Labor & Delivery Considerations: Preparing for delivery
What is the second stage of labor and what would be helpful to consider when the pushing begins?
The final stretch! You have finally reached the stage of active labor where you can start pushing and you are that much closer to meeting your sweet baby. Consider the following tips on posture and positioning and breathing patterns during the second stage of labor. If you haven’t already, check out part one of this blog to learn about helpful considerations for the first stage of labor. At Materra Method, we strive to support and empower you in any way we can, labor and delivery included!
The second stage of labor is the pushing. So, you have progressed through the entire first stage of labor and you are finally ready to begin pushing, now what? It is important to note that the pushing can often take longer than anticipated, especially for first-time birthers. The average push time for a first-time birther can range from 1-4 hours. Multiple factors can impact this length of time including tolerance by the mother and baby, epidural versus no epidural, posture and positioning, and more. That is why it can be very beneficial to have this knowledge with the goal of reducing the push time and improving mother and baby outcomes.
The following considerations are specifically related to the second stage of labor, the pushing. These are key tips are recommended by Dr. Colleen Lind, our Specialized Pelvic Floor Physical Therapist at Materra Method.
Four Considerations During the Second Stage of Labor
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Some of the key principles to consider as you begin to push are:
Your uterus is going to be the primary pusher, your pelvic floor needs to lengthen and get out of the way. Focus on not only relaxing, but also lengthening the pelvic floor during this stage - this is where working with a specialized pelvic floor physical therapist prior to labor and delivery can be SO beneficial!
Request a warm compress on your perineum, which can lower the risk of an episiotomy and severe perineal trauma and tearing.
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One important consideration is how you should position your back and pelvis during the pushing stage of labor. The bottom of the pelvis is the last structure that your baby needs to engage as you are pushing. In order to open the bottom of the pelvis during this second stage, you want the knees turned in and the ankles out and an extended (arched) low back.
Potential pushing positions include: lying on your back (most common), deep squat, hands and knees, or side-lying. See additional information on epidural considerations below.
KEY TIP: if you push on your back, use a towel roll under your sacrum to offload your tailbone (this can reduce the risk of tailbone injury and/or postpartum tailbone pain) and let your legs come in slightly to take tension off the perineum.
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Do what is most comfortable for YOU. There is no ONE right way.
Remember, the primary goal is to relax and lengthen the pelvic floor, which can be accomplished with an audible, strong exhale for a 6-8 second count. This technique is more beneficial for the pelvic floor compared to a sustained 10-second breath hold, which is the most commonly cued technique by birth workers.
If it does feel best and most effective to hold your breath (which is perfectly fine and completely normal), hold for a 5-7 second count and then forcefully exhale for the remainder of that push. This is less stress on the pelvic floor compared to a full 10-second hold.
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Just like the first stage of labor, unclench your jaw! Your pelvic floor and jaw are highly connected, so when we clench one, we often clench the other. And remember, a relaxed and lengthened pelvic floor is the goal while pushing.
Pushing Breaths
Imagine (and actually practice before you are in labor) blowing up a balloon! This is similar to the audible, strong exhale you want to utilize while you push. Exhaling while pushing reduces the stress on the pelvic floor compared to a breath-holding technique.
Towel Trick
If you choose to push on your back (a lot of birthers prefer this), try this simple towel trick! The sacrum and tailbone are made to move and give during labor and delivery as your baby moves down and out. While lying on your back on the bed, your sacrum and tailbone get pinned against the bed and cannot move as they should. Using a towel roll positioned like this removes this pressure and allows for proper opening and movement. This can reduce the risk of injury and experiencing postpartum tailbone pain.
Posture and Positioning for the Second Stage of Labor
The following are positions that can be considered for the second stage of labor, while you push. These positions allow for the necessary opening and movement of the pelvis, sacrum, and tailbone while your baby’s head descends down and out through the bottom of the pelvis. These could differ depending on the use of an epidural, reference this information below.
Lying on your back (don’t forget the simple towel trick!)
Side-lying (you can use a peanut ball between the knees to rest between pushes as needed)
Hands and knees with or without support on an exercise ball
Deep squat to the floor with support from a stable surface or partner
*Remember - knees in, ankles out, and an arched low back is the ideal position while you push.
Epidural positions to consider and discuss with your provider.
The standard position following an epidural injection is lying on your back. However, alternative options can be considered and discussed with your provider. The amount of support required will depend on the strength of the epidural and safety considerations. Discuss this with your provider as part of your birth plan and preferences prior to actually being in active labor, as it will depend on their preference and comfort level as well.
Potential epidural positions include: lying on your back, side-lying, supported hands and knees, or supported tall kneeling.
Regardless of how you breathe and birth, you are incredible!
Everyone has different labor and delivery processes and birth preferences - listen to YOUR body, YOU know best. Labor and delivery is one of the most difficult AND rewarding experiences. This information is provided to educate and empower you to make the best choice for you and your baby. When in doubt, follow your intuition and know, you always know best!
