Vaginal Delivery and Pushing Your Baby Out

Most expectant mothers spend a great deal of time during the 40 weeks of pregnancy thinking ahead to the actual delivery. The most common method of delivery is, of course, a vaginal delivery.

Most likely, you’ll experience what doctors call a spontaneous vaginal delivery, which means that it occurs as a result of your pushing efforts and proceeds without a great deal of intervention.

Credit: Kathryn Born, MA

If you do need a little help, it may come in the form of forceps or a vacuum extractor. A delivery requiring the use of one of these tools to help pull the baby out is called an operative vaginal delivery.

During the first stage of labor, your cervix dilates and your membranes rupture. When your cervix is fully dilated (open to 10 centimeters), you reach the end of the first stage of labor and are ready to enter the second stage, in which you push your baby through the birth canal (vagina) and actually deliver the baby.

At the end of the first stage, you may feel an overwhelming sensation of pressure on your rectum. You may feel as if you need to have a bowel movement. This sensation is likely to be greatest during contractions. Your baby’s head descending in the birth canal and putting pressure on neighboring internal organs is causing this sensation.

If you have an epidural (a type of regional anesthesia used to take away the pain of labor), you may not feel this pressure, or the feeling may be less intense. If you do feel it, let your nurse or practitioner know because it’s probably a sign that your cervix is getting close to being fully dilated and that it may be time for you to push.

Your nurse or doctor performs an internal exam to confirm that your cervix is fully dilated. If it is, she tells you to start pushing.

Whether your nurse, doctor, or midwife is actually coaching you during pushing varies from hospital to hospital and from practitioner to practitioner. The important factor is that someone is with you to help you through this stage of labor.

Occasionally, you may be fully dilated when the fetal head is still relatively high up in the pelvis. In this case, your practitioner may want you to wait until the contractions cause the head to descend more before you start to push.

Pushing generally takes 30 to 90 minutes (though sometimes it takes as long as three hours), depending on the baby’s position and size, whether you have an epidural, and whether you’ve had children before. (If this isn’t your first delivery, your cervix may begin to dilate weeks before your due date, and, after you’re fully dilated, you may push only once or twice to deliver!)

Your nurse or practitioner gives you specific instructions on how to push. While you’re pushing, your baby moves farther along its downward course.

Women often begin pushing as soon as the baby’s head has descended into the pelvis. How long you push depends on how far down the head is when you start pushing, and how efficient you are at it. Sometimes it takes a while to get the hang of it.

After you deliver the head, your doctor may tell you to stop pushing, so that she can suction some fluid out of the baby’s mouth, and also feel to see if the umbilical cord is around the baby’s neck. After that, you’ll push one or two more times to deliver the rest of the baby.

You have several possible positions in which to push. Here are three that can help:

Credit: Kathryn Born, MA

• Lithotomy position: In this position, which is the most common, you lean back and pull your flexed knees to your chest. At the same time, you bend your neck and try to touch your chin to your chest. The idea is to get your body to form a C. The position isn’t the most flattering, but it does help to align the uterus and pelvis in a position that makes delivery relatively easy.

• Squatting position: An advantage of squatting is that you have gravity working with you. A disadvantage is that you may be too tired to hold the position for very long, and any monitoring equipment or an intravenous line you may have can be cumbersome.

• Knee-chest position: The knee-chest position is one in which you push while on all fours. This position is sometimes helpful if the baby’s head is rotated in the birth canal in such a way that makes pushing the baby out in the lithotomy or squatting position difficult. The knee-chest position may be awkward for some women and difficult to stay in for very long.

Finding the one position that feels and works best for you may take a bit of experimentation. If you find that you’re not making progress, try changing positions.

When you start to feel a contraction, your nurse or doctor usually tells you to take a deep, cleansing breath. After that, you inhale deeply again, hold in the air, and push like crazy. Focus the push toward your rectum and perineum (the area between the vagina and the rectum), trying not to tense up the muscles of your vagina or rectum.

Push like you’re having a bowel movement. Don’t worry or be embarrassed if you pass stool while you’re pushing. (If it happens, a nurse quickly cleans the perineum.) It’s the rule rather than the exception, and all the people helping to take care of you have seen it many times before.

In fact, passing stool is a sign that you’re pushing correctly, so congratulate yourself. Trying to hold it in only impedes your efforts to push the baby out.

Hold each push for about ten seconds. Many nurses count to ten or ask your coach to count to ten to help you judge the time. After the count of ten, quickly release the breath you have been holding, take in another deep breath, and push again for another ten seconds, exactly as before. You usually push about three times with each contraction, depending on the length of the contraction.

Between contractions, try your best to relax and rest so that you can get ready for the next one. If it’s okay with your practitioner, your coach may give you some ice chips or pat your forehead with a damp, cool cloth.

After your baby gets far enough down the birth canal, the top of the head becomes visible during your pushing efforts. This first glimpse is called crowning because your practitioner can see the crown of the baby’s head. Some labor rooms have mirrors so that you, too, can see the head crowning, but many women have no desire to look. (Don’t feel bad or somehow inadequate if you don’t want to — you’re busy enough.)

After the contraction, the baby’s head may again disappear back up into the birth canal. This retraction is normal. With each push, the baby comes down a little farther and recedes a little less afterward.