Pushing in Labor: What You Need to Know

When people imagine pushing during labor, they usually picture themsleves laying flat in a hosptial bed, with their legs in stirrups, while the nurse counts loudly to ten.

Good news…that is not your only option, even with an epidural.

There’s More Than One Way to Push

There are generally two approaches to pushing your baby out: coached pushing and mother-directed pushing (also called spontaneous pushing).

With coached pushing, your nurse helps guide you through when and how to push. This way of pushing is commonly used when an epidural is in place and you aren’t feeling a strong urdge to push.

Mother-directed pusing is exactly how it sounds, you follow your instincts and push when your body tells you it’s time and you work with those sensations and breathe whatever way feels most natural.

Please note, neither method is all-or-nothing. I have witnessed many women with epidurals push thier baby baby out using the mother-directed pushign method. It is possible but with a dense epidural in place, it can be challening. At the end of the day, your birth, your body, and your baby all call for a little flexibiltiy.

Yes, You Can Change Positions with an Epidural

One of the biggest misconceptions I hear women say is, “If I get an epidural, I will have to push on my back.”

Nope.

Your mobility during labor will depend on how dense your epidural is and what you can do safely but there are plenty of options.: Side-lying, semi-reclined, supported squat, and even hands-and-knees may be possible with help. The peanut ball can also be your best freaking friend.

Without an epidural, you generally have evenn more freedom to move and to push in whatever position makes your body say, YES. THIS IS THE POSITION.

What About Protecting the Perineum?

There’s no magic trick that guarantees you won’t tear but there are some things you can ask for that may help.

• Warm compresses on the perineum between pushes
• Pernineal massage done by your provider while pushing (super helpful when you have an epidural becasue it gives you something to push against).
• Mineral oil (provided by the hosptial)
• Slower, more controlled pushing as baby crowns

Sometimes, you can do everything “right” and still tear. Birth