There are two possible scenarios:
The mama reports that she feels like pushing. She is asked to get onto the bed, is set in a semi lying position, the light is on Ms. V who is the main character, the care providers confirms that the cervix is fully open, dresses up and/or prepares for the birth, every one in the room is set to action and the main care provider says to the Mama, “Okay Lucy, your cervix is fully open and we are ready for the baby. When the contraction comes just bring your chin to the chest, count to 4 so the pain builds up, pull your legs towards you and at 5 puuuush hard like you are constipated. Got it?” Lucy nods in anticipation of the contraction.
Once the contraction comes, count down starts, “…1, 2, 3,4 now puuuush Lucy, puuush harder, take another breath and puuuush hard…like you are going for hard stools…okay relax now the pain is gone. Well done, we can see your baby’s long hair. So next push, give it all your best and get the baby out. Okay?” Lucy nods again.
Lucy, standing by her husband reports to the Midwife that she feels like pushing. The Midwife says, “Relax, be in tune with your body, it will guide you on what to do and you just follow. Take the position you want, and at the pick of the contraction follow the urge to push” When the contraction comes, Lucy kneels on the bed and instinctively pushes her baby at the height of a contraction. The Midwife places a clean towel on the bed and waits for Lucy to finish pushing. ‘Well done, Lucy, now relax, take a sip of water. Keep breathing down your baby, and keep the gentle pushes.”
What scenario would you pick?
Well, I am a Midwife, I have a bias to the second scenario. That is how I would like my birth conducted and that is what I give to the Mothers I care for. Women are like flowers, they blossom differently, each in their own way. Every woman has a birth instinct that guides her body. Her body knows how to follow the cues.
Patience with the process is one of the best gifts you can give a mum at birth. We sometimes forget that she has a birthing instinct that guides her. From my experience, it takes a few minutes to hours. The cervix being 10 centimeters dilated doesn’t mean the Mum has to push. Most first time mums will take about an hour to get baby out. Together with all else mentioned above, patience helps a great deal. As long as the Mum and baby are well, Mum not exhausted and baby not distressed, the push time can last till baby is born.
Performance is not necessary. Pressure to perform quite discourages a Mum. Let her know that there are no scores. She does what is necessary to do and under no pressure. “Will I be able to let my baby out?” is a statement I hear a lot of times. Pressure to perform causes fear and anxiety and that can delay the progress of birth. If mum is fine and baby is okay, allow the mum to relax, be free and have no scale in time or how she gives birth.
Privacy is an important part of the birth process. Every woman knows that Ms. V is the main character at birth. She also knows that there will be an audience, and most of the people watching are strangers especially if she will have a hospital birth. This troubles her in a sense but she knows there is no way out. Allowing her to maintain her privacy only makes her a lot more relaxed and able to focus on the main act. As her care provider (Midwife in this case) I do not need to watch the baby come out, I just need to support her external part and that I can do without lights too.
Practically, a woman is unable to focus on other things when she is at the push stage.
I have found that less instructions, noise, lights, requirements allow her to internalise the demand her baby is putting on the body and allows her to let her body do what it wants to do. Holding the breath, holding the legs takes away the focus on pushing. Keeping the mouth open and jaw relaxed allows the sphincters to relax and let out baby. Placing a hand on the abdomen just below the burst and pushing just the part below the hand during the push feeling helps relax the perineum.
Positions that allow gravity work best. They help with baby’s descent and gravity aids Mum as she pushes the baby out. An up hill task only makes the journey out longer for baby and a lot more effort for Mum as she aids baby out. Kneeling, squatting, laying on the side, semi sitting, all fours, standing are all great positions for pushing. They are easy on baby and more comfortable and natural for the mum. Changing from one position to another helps.
Preserving Ms. V’s tissues is key. She has a lot more work awaiting her later;-)…Thankfully, her tissues are quite elastic and can stretch well enough to let baby out. Preparing her well before birth is necessary. Perineal massages and kegel exercises are great to help achieve good prep. The Mum should push only when she feels like. She should do it slowly without exerting herself. As baby crowns, warm massages, letting the tissues get the benefit of gravity and supporting them externally without touching them internally contributes to Ms. Vs preservation.
I managed to keep the Ps going:-) but I hope you get the message, Birth is sure a no brainer.