Labor & Delivery

Introduction

The second stage of labor, where you push your baby through the birth canal, is a physically demanding process. The right position and technique can significantly impact your comfort and efficiency. This guide outlines effective positions, how to push, and what to expect during this critical phase of childbirth.

Optimal Position for Pushing

1. Bent Hips and Knees: Keep your hips and knees bent as much as possible.
2. Thighs and Legs Position: Move your thighs and legs away from the centerline of your body, with your feet slightly pointing outward.
3. Lifted Buttocks: Lift your buttocks off the bed to create more space in the pelvis.
4. Hand Support: Use your hands to maintain the above positions.
5. Chin Tucked: Tuck your chin to your chest, looking towards the front wall to help engage your core muscles effectively.

How to Push

1. Deep Breath and Hold: At the beginning of a contraction, take a deep breath, hold it, and tighten your abdominal muscles. This technique is known as “bearing down.”
2. Close Glottis: When the contraction starts, take a deep breath in, fill your lungs with as much air as possible, then hold it by closing your glottis (at the throat level).
3. Push Down: Strain and push downwards as if you are having a bowel movement, but with more intensity. Continue pushing for the duration of the contraction.
4. Rest and Breathe: Once the contraction ends, take deep breaths and relax until the next contraction.

Individual Techniques

• If not coached to breathe in a specific way, use your preferred and most effective technique. The American College of Obstetricians and Gynecologists (ACOG) recommends that women be encouraged to use whichever pushing technique they prefer and find most effective.

When to Start Pushing

• Immediate or Delayed: Once you are fully dilated, you can start pushing immediately or wait for the urge to push. Acting on the urge can be satisfying as you feel your baby moving down and out.
• Guidance: If you do not feel the urge to push, your healthcare team will guide you on when to start and support you through the process.

Duration of Pushing

The time it takes to push a baby out can vary greatly, ranging from 20 minutes to several hours:

• First-Time Moms: Pushing usually lasts longer, often over three hours. With an epidural, it may take up to four hours.
• Subsequent Deliveries: For women delivering their second (or later) baby, pushing may take up to two hours, or up to three hours with an epidural.

These durations are considered safe limits. Beyond these, labor may be classified as prolonged, potentially necessitating instrumental delivery or a cesarean section.

Message from Dr. Bushra Gul

Dear Patients,

The second stage of labor is a crucial phase where effective pushing can make a significant difference. Understanding the optimal positions and techniques can help you push more effectively and comfortably. Whether you choose to push immediately or wait for the urge, your healthcare team and I are here to guide and support you through the process.