The contractions which dilate your cervix to 10 centimeters are known in clinical terms as the first stage of labor. What a thrill and a relief to know you will soon meet your baby! The second stage comes next, and there is a fascinating debate about techniques to best accomplish this pushing phase.
For the last half century, maternity care providers were taught to dramatically coach mothers to “Push!” with all their might. After all, seven or eight pounds of baby must be delivered through the tissues of a pelvis which are otherwise never called upon to achieve such a feat.
Impressively though, women’s bodies are designed to do just that, and there is increasing evidence that it can occur without as much force as previously believed. The walls of the vagina consist of an amazing one thousand tiny folds of skin which expand like an accordion to accommodate an infant. Beneath this layer of skin lie the sphincter muscles of the vagina, which relax and open (rather than stretch) to the correct size. The only real stretching occurs during the last five minutes, when the baby passes through the skin at the opening of the birth canal. Mothers have called that brief, intense sensation “the ring of fire.”
Your uterus continues its involuntary contractions in second stage, adding a downward momentum to cause your baby to be born. Even women in comas have birthed babies; remember the days when some of our grandmothers described being knocked out with drugs during labor? The textbook Williams Obstetrics did not teach doctors to coach women to push until its tenth edition, published in the 1950s.
What may be crucial to supporting the body’s abilities is a technique that, until recently, has not received widespread attention. Although nearly every clinician has heard of “laboring down the baby,” practices in hospitals are in flux when it comes to implementing this important procedure. Other names for this technique include passive descent and delayed pushing. Rather than declaring it time to push when a woman reaches 10 centimeters, a waiting period is incorporated.
During the waiting period, what happens? All babies must swivel their heads to the correct position to fit through their mother’s pelvis. Also, many babies need their head shape to become molded to fit through, resulting in a temporary “conehead.” Babies must tuck their chins so the point on the back of their skull comes through first, rather than the broader surface of their forehead. Each of these maneuvers takes time, and not all babies are ready right at 10 centimeters.
Some hospitals do incorporate laboring down the baby, usually for one or two hours. Occasionally, a hospital will wait ten hours or longer, though this is still an unusual practice. More commonly, a time limit of two or three hours is prescribed for all of second stage, before a doctor recommends a cesarean for failure to descend. However, medical research shows that when mother and baby are healthy, simply incorporating laboring down results in fewer cesareans.
Laboring down is beneficial for mothers with an epidural as well as those doing natural childbirth. The woman waits for an overwhelming urge to push (stronger than a sensation of the baby moving down and creating pressure). For stories of mothers who delayed pushing for 5 to 15 hours, visit www.thedoulaguide.com/pushing.
Pushing is a vulnerable phase for the mother. She may need to advocate to labor down, although negotiating can be stressful during childbirth. As hospital practices catch up with scientific evidence, eventually surgery can be avoided for those mothers and their babies who simply need more time in order to come out.