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The urge to push (bear down) in labour

How to push during labourSometimes I get the ‘eye-roll’ when I mention breathing/bearing down with hypnobirthing, during the ‘pushing’ stage of birth. The biggest culprits for this reaction tend to be caregivers such as midwives, doctors and obstetricians (certainly not all, but some) and women who have birthed using a method of forced pushing. They will say something to me such as, “Yes, hypnobirthing is all well and good… but I find that it fails when it comes to the pushing stage of birth. Mothers have to push. Hypnobirthing can set up unrealistic expectations about ‘breathing the baby out’.”

So, I wanted to set the record straight once and for all regarding hypnobirthing and ‘pushing’.

Firstly, I am speaking on behalf of the Hypnobirthing Australia™ / Hypnobubs® program (not other hypnobirthing programs which can differ greatly in what they teach)… but let me explain what we mean when we talk about using our breath and energy during the pushing stage of birth.

Unfortunately, I find that caregivers often put all hypnobirthing programs into the same basket. The Hypnobirthing Australia™ / Hypnobubs programs teach the ‘breathing’, ‘bearing down’, ‘pushing’ part of the birth very differently to the way that other hypnobirthing programs describe this part of the birth.

In a normal, undisturbed birth (in the absence of special circumstances); the birthing mother will experience an urge to bear down. This is sometimes referred to as the ‘natural expulsion reflex’ or the ‘fetal ejection reflex’. Nothing on earth can stop us from acting on this strong urge or force! The urge comes from deep within us and is very instinctual. We may also find ourselves vocalising at this time (grunting, deep guttural style noises, humming etc.).

Sometimes we do need to hold our breath a bit when we bear down. It’s comparable to the urge we have when we are having a bowel movement (doing a poo). Sometimes we need to ‘hold our breath for a bit’ to build up the pressure – then we release our breath as we expel. But we don’t hold our breath for extended periods of time when going to the toilet, as this would be counter-productive and could cause all sorts of other issues (such as tearing and haemorrhoids).

Birthing a baby is very, very similar to doing a poo. A big poo! Melissa Spilsted

So, when we are birthing our baby; we don’t want to be holding our breath for long periods of time, turning purple in the face and going against our instincts whilst performing to the chorus of people instructing us to “push, push, push”! ? It would certainly not be healthy to empty our bowels in such a way, and so (surprise surprise!), it is not healthy for us to hold our breath and forcefully push for an extended period of time when we birth our baby!

It isn’t just haemorrhoids that we want to avoid during birthing; it is also tearing, maternal exhaustion, tension in all the wrong places and the restriction of oxygen to our baby (which can cause fetal distress and complications). There are MANY very good reasons for us to go with our instincts during birth (as other mammals naturally do) and avoid directed or extended pushing.

You could call what we teach ‘instinctive pushing’ or ‘mother-directed pushing’… but think about the word ‘pushing’ in the context of birthing, for a moment. The word ‘pushing’  conjures up visions of women holding their breath, with a contorted, purple face. It really isn’t a good word to describe what we actually do during an uncomplicated, physiological birth.

What women really do, is bear down. 

Something that distinguishes our programs from others is our techniques and content are very down-to-earth, realistic and evidence-based. 

That’s why Hypnobirthing Australia™ and Hypnobubs® mamas talk in terms of ‘breathing/bearing down’ during birth, rather than ‘pushing’.

And to anyone who is still rolling their eyes at this point… please, be my guest and knock yourself out with some good old-fashioned evidence to back up what we do. ?

A review of existing studies showed there is little evidence demonstrating benefits from directed or purple pushing. The authors conclude that…

“Until more evidence is available we think spontaneous pushing should be accepted as good practice and women preferably should be encouraged to choose their own pushing technique. They should be supported in following the feelings of their bodies and use their own bearing down efforts and urges to push. The caregiver can provide more explicit direction, guidance and assistance with bearing down on the woman’s request or whenever it seems reasonable, e.g. when the second stage of labour needs to be hastened..” Aldrich C, D’Antona D, Spencer JAD et al (1995). ‘The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour’. Brit Jour Obs Gyn, 102(6)

Not that I want to push my point too strongly. ??

Some more references

Aasheim V, Nilsen ABV, Lukasse M et al (2011). ‘Perineal techniques during the second stage of labour for reducing perineal trauma’. Coch Data Sys Rev, 12: CD006672. DOI: 10.1002/14651858.CD006672.pub2.

Bosomworth A and Bettany-Saltikov J (2006). ‘Just take a deep breath: a review to compare the effects of spontaneous versus directed Valsalva pushing in the second stage of labour on maternal and fetal well- being’. MIDIRS Midwif Dig, 16(2): 157-165.

Prins M, Boxem J, Lucas C et al (2011). ‘Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trails’. BJOG, 118(6): 662-670.

Roberts J, Goldstein S, Gruener JS et al (1987). ‘A descriptive analysis of involuntary bearing-down efforts during the expulsive phase of labor’. Jour Obs, Gyn Neon Nursing, 16(1): 48-55.

Yildirim G and Beji NK (2008). ‘Effects of pushing techniques in birth on mother and fetus: a randomized study’. Birth, 35(1): 25-30.

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