Pushing
Excerpt from Chapter 23
pregnant woman

WHAT YOU NEED TO KNOW DURING THE PUSHING PHASE

The focus of this chapter is to give you the information you need to attend your partner during pushing. The pushing phase of labor is marked by shared intimacy between you and your partner. Excitement increases as the birth draws close.

Pushing actively engages your partner. She is more alert and responsive than she was during the late stages of active labor. You may

be surprised by the resolve and power your partner exhibits as she pushes. The pushing phase can be swift and straightforward, lasting only twenty to thirty minutes; or it can last three hours (or more) and be demanding and challenging.

TRANSITION LABOR: THE LAST STAGE OF ACTIVE LABOR

Immediately before your partner’s pushing phase begins, she will be in transition labor. This is the shortest and most intense phase, lasting fifteen to sixty minutes or more. During this phase, your partner’s body is working hard to finish the work of dilating the cervix so the baby can move out of the womb and into the birth canal.

As transition accelerates, contractions may be unbearable and continual. She may weep. She may vomit. She may fall asleep between contractions. She may doubt her ability to continue. She may demand drugs. She may think she is dying. She may be clueless she is making the last major incline of labor and soon will be pushing. She needs your rock-solid support and your full attention. You will likely be intensely involved with your partner during transition labor. It will require you to dig deep to offer her the best you have to help her through this period.

But depending on the woman and the labor, her transition labor may not look difficult. If she is on pain medication, it will not be as intense. Or, if she is not on medication, she may be in such an altered state and be so connected that she rides out the last phase with such a deep, inward focus, she transcends pain and is consciously in touch with an expanded reality and grace. Observe how intently your partner needs to focus and mentally note the pace and length of the contractions to help you determine whether she is in transition labor. Contractions may pace at about thirty-second intervals and last around ninety seconds to two minutes.

HOW TO TELL WHEN THE PUSHING PHASE OF LABOR BEGINS

At the end of transition, your partner feels pressure as the baby’s head begins to move toward and into the birth canal. She may begin grunting and pushing involuntarily at the peak of her contractions. When this happens, you will know that the pushing phase is almost beginning. She may feel a powerful, irrepressible urge to push. Or she may simply be aware that an energetic shift has occurred, which she may not initially interpret as pushing. She knows something is distinctly different, but she may have a few contractions before it rationally registers that her body is pushing. You may be the first one to realize your partner is pushing. Tell her.

If you are in the hospital and alone in the room as a couple, go to the nurse’s station to alert the staff that your partner has the urge to push. A medical attendant will do an internal exam to ensure the cervix is completely dilated. If she is completely dilated, the attendants will gather and give her the go-ahead to push. You will notice a difference in your partner’s demeanor. Many women become exhilarated when they realize it is time to push. They become more responsive, communicative, and aware of their surroundings.

Your partner needs to be completely effaced and dilated before she begins actively pushing. Occasionally, a thick edge (lip) of cervix needs to thin and slip aside. If that is the case, the practitioner will ask your partner to hold off on pushing. Unreserved pushing through a cervix that is not fully effaced and dilated may cause swelling that could interfere with the birth.

TAKE A BATHROOM TRIP

Now is the time to make a bathroom trip. If your partner is using drugs, consult with the staff before getting her up. Getting your partner up to use the bathroom before she begins pushing serves several purposes.

First, if there is a lip that needs to slip aside, sitting on the toilet and relaxing the pelvic floor to release urine may be all that is needed to promote the cervix to completely efface and dilate.

Second, having an empty bladder during the pushing phase is important to your partner’s bladder health. Your partner experiences tremendous pressure during the pushing phase. Increased pressure because of a full bladder adds unnecessary resistance, discomfort, and risk.

Third, sitting on the toilet utilizes gravity and may assist the baby to move into a more optimal position for descent through the birth canal. You tremendously assist your partner by taking her to the bathroom before she is fully engaged in pushing. If your partner has an epidural, the staff may catheterize her or assist her with the bedpan to relieve the bladder. Run the water in the bathroom if she uses the bedpan.

HOW TO HELP YOUR PARTNER AVOID PUSHING WHEN NECESSARY

If the medical attendant asks a mother to hold off on pushing during any part of the pushing phase, the mother can do so by simply keeping her breath flowing. However, for some women, the urge to push is strong and they need assistance to avoid pushing. If your partner is holding her breath or grunting, she is involuntarily using the breath and abdominal muscles to push.

To help your partner avoid pushing, encourage her to keep her mouth soft and make a haaaa sound with the exhalation. The haaaa sound keeps her jaw and throat open, which prevents her from closing off the vocal cords and using her strength to push. She can also slowly pant, sounding like this: Haa, haa, haa.

To further assist her, hold your finger several inches in front of her face to give her a focal point. Ask her to use a soft gaze to keep her body soft. Use a touch-and-say at the eye to help her relax. Your assistance to help her refrain from pushing when needed is important because her urge to push may be almost irrepressible.