When to Start Pushing in Labour?

Labour is a journey that requires strength, patience and anticipation. As expectant mothers approach the final stages of childbirth, a pivotal question arises. At what point should I start pushing? This is not always a straightforward answer, because it depends on many factors, including medical advice, comfort and the baby’s positioning. Recent studies have explored this question and provided insights that challenge conventional practices. They also provide clarity to expectant mothers. When to Start Pushing in Labour?

Understanding the Second Stage of Labour: When to Start Pushing in Labour

Labour is a unique experience. Some people can finish their work in just a few hours. A long work may be a test of both physical and mental stamina for others.

It is impossible to predict how childbirth and labour will go until they happen. You can prepare yourself by knowing what to expect during childbirth and labour.

Stage 1: Early Labor and Active Labor

When you start to feel contractions, it is the first stage. As time passes, these contractions get stronger and more frequent. The cervix opens up as a result. Dilation is the term used for this. These contractions also shorten, soften and thin out the cervix. This process is known as effacement. This allows the baby to enter the birth canal.

It is divided into two phases: early labour and active labour. Early labour and active work are the two phases.

Early Labor

The cervix softens and opens during early labour (also called latent labour). The cervix also becomes shorter and thinner. Early labour is characterised by a cervix opening of less than six centimetres. The contractions are usually mild and may not occur consistently.

You may notice a pinkish or slightly bloody discharge coming from your vagina as the cervix opens. This is likely the mucus plug that blocks the cervical opening in pregnancy.

The length of early labour: It is not predictable. It can stop and start. The average duration can range from a few hours to a couple of days. People who have already had children tend to experience a shorter recovery.

Stage 2: Birth of your baby

It’s time! Your baby is delivered during the second phase of labour.

Duration: Pushing your baby can last anywhere from a couple of minutes to several hours. People who are new to motherhood and have epidurals usually need more time to push than those who already have a child or do not have one.

What to do: Press! You may be told to push by your healthcare provider when you feel the urge to do so. You might also be told to push if you feel a strong urge to.

You can experiment with different positions to find the one that feels most comfortable. You can push while sitting, squatting or kneeling, even on your hands. You can ask a member of your healthcare staff to check your progress while pushing. This will let you know whether your efforts are effective.

You may be asked at some point to push less forcefully — or even not at all. Slowing down allows your vaginal tissue to stretch instead of tear. You can stay motivated by asking if you can feel the baby’s head between your knees or look at it in the mirror.

The shoulders will follow shortly after the head. Soon, the rest of your baby’s body will follow. If necessary, the baby’s airway will be cleared. Your healthcare professional might wait for a few seconds or minutes to cut the umbilical cord if there are no health concerns during the delivery. The umbilical cord can be clamped and cut after the delivery. This increases the amount of blood rich in nutrients that flows from the cord to the baby. The baby’s iron reserves will increase, and the risk of anemia is reduced. This is good for healthy growth and development.

Stage 3: Delivery of the placenta

You’ll probably feel great relief after your baby is delivered. You may hold your baby in your arms or even on your stomach. Enjoy the moment. There’s still more to do. You deliver the placenta during the third stage.

Duration: Typically, the placenta is delivered in 30 minutes.

What You Can Do: Relax. Your focus is likely to have shifted by now. It’s possible that you are not paying attention to the world around you. You can try to breastfeed your baby if you like.

After delivery, milder contractions with a close interval between them continue. The contractions are what help move the placenta through the birth canal. Push gently once more to deliver the placenta. Before or after delivery of the placenta, you may be given medication to promote uterine contractions. This will minimise bleeding.

The placenta is examined by your healthcare professional to ensure it is intact. To prevent infection and bleeding, any placenta pieces that remain in the uterus must be removed. Ask to see the placenta if you are interested.

Your uterus will continue to shrink after you have delivered the placenta to return to its normal size. Your healthcare team member may massage your stomach. This will help the uterus to contract and reduce bleeding. You will be asked by your healthcare professional if you require repair of any tears in the vaginal area. You will receive a local anesthetic injection if you did not have an epidural.

The debate: Immediate or Delayed Pushing? Delayed Pushing

In a significant study, published in the Journal of the American Medical Association, over 2,400 mothers who were first-time moms were randomly assigned to push immediately or delay pushing once they reached full cervical dilation. The results were fascinating:

• Rates of spontaneous vaginal delivery There was no difference between the groups that were pushed immediately (85.9%), and those that were pushed later (86.5%).

• Duration for Second Stage: The group that pushed immediately had a shorter average duration (102,4 minutes) than the group that pushed later (134,2 minutes).

• Active pushing time: It is interesting to note that the immediate group actively pushed for more time (83.7 minutes) compared to the delayed group (74.5).

• Postpartum Results: The immediate push group had lower rates of chorioamnionitis (6.6 vs. 9.1) and postpartum bleeding (2.3% vs. 4.0%).

These results suggest that pushing immediately may result in a shorter labour period and fewer complications, without compromising the delivery outcome.

The decision to push or not?

The study is valuable, but it’s important to remember that every labour experience will be different. Many factors can affect the decision to push.

• Urge to Push Some women may feel an overwhelming urge once they are fully dilated. Others, however, might not.

• Medical Advice: Health care providers may advise waiting for the baby to be in the best position or to allow the mother to rest.

• Epidural Analgesia: Women who receive epidurals may have less urge to push. This could lead to a delayed push.

• Baby Position: The position of the baby in the birth canal will affect timing and ease.

To make an informed choice, it’s important for expecting mothers to talk to their healthcare provider about these factors.

The Role of Healthcare Providers

Obstetricians and midwives play an important role in helping women navigate the second phase of labour. They are responsible for:

• Monitoring Progress: Assessing cervical dilation and the position of the baby.

• Support: Offer encouragement and physical assistance during pushing.

• Making recommendations: Advice on the best time to push based on circumstances.

To ensure a safe and positive birthing experience, expectant mothers must communicate with their healthcare team.

Experiences of Expectant Mothers

Consider the personal experiences of two pregnant mothers.

• Sophia’s Story: “I felt a strong urge to push once I was fully dilatation.” My midwife encouraged me to start immediately, and the birth was quick and easy.

• Olivia’s Experience: “My doctor recommended waiting a little after full dilation to allow the child to descend more. I knew it would be a difficult decision, but in the end, we felt that this was the best choice for us.

These stories emphasise the importance of personalised care and encourage expectant mothers and their providers to work together and trust their instincts.

Empowering expectant mothers

There is no one answer to the question of how long you should wait before pushing in labour. Recent studies have shown that pushing immediately may be beneficial in some situations. However, each woman should consider her unique circumstances and preferences. Expectant mothers who engage in an open dialogue with their healthcare providers and stay informed can make decisions aligned with their values, ensuring the best outcomes for them and their baby.