Maternal pushing , during the second stage of delivery, is essential for the baby to be able to descend through the maternal pelvis and go outside. They are the force that the mother uses to push the baby through the birth canal.
It is a reflex action that usually coincides with the dilation of the cervix of 10 centimeters and the moment when the baby’s head fits into the maternal pelvis. These spontaneous pushes are the most effective and respectful for mother and baby.
But … how are they different from thrusts directed by the midwife? Are there different ways to push? Sara Cañamero, midwife and director of Maternatal answers all our questions.
When to push
At the moment when the baby’s head fits into the maternal pelvis, it presses on a specific place, which is what causes the need to push, which generally coincides with the contraction. In this way, both forces are united: that exerted by the mother with the abdomen and uterine contraction.
Although childbirth means patience and its duration must be respected, there are times when the mother does not feel the desire to push, as Sara Cañamero explains:
“A good epidural anesthesia should ensure that the woman does not feel pain but does notice the contractions . But it is not always achieved, so on many occasions the mother does not feel that need to push, does not know where to direct the push and does not even you can exert the force you need to help your baby be born. “
That is when the midwife or gynecologist should tell you when to push, so that the push matches the contractions: they are the directed push.
Health professionals tell women when to start and stop pushing, where to direct the force, and sometimes ask them to stop pushing. Sara Cañamero explains that:
“We can ask to stop pushing at the end of the delivery, when the baby’s head is crowning through the maternal vulva, and the perineum is so tight that it can tear if the mother keeps pushing so hard. So we try to eliminate the force of I push, letting only the force of contraction and gravity help the baby’s head pop out. “
How to push
But the direction of the push is also essential . As the midwife explains, the woman must direct her force towards the vagina, something that seems obvious but is not always done this way:
“Postpartum women continue to come for consultation saying that the midwife or gynecologist told them that they should ‘push as if they wanted to poop’. By exerting so much force towards the posterior perineum (towards the anus) we lose not only effectiveness, but we increase the risk of perineal injury “.
Contractions and the abdominal press are the ‘motor of labor’, helping the baby to come out.
These pushes will be more effective, and therefore will achieve a shorter labor, if they coincide with the contraction and with the mother positioned vertically, the most physiological position.
Two types of pushes
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Push on expiration or exhalation (open glottis). An inspiration is taken and, after finishing it, the air is slowly released while the transverse muscle is activated (something like hugging the baby with the abdomen), and the force is directed towards the vagina.
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Pushing in apnea (closed glottis). An inspiration is made and, after finishing it, the air is kept inside the lungs, it is not released. And there, in apnea (without breathing), he pushes himself. According to Sara Cañamero “it is similar to doing a classic abdominal, bringing the chin to the chest to keep the glottis closed and activating the rectums”.
In the last weeks of gestation you can practice pushing, to have confidence on the day of delivery, to train the abdominal muscles and know how to perform them correctly. The expert explains that:
“They are usually worked on in maternal preparation classes with the midwife, although they can also be practiced privately in consultation. Sometimes we use intravaginal devices that inflate like a balloon and resemble the baby’s head.”
Poor pushing in labor has consequences
Sara Cañamero points out that:
“The more pressure on the pelvis, the more time pushing and in a less physiological way (with directed pushes that do not coincide with the contractions), the greater possibility the mother has of suffering pelvic floor injuries.”
Because although the objective of the directed and spontaneous pushing is the same, the scientific evidence points out that “carrying out the former in a systematic way alters the physiology of childbirth, by increasing the probability of sanitary intervention with episiotomies and instrumental”.
This poses a risk to the perineum of women, and can cause injuries that result in urinary incontinence, gas, pain in the perineum, coitalgia, prolapses, and other dysfunctions.
In summary: as pushing is a reflex action, the mother must be allowed to live the birth naturally. Allow it to move freely and adopt the posture that the body requires. “This translates into less suffering for the baby and fewer injuries for the mother,” concludes midwife Sara Cañamero.
Photos | iStock
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