When your cervix has completely effaced and dilated, you can actively help the uterus move the baby down the birth canal by bearing down or pushing with the contractions. Most women feel a strong desire to push, but a few do not. If you do not immediately feel an urge to push, just continue to breathe through the contractions. In addition, assume an upright position to help the baby descent into the pelvis. His head may not be deep enough to pres on the sensors that trigger the bearing-down reflex. It has been found that if a woman delays bearing down, she eventually does feel the urge to push. But if the woman starts pushing without having the urge, she may never feel it. Absence of the urge to push makes the pushing stage more difficult and less satisfying. If you do not feel the urge to push as the result of an epidural, request that the medication be turned down or off, and delay pushing until you feel the urge.
Use your body’s natural massages, and bear down or push only as your uterus directs. You may have a desire to bear down just mildly, or you may feel a need to push strongly.
Many women are surprised that that make noise as they bear down. Use low moans or deep guttural sounds, rather than high-pitched screams or squeals. Low tones encourage a relaxed pelvic floor. Also, during the contractions, try not to completely release the bearing-down effort between breaths. If you can continue to apply some pressure as you get the next breath, you will help to hold the position of the baby and make better progress.
You should also assume the position for pushing that you prefer, not necessarily the one that you practiced in childbirth class or observed in childbirth films. You may find side-lying, squatting, standing, kneeling with you upper body elevated, or kneeling on all fours to be the most comfortable for you and the one most advantageous to your baby’s descent. In any pushing position, tuck your chin down onto your chest to curve your body into a C position. This curves the lower back and aids the descent of the baby under the pubic bone. Avoid the temptation to throw your head back, which would cause an unnatural arch in your back. Your partner can remind you to “look for the baby”.
While natural or gentle pushing may not produce results as quickly as forceful breath holding does, no evidence exists that a longer second stage is harmful to a baby who is not in distress. In fact, babies may benefit from experiencing a slower, more gentle birth, instead of a forceful surge down the birth canal.