Hold Your Breath and PUsh

Hold your breath and push with all your might.  Is it doing more damage than good? 

Our uterus labors for many hours working to open up the cervix.  Once a woman is 10cm she is often told to start pushing.  When really what we are going for is continuing to labor the baby down before we begin the pushing process.

In HypnoBirthing we do not use the word push.  Let me explain why.  Pushing is forceful.  And it doesn’t need to be the first course of action.  If we begin pushing because we are told we are 10cm, we could be pushing against our pelvic floor that has not yet expanded.  How does it expand?  By laboring the baby down.  Holding off until the baby is at a lower station in the pelvis.  At this point let’s use the word bearing down rather than push. We are giving effort but without extreme force. 

When given this time and space the woman’s Natural Ejection Reflex will kick in.  Her body will feel the urge to bear down and she should do so if that is what her body is telling her.  There are some women that say when the NER kicks in they didn’t even feel like they were pushing, their baby was just coming out.  If we start pushing before this kicks in, we could miss that natural urge.  (Evidence Based Birth information below)

When we feel that urge, how do we protect the pelvic floor so we do not do damage?  We use our breath and our abdominal muscles.  We take in a big breath, bring our chin to our chest  and send all that air and energy down to the baby.  Our abdominals will engage like we’re doing a crunch.  This method will help assist the natural ejection reflex.

Often women are told to hold their breath and push with all their might and people are chanting by counting to 10.  Doing this repeatedly, potentially for hours can not only hurt our pelvic floor but can stress a baby out.  Holding our breath and pushing really hard creates tension which creates more pain and possibly tearing that didn’t need to happen.

Someone might say, I did try using my breath and abdominals but it wasn’t enough.  Ultimately, I had to hold my breath and push hard.  Instead of assuming that is because it is the right way, maybe we need to question other factors.  The position of the mother.  If she is flat on her back and her knees are up at her ears because people are holding them there? If yes, we are actually creating more tension.  Our knees pointing outward are actually closing the outlet (where the baby is coming out).  Getting in a different position that brings the knees slightly inward and feet outward actually opens up the pelvis outlet.  Give it a try.  Get on the ground on all fours.  Bring your feet together and notice how your sit bones come together.  Now bring your feet slightly outward and notice it open up.  Creating so much more space for the baby is to come through. This approach can be used in a variety of positions. 

But I did all of that and it didn’t work.  Yes, sometimes babies are in positions that do not allow them to move through the pelvis easily.  This is when our doula, nurse or provider can step in and help us brainstorm ideas of how to get the baby in a better position.  And those positions can sometimes require more pushing efforts.  And with those pushing efforts if we can still use our breath as much as possible, then we reduce damage being done to the pelvic floor.  The tension in our jaws reflects the tension in our pelvic floor.  Now we have insight from Pelvic Floor Therapist, Dr. Lindsay Durand Massumi. 

“Open glottis pushing where you breathe as you bear down is a great alternative to the “purple-pushing” that we typically see in the delivery room. When we close the glottis or hold our breath, we create tension in the pelvic floor muscles, making it difficult for the baby to move down and through the pelvis. When we focus on keeping our glottis open and moving air while gently bearing down, we keep oxygen flowing to the uterus, baby, and pelvic floor muscles and those muscles move with greater ease. The combination of intuitive, open glottis pushing, and using movement and positions that help open up the pelvis, can reduce your chances of tearing during birth and reduce the chances of needing a c-section.” ~Dr. Lindsay

Now let's talk about what we can do prenatally to help get the baby in a more ideal position.  Stay active!  Walking daily and regular yoga can promote balance in your body. Continuing the exercise you were doing prior to pregnancy is typically approved.   Receiving bodywork.  In our modern world we do a lot of sitting.  Seeing a Chiropractor, Massage Therapist and Pelvic Floor PT is so valuable.  Let me explain simply how each of these can help you, though they are not limited to these descriptions.  A chiropractor will help create space and balance in your body.  A Pelvic Floor PT will help create stabilization and strength and help you understand how to release your pelvic floor for birth.  A Massage Therapist will help relieve muscle tension and soreness helping your body move with more ease.  All will help regulate your nervous system, create mobility and help you build confidence and trust in your body. 

In my HypnoBirthing class I educate parents on how to stay active, more ideal sitting positions, Spinning BabiesⓇ Techniques, comfort measures in labor as well as practicing birth positions. We want to instinctually move our bodies during birth, but if we have never been in a position, we are unlikely to do it in labor.  

In my extensive Spinning BabiesⓇ training one of my favorite phrases is “Physiology before force”.  It is in relation to helping breech babies turn.  As a massage therapist I do not move the baby but I do help create space in the woman’s body to help the baby find the space it needs to move. How I feel it relates to labor and birth… We first should trust birth.   We should let her labor without a watchful eye that may make her feel pressure to do something.  We should let the woman tell us what she is feeling and she decides when to bear down.  If mom and baby are doing great, then we should not force or rush the process. 

Labor and birth have many nuances and it is very unpredictable.  We do not know how it will play out for each person or her subsequent births. There are always going to be unique circumstances where what we described above will look different for someone.  However, for the majority of people, this approach should be used.  

We don't want to leave things up to luck or hope for the best.  Educating ourselves on the process, preparing our mind and body for birth can help us navigate what comes our way.  Preparation is Power!  Learn more about Caroline’s HypnoBirthing Course HERE and Dr. Lindsay’s Preparing Your Pelvic Floor for Birth HERE

Written by Caroline O’Neill and contributor Dr. Lindsay Durand Massumi

Additional Resources:

Evidence Based Birth Article on Pushing and Birth Positions

A great podcast listen is this episode from Birthing Instincts.  Dr. Stu was an OB in the hospital system for 25 years before he left to support families at home.  He is joined by homebirth midwife, Blyss.  I love their conversation on episode #256-Pushing, Tearing and Repairing. They chat for a while, you can skip ahead to minute 18 to hear the topic of the podcast.  Listen HERE

An article from Midwifery Today