I was taught purple pushing as a nurse. That’s what they call the way the pushing stage is done in the hospital. The woman is on her back with her legs being held up. She holds her breathe and pushes while the familiar cheers of “push” ring out while someone else counts to 10. This is repeated two more times before the woman rests. Often times a woman would look up at me with either anger or desperation and say, “I AM pushing”. I could tell the cheer-leading was causing her grief and worry, as if we were telling her that even her hardest pushes were not good enough. Often, people in the room were at a loss on how to support her, and the woman was scared and confused.
We now know that this kind of pushing actually causes more harm, but thankfully more medical professionals are becoming familiar with spontaneous pushing and allowing women to follow their own instincts in regards to pushing. Even so, a large number of women who choose this option are not supported as well as they should be due to lack of knowledge about labor support techniques. No matter which technique a woman is using to push, there are a few simple, yet effective support measures a doula can take to help during this time.
Creating a comfortable environment
The environment in which women gives birth can have an impact on how safe a woman feels and the amount of interventions used. As a doula, you can help create an environment that will promote normal labor. Three areas you can look at are how homelike the environment feels, the amount of control a woman has over her space, and privacy.
Hospitals were originally designed to facilitate quick use of interventions and ease of access for the medical personal, thus some changes may need to be made. One of the easiest is the lighting and temperature in the room. Both of these can be adjusted to suit the mother’s desires and needs. Interruptions can also be minimized. Working with the medical staff, a doula can help keep the room quiet, with few visitors or disturbances. The surroundings can also be adjusted to support movement. Beds and chairs can be moved, tools such as birth balls and stools can be brought in, and technology hidden if desired.
Different positions can help aid in decent as well as provide comfort. Upright postures appear to provide the best outcomes during pushing. Not only do they allow gravity to assist in bringing the baby down, but some kneeling and squatting also allow more space for the baby to move in. Other positions that may provide more comfort is one leg brought up in a lunge position or sitting up in bed. Birth stools can also be used for a woman to sit on while pushing. Following the woman’s cues will aid in knowing what positions to try. If women are needing to move, do so slowly and carefully.
Labor during the pushing stage can be intense and different from the rest of labor, and this can cause a lot of anxiety and fear at this time. Maintaining eye contact may help the mother feel more grounded, and explaining what is normal to feel may help ease those fears. You can also communicate any observations and as always, offer praise and encouragement.
Help the Woman Feel Empowered and Respond to Her Own Cues
If at all possible, you should avoid asking about the urge to push. This may interfere with the mother’s own instinctive behavior. Instead just allow the process to unfold and give encouragement if the urge to push is felt. There is also no need to disturb the breathing and pattern that the birthing woman sets for herself. Once a baby is low enough in the birth canal, a woman is unable to control the urge to push. Telling her to not push can lead to the assumption that she does not know how to birth, or that there is something wrong. Instead, you can assure her that she is doing great and that her body knows exactly how to birth her baby. If the doctor or midwife feel like it is too early to push, you may have to use some instruction, but you can help her by letting her know that she can breathe with her contractions until she has to push, and then just push with the least force possible. Again, let her know that her body isn’t failing or doing something wrong.
Additional Information You May Be Interested In:
- Handout: Action steps for second stage labor
- E-book: Rethinking the stages of labor
- Blog: How a doula helps during a c-section
Aasheim V, Nilsen ABV, Lukasse M et al (2011). ‘Perineal techniques during the second stage of labour for reducing perineal trauma’. Coch Data Sys Rev, 12: CD006672. DOI: 10.1002/14651858.CD006672.pub2.
Borrelli SE, Locatelli A and Nespoli A (2013). ‘Early pushing urge in labour and midwifery practice: a prospective observational study at an Italian maternity hospital’. Midwif, 29(8): 871-875.
Downe S, Trent Midwives Research Group, Young C et al (2008). ‘The early pushing urge: practice and discourse’. In: Downe S (ed.). Normal childbirth: evidence and debate, 2nd edition. London: Churchill Livingstone: Elsevier.
Gupta, J. K., G. J. Hofmeyr, et al. (2012). “Position in the second stage of labour for women without epidural anaesthesia.” Cochrane Database Syst Rev 5: CD002006.
Jenkinson, Bec, Josey, Natalie, Krusk, Sue. (2014). BirthSpace:An evidence-based guide to birth environment design. Brisbane: Queesland Centre for Mothers and Babies.
NICE (2014). Intrapartum care: care of healthy women and their babies during childbirth. NICE clinical guideline 190, London: NICE.
Reed, R. (2015). Supporting women’s instinctive pushing behaviour during birth. Retrieved online: https://midwifethinking.com/2015/09/09/supporting-womens-instinctive-pushing-behaviour-during-birth/