Labor & Delivery

Introduction

Childbirth is a personal and unique experience for every woman. Understanding the different methods of pushing during labor can help you make informed decisions about your birthing plan. The two main methods are directed (coached) pushing and spontaneous (physiological) pushing. Each method has its own benefits and techniques. This guide will explain both approaches to help you decide which might be best for you.

Directed (Coached) Pushing

What is Directed Pushing?

Directed pushing involves following the guidance of a labor support person, such as a nurse or midwife. They will tell you when and how to push during contractions.

When Does It Start?

• Directed pushing usually starts when you are fully dilated to 10 centimeters, even if you don’t feel the urge to push.
• It’s particularly useful if you have an epidural, which can numb the sensation to push.

How to Do Directed Pushing

1. Instructions: Your support person will instruct you to take a deep breath at the start of a contraction.
2. Hold and Push: Hold the breath, tighten your abdominal muscles, and push down as hard as you can while they count to 10.
3. Repeat: After the first push, take a quick breath and push again for another count of 10. Aim for three pushes per contraction.
4. Rest: Rest between contractions. If you’re very tired, you can rest through a contraction occasionally.

Benefits of Directed Pushing

• Helps guide you, especially if you’re numb from an epidural.
• Can be useful in long labors to help progress.

Spontaneous (Physiological) Pushing

What is Spontaneous Pushing?

Spontaneous pushing is when you follow your body’s natural instincts to push, rather than being directed by someone else.

When Does It Start?

• You start pushing when you feel the natural urge, which can happen at different times during labor.
• This method respects your body’s own signals.

How to Do Spontaneous Pushing

1. Follow Your Urge: Push when you feel the urge, which might initially be brief and occur only at the peak of contractions.
2. Intensity and Frequency: As your baby moves down, you might push harder and more frequently.
3. Vocalization: It’s common to make noises like grunts or groans while pushing.
4. Natural Response: Let your contractions build before pushing, and push in shorter, more frequent bursts.

Benefits of Spontaneous Pushing

• Allows you to follow your body’s natural instincts.
• Often leads to a more comfortable and natural birthing process.

Crowning and Controlled Pushing

When your baby’s head becomes visible at the birth canal (crowning), your doctor may ask you to stop pushing to avoid tearing. To manage this:

• Use breathing exercises to control the urge to push.
• Relax your perineal muscles by leaning back.

Choosing the Best Method for You

• Directed Pushing: Offers structured guidance, helpful if you have an epidural or a long labor.
• Spontaneous Pushing: Respects your body’s natural cues, potentially more comfortable and effective.

Conclusion

Both directed and spontaneous pushing have their advantages. Directed pushing provides structured support and is beneficial if you have an epidural, while spontaneous pushing allows you to follow your natural instincts. Discuss these options with your healthcare provider to determine the best approach for your labor and delivery.

Message from Dr. Bushra Gul

Dear Patients,

Choosing how to push during labor is a personal decision that can greatly affect your birthing experience. Understanding the differences between directed and spontaneous pushing can help you make an informed choice that aligns with your preferences and needs. Please discuss these options with your healthcare team to create a plan that supports a safe and positive delivery.