This is one of the most common questions I get.

I will say that most un-medicated moms don’t end up needing any guidance with this.  Especially if it is not their first baby.  Their bodies just take over and do it!

• Kind of like sneezing – it is really hard NOT to sneeze.
• It is really hard NOT to push!

Here is a compilation of posts to help answer the question of How to Push!

Breathing Your Baby Out VS Purple Pushing

Great post with pictures showing different pushing positions.

Is Mother Directed Pushing possible in the Hospital?   YES, I have video to prove it.

This is a great post on OP babies.  I love how this midwife takes a fairly neutral position on this position.    She explains how it works and some tips on how to deal with it.  I especially loved this:

• Reinforce the woman’s trust in her body and baby to birth.
• Discuss the possibility that her labour may be different (not better or worse) and might not fit general expectations about labour patterns/progress.

Hormones released in men during and after birth help them become better fathers!

Wonderful Pushing Link, this is also from the same Midwife’s blog with the OP post above.  I just found her blog and have enjoyed catching up on all her posts.

The F-Word and Natural Childbirth - no, not THAT f word.

Finally – Creating your Birth Circle was a nice post about choosing carefully those who join you during your birth time!  It fits nicely with my guest post on Three Types of Care Providers

Here is a great pushing idea from Juju Sundin’s Birth Skills: Proven Pain-Management Techniques for Your Labour and Birth

In the book, the author talks about imagining a coffee plunger, and that you are pushing down from your diaphragm/ chest with your breath. She says to make sure you are not pushing with your neck or your face.

Pushing seems to be something moms have lots of questions about.

I love this post on Science and Sensibility’s Blog - It has posts from many different birth bloggers about pushing.

Have your questions answered here!

I love Lamaze’s 5th Healthy Birth Practice: Avoid giving birth on your back and follow your body’s urges to push.

Polly is having a wonderful un-medicated hospital birth – things have progressed quickly and the staff has been supportive about her birth preferences.   It has been a calm and peaceful un-medicated birth.

She starts having an urge to push and the nurses check her to confirm she is 10 cm and then call her OB, who is about 15 minutes away.

The feeling in the room has changed.

“Don’t push!” The nurse keeps barking at her as she bustles around getting the room set up.

Polly struggles not to push.

“Don’t push!” the nurse orders as more people fill the room, including an on staff OB.

Polly can’t help but push.

“Don’t push!” the nurse chastises her as she gets the mom into the stranded beetle position.

Oops, I meant something like this -

Polly’s OB arrives.  Now there is a new urgency in the room.

“PUSH! 2,3,4,5,6,7,8,9,10″

Polly starts pushing at their command.

“Push again!”

Polly tries to rest and she is chastised again, “Keep going, one more push!”

“PUSH 2,3,4,5,6,7,8,9,10″

It is as if now that the OB is here it is a huge rush to get the baby out.

Polly keeps following orders and after X minutes her baby is born.

This is so frustrating to see when it happens to my doula clients.  (there is one hospital in my area that is very supportive of mother directed pushing, but at the other hospitals it is an uphill battle).

I teach about Mother Directed Pushing (MDP)  in my Hypnobabies class and I try to help make it happen at births I attend by telling the nurses way before pushing - “Mom wants to push in hands and knees position (or whatever mom wants) – I also remind her she wants to do mother directed pushing.    But somehow when the pushing stage begins, most care providers fall back into their “normal routine” and it takes a lot of work to get them out of that routine.

I try to balance what the nurses are barking at my client with “Follow your body, you are doing great!”  and remind care givers mom is doing MDP.  But the mom has to choose who to listen to.  (These are in situations where mom and baby are doing well.  If there is a problem with the baby then certainly I would let the nurses take charge… I always check, “Is baby doing ok?” )

So YES it is possible, but it takes preparation and support to make it happen. I made this video showing 2 hospital births where it did and give tips for mom, birth partner and doula as to how to help make it happen for you!  I would love nurses to watch it too and give feedback.

