The active phase of labor is complete when your cervix is open wide enough to accommodate the baby’s head (about ten centimeters, or four inches) or there is full or complete dilation. Around this time, you will likely feel a strong urge to begin pushing your baby out the final few inches. Often, after transition and just before you feel like pushing or bearing down, your contractions may space out or even stop for a while, allowing you to rest.
The contractions were coming hard, [but] I could actually sleep between them. It was all very surreal and otherworldly. Immense pain and then total relaxation. I felt like I was in a scene from “The Red Tent” [a novel set in biblical times; the title refers to a tent in which women gave birth]. I pushed from somewhere buried inside me. Deep, guttural, almost animal-like noises came from within me. Loud noises. Noises I soon had no control over. My body was pushing out my baby, and I was merely providing the soundtrack.
More rapid, intense contractions, a powerful opening-up feeling, and rectal pressure (a sense that you need to have a bowel movement) are signs that you are completely dilated and ready to push your baby down through your vagina and give birth. Pushing can be a great relief because it requires you to become an active participant, in contrast to the yielding and letting go necessary for inactive labor.
After a few pushes, I somehow realized that I had to change gears. Pushing was up to me. I wasn’t supposed to lie there and cope with it, counting and breathing and moaning until it was over. It time to be active, to decide when to push, when to breathe, when to rest.
Pushing your baby out works best when you do just what your body wants, without external direction. Bear down when you feel the urge— an innate reflex stimulated when your body produces high levels of oxytocin in response to pressure from your baby’s head low in your pelvis. In the past, women were taught to hold their breath and push during each contraction. Many providers may still tell you to hold your breath and push down as hard as you can for a count of ten. However, breath holding and sustained, directed bearing down can be exhausting and frequently do more harm than good. Studies of women in labor have shown that holding your breath can increase the chance of worrisome fetal heart rate patterns because your baby does not get as much oxygen when you push this way. With gentle support and positive feedback, you can follow your own urges and find a rhythm that feels right and moves your baby down. You or your labor support companions may need to tell your care providers not to direct you how and when to push.
When I was pushing, really pushing, I felt powerful. When I realized that I was in charge of pushing, and when I felt my contractions as guides to how often and for how long I should push, I started to reel in my mounting panic and to harness my energy.
Depending on the baby’s position, pushing can sometimes be very painful and very hard work. Change positions to relieve pressure points and to find positions that are more comfortable for you. Sometimes pushing while sitting on the toilet can be effective, as we are psychologically conditioned to relax our pelvic muscles there. Being upright (leaning, squatting, hanging from something or someone) may lessen pain and backache. Upright positions may also help align the baby in your pelvis better and open the pelvic bones a bit to give the baby more room, allowing her or him to navigate through the birth canal more easily.
It may take only a few pushes, or it may take a few hours of pushing, to birth your baby. As long as both you and your baby are doing fine and the baby is moving down, there’s no reason to limit this phase of labor.
Between pushes, breathe slowly and rest. You might even fall asleep for a few minutes. Remember that—just as in earlier phases of labor—your uterus works involuntarily to move the baby down and out. Work with it, and give it time. Your labor may not progress as quickly as you had imagined or as others around you expect.
When the pushing stage of labor is nearing its end, the baby moves under your pubic arch, and your perineum, the area between the vaginal opening and the rectum, stretches slowly to accommodate the head. Gentle guidance to push slowly and with short pushes at this stage, encouragement of favorable positions, and techniques such as touch, hot compresses, and warm oils applied to the perineum for comfort all work with this process and may prevent or minimize tearing. When you feel a burning sensation, breathe lightly so as not to push too rapidly and risk tearing. Reaching down to touch your baby’s head for the first time often produces an “Ahhhh” that opens you up even more.
A midwife who gave birth at home says:
I often tell women in labor that they will feel a second wind—a surge of energy—when it is time to push. I found that this didn’t really happen when I started pushing. But I definitely felt this when I started feeling the stretching and knew [my baby] would be born soon. It was like the only thing I needed to do in the world was push with all of my might. And that was true! It was the only thing I had to do. All the wonderful people supporting me were taking care of every single other thing. I pushed and the burning peaked, and then, all of a sudden, nothing. My baby’s head was out. It is truly amazing how quickly you can go from the most intense pain to no pain at all.
Within seconds of birth, babies make a remarkable transition from life in the womb, where all of their needs were met by the placenta, to life outside the womb, where they must regulate their own breathing, temperature, and digestion. These transitions happen most easily when the baby is placed on your chest for skin-to-skin contact with you, with the umbilical cord intact (not clamped immediately) and in an environment of peace and calmness. Sometimes hospital routines or medical complications make it difficult or impossible for the mother and baby to remain in such close contact right after birth. Babies can overcome these disruptions when they are medically necessary, but it is best to keep the mother and baby together barring extreme circumstances.
Some babies breathe as they are being born and look pink immediately. Others take a few moments to begin breathing, a process that unfolds as blood continues to flow through the umbilical cord. Gentle stimulation such as rubbing the baby’s back can also help a baby begin breathing in a regular, sustained way. Healthy babies are usually able to clear their own airways of fluid and mucus without suctioning. If there was meconium (the baby’s first bowel movement) in the amniotic fluid and the baby isn’t breathing immediately, she or he may need suctioning right after birth to prevent the meconium from getting into her or his lungs.
Not all newborns cry. Some do for a moment and then stop. Often they breathe, blink, and look around or cough, sneeze, and snuffle. Your baby’s head may appear oddly shaped, having been temporarily molded by coming through the birth canal. Her or his body may be covered with patches of vernix, a white, waxy substance that coats and protects the baby’s skin inside the uterus. All babies arrive wet with amniotic fluid.
Mothers and babies belong together during this precious time. When you feel ready, hold your baby naked against your belly and breasts, near the familiar sound of your heart, so that she or he can touch your skin and smell, hear, and see you. You and your new child need as much peace and quiet time together as you can create. In any setting, well-meaning providers and others can interrupt this important personal time because they want to know how you and your baby are doing. In a hospital, medical personnel may have their own schedules for evaluations. Providers can often unobtrusively examine your baby in your arms. It is usually not necessary to have tests done right away. If there is a medical reason to take your baby away from you for a short time, your partner or support person may accompany the baby.