even push her baby down for a while? By the way, a toilet is sometimes the best place for this.
So what is the deal with pushing a baby out anyway?
In this article I will address some of following questions briefly. I’ll try not to get too technical – I don’t want any readers falling asleep at the keyboard!
Why can pushing a baby out be such a tedious and painful marathon for some and a quick and energetic jog in the park for others?
If you have pushed out a baby before, it’s usually faster the second time around. Another factor that plays a role is the position of the baby’s head.
It is much easier if a babe enters the world looking towards mom’s back. It just makes the process faster and less painful than if she/he was looking face up.
Here’s a slightly technical tidbit. There are four types of pelvis a woman can have. Two types are fine for a vaginal delivery, but of those two, one is easier.
The other two types of pelvis make life harder and one of those is incompatible with vaginal delivery.
Officially the second stage lasts from the time when the cervix is fully dilated to when the baby is born. Not all women feel the urge to push right away - or at all.
Of course, you will likely not feel it all if you are using epidural anesthesia for pain relief.
If everything is going okay, the woman is correctly determined to have a fully dilated cervix, and she feels a strong urge to push - then by all means go for it!
But sometimes a woman feels a strong urge to push before she is fully dilated. This is not encouraged, as there is a risk of tearing the cervix or prolonging labor.
I am just smiling at what I just wrote.
I remember the days before I became a midwife or mother. I was working as a high-risk obstetric nurse in downtown Minneapolis, Minnesota. There was a large population of Hmong refugees. Hmong people come from mountainous regions of southeast Asia.
Not to stereotype, but in my time there I saw at least half a dozen Hmong women arrive via wheelchair, trying to balance on one butt cheek.
Often it was far from her first child, so we would rush to get everything ready for an imminent delivery. Her cervix was quickly checked to find out there was at least half left! Then we would get a language interpreter and strongly advise her not to push. She would never listen and just continue to push the rest of her cervix out of the way.
The baby would come out fine and her cervix intact. After everything was all cleaned up and the baby was suckling on mom, she would give you that look with a slight smirk. And you would just accept it.
She was from the old country and the wrinkles on her hands and face were earned from working the land and raising her large family. Who was I, a spoon fed Westerner and childless at the time, to tell her not to push. She somehow seemed closer to her instincts than I could ever imagine being.
Luckily I was wrong. Birthing my own babies made me feel right there with the Hmong women, pushing with instinct.
Just a few words about guiding a woman during the second stage of labor…
Some midwives and obstetricians insist on controlling and guiding a woman’s pushing while other’s advocate waiting for a woman to push on her own when she has an urge?
I think this is a very personal issue for both provider and client.
Some baby deliverers insist on play by play instruction which can even include counting to 10 three times during a contraction and having the woman hold her push for that time.
Other healthcare providers employ a hands-off approach and just let the woman do what comes au naturale.
I have helped women get through the second stage of labor both ways or even used a combination of both.
Ideally, it is great to discuss this all before the pain of labor sets in. This is not always possible – especially if the person who ends up being with you is one of many you have met during prenatal visits.
The best thing you can do is figure out who you are and what may help you during one of the most intense and amazing times of your life. Then discuss that with all the potential people who may be with you when you have your baby.
Photo of Hmong woman and child courtesy of Travel Sapa.
Category: INSPIRED ACTION, Pregnancy
About the Author (Author Profile)
Deepa is an Indian born, US raised and US trained nurse and midwife. She met her Irish husband in Afghanistan while volunteering as a midwife with MSF (Medecins Sans Frontieres = Doctors without Borders). She and her family (husband and 2 young daughters) recently moved to the Comox Valley from the west coast of Scotland.Subscribe
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The best advice I received for pushing was from a doula instructor. She told everyone that fear is natural, and your instinct might be to fight the pain and tense up when it is time to push. She said: “If you can surrender to the pain and know that your body is doing the right thing, you can relax into your pushing and it will go much easier.” During my second birth, everytime I felt myself start to tense up, I would remember this and say to myself “surrender”. My second birth was much easier (about 1/2 hour of uncoached pushing) compared to my first (3 hours of coached pushing).
Great article, Deepa! Such a huge subject; each of us have our own stories.
The best advice that I received from my midwife was to push down, not out. My own experiences taught me to be in the moment, totally and completely, and to trust my instincts. Very similar to Stacey.
Great article, Deepa! Such a huge subject; each of us have our own stories.
The best advice that I received from my midwife was to push down, not out. My own experiences taught me to be in the moment, totally and completely, and to trust my instincts. Very similar to Stacey.
The song in my head at pushing time was “Drop it like it’s hot” by Snoop Dog!
Hi Deepa! I haven’t heard from you forever- hope all is well. Do I have the right e mail address?
I am a Hmong woman. I grew up in Metro Detroit but lived in the Twin Cities for 3 years a while back. I had a natural home birth and followed my gut to push my 8lbs 8oz baby boy in March 2010. He was on the heavy side for Hmong babies which average about 5 or 6lbs. I think it’s neat that you wrote about your experience with the Hmong women in Minneapolis. I am contemplating becoming a future doula/midwife but don’t know how well this will work since I’m not familiar with other Hmong Doulas/Midwives or even if the Hmong community will be open to such a thing. Besides that, my 2nd stage of Labor, after he crowned, I pushed him out in less than 15 mins, screaming then letting my body do the pushing while holding my breath for as long as I could so my body could push him as much as possible. If I can do that, I can do anything. =)