Is it possible to do Mother Directed Pushing with an Epidural? Yes!  I have seen it done with moms who can feel what is going on.  Here is an amazing video of a mom doing so!

So here is a set of tips to help make MDP happen.

• Talk to your care provider during pregnancy to see if they are open to different pushing positions and MDP.
• Tell your nurse before pushing starts you want to use different pushing positions and MDP.
• As pushing phase begins, quickly get into alternative pushing position (once you get in the stranded beetle position, it is hard to get out.)   Having a supportive nurse or doula can help so much with this!
• Follow your body and push when you feel the urge.    If you don’t have a strong overwhelming urge to push, you may want to start by breathing the baby down and out, or change to a new more upright position.
• If the care providers are coaching you, remind them you are doing MDP and ask them to stop.

Pushing…
 
By “breathing baby down”, we mean that moms are breathing, “aaaahhhhhh” to open their throats, because we know that if their throats are open and relaxed so are their bottoms. Through a process called peristalsis, our ‘gut’ which is one continuous tube, ‘communicates’ from one end (the mouth) all the way down through the digestive tract to the other end (the rectum). Whatever is going on in mom’s face, is being mimicked by her bottom. So, when mom is ‘breathing her baby down’, she is relaxing her jaw, her throat is open, and she is relaxing and allowing her birthing muscles to bring her baby down through the birth canal slowly, and gradually. This is so the birth canal can unfold accordion-style, and open gently, and so that baby’s head can also mold to fit the pelvis slowly and gently. Baby is propelled by the force of the pressure waves, down a little, down a little more, and even a little more each pressure wave, and then baby slips back a bit when the pressure wave ends, in a gradual, “two-steps down, and one-step back fashion”.
 
Mom breathes and relaxes and allows her body and her baby to do all the pushing in the beginning. She allows her body to do what it already knows how to do, inhaling relaxation, and then exhaling and saying “peace” while powerful anesthesia automatically flows down and out ahead of her baby to exactly where she needs it in her bottom. This is similar to what women who have epidurals experience, and the hospital staff calls it ‘laboring down’. Those moms typically don’t push at all until baby is on the perineum.
 
Then, when baby’s head is so deep in the pelvis that it is pressing on the nerve endings in mom’s rectum, it will trigger a powerful, automatic bearing-down response. When this urge to push becomes strong enough that mom just HAS TO PUSH, her body will involuntarily push…POWERFULLY. And, she’ll begin to want to help that process by bearing down just a little at the peaks of some of the pressure waves. Then gradually that urge to push becomes longer and stronger until mom has an overwhelming urge to push throughout the entire pressure wave, each and every time. And, she will push because her body is guiding her to do so. She can be encouraged at this time, and guided by her doula or caregivers if she’s not being ‘effective’ in her efforts.
 
Because I seldom see a mom be ‘quiet’ all through second stage and only relax and breathe her baby all the way to born…especially first timers. I tell birth partners that mom might begin to make powerful bearing-down sounds, similar to the sounds a martial arts expert makes as they execute a forceful karate chop! The power that she releases as she bears down, as she keeps her throat open enough for sounds to escape, can be quite loud, and sometimes startling to those around the mom if they misinterpret them as discomfort rather than a release of power. This is especially true since most caregivers are used to seeing moms with epidurals who don’t make any sound at all, and it can be unnerving to them. But, you’ll know that those sounds are power and most moms who vocalize as they push report that “it didn’t hurt, it simply felt good to make those sounds”.
Carole
Yours in gentle, natural birthings…
521 sweet babies births attended!
Carole Thorpe, VP Hypnobabies
Hypnotherapist (NGH), Hypnobabies Birth Assistant
Hypnobabies Childbirth Hypnosis Instructor
Lactation Educator/Counselor (UCSD)
CPR for the Professional Rescuer (Red Cross)
Neonatal Resuscitation (AAP & AHA)
Homeopathy Consultant, Reiki Healing Touch 
Happiest Baby on the Block Instructor
BIRTH PARTNER SERVICES
www.hypnosis4birth.com

I need to write a whole blog post about my pushing. When I was birthing Bryson and my husband was filming it, I never though it would end up on You Tube! My DH didn’t want the whole thing out there, so I cut that out of the You Tube version.  I do show the whole video to my Hypnobabies students. 

I was calm during pushing. Between pushes it looks like I sleep a little. At first I was breathing him out.  The OB says, “No, now you need to push.”  I say, “I am pushing, I am breathing him out.”  I did that for about 4 minutes or so.   Then there were about 2 pushes where I “yelled him out” I felt like a powerful lion roaring. It just felt right to do that and I was listening to my body.  It felt really cool, I liked that part. 

I was comfortable while pushing. I remember the OB saying “Now you are going to feel the ring of fire” and I remember thinking, “I haven’t felt any pain yet, why should I now?” and I bounced her comment right off my bubble of peace. And I felt only stretching, no pain. 

The last push, the nurse had said, “If you hold your breath and really push, you can get him out with this next push.”  I didn’t really want to do that, but I worried maybe there was a problem, so I did.  I held my breath and pushed his head out with the next push.  Then they suctioned his mouth and nose out.  The cord was around his neck 3 times.  The OB tried to unloop it, but it wouldn’t unloop.   She had me push again and I pushed really hard and his shoulders came out.  You can see her unlooping the cord, by moving his body in 3 circles.  Then he went right up onto my chest. 

I think this is where the video resumes. 

Overall I loved pushing Bryson out.  I wish the nurse hadn’t said anything about holding my breath.  I was doing fine, pushed for less than 10 minutes and I did tear at the end.  I wonder if I had been able to push my own speed the last few pushes, if that would have helped prevent my tear or at least lessen it.

But, it was great.  I always tell my dads during class.  If mom makes noise during birth, that is great.  If mom has been quiet and then is making noise during pushing, that is fine.  It doesn’t mean she is in pain.  They are working sounds, powerful sounds!  So I wasn’t silent during pushing, I yelled a bit.  But I was comfortable and powerful!

This birth story exemplifies how a good birth can change and become stressful during the pushing stage, if care providers insist on purple pushing.  Mother directed pushing is much gentler and frankly most un-medicated moms do not need any direction in how to push.  Their bodies know what to do!  We need to get out of their way and let them do what feels right.

What is Mother Directed Pushing?

If the mom is ok and baby is ok, there isn’t a rush to get the baby out.  Letting the mother push in a way that feels right for her is better for her and the baby.  Some moms AHHHH or grunt the baby out.  Some moms sing the baby out.  Some might hold their breath and push on their own, but usually not for the duration that they are coached during “purple pushing” 

I have seen moms told to “WAIT, don’t push” when the OB isn’t there yet.  Waiting for up to 20 minutes fighting that urge to push.  Then the OB gets there and suddenly the atmosphere changes.  “PUSH, PUSH, PUSH!”  After patiently waiting for the OB to arrive, suddenly we are on the clock and everyone is in a hurry to get the baby out.  I understand that the OBs may have other patients waiting or other pressing needs.  But respect the mom and baby. 

I try to remind moms to push how they want.  But it is hard when everyone is yelling at you.  Sometimes moms get worried that something is wrong and that fear doesn’t help. Also moms are very suggestible while in their birthing time.  Even if someone isn’t yelling.  I remember when I was pushing Bryson out, the nurse said to me “If you hold your breath and push really hard, he will come out with your next push.”  I then worried that he needed to get out on the next push and I did what she said.  I had been doing it my own way and had been pushing less than 10 minutes.  I did tear and I wonder if I had been able to keep pushing my own way, if that would have been better. 

Talk to your OB about pushing in a mother directed fashion.  Add it to your birth plan, have your birth partner remind the nurse and the care provider before you start pushing.  If they are yelling at you, ask, “Is Mom Ok? Is Baby OK?”  If the answer is yes, “Stop Yelling” is a fine response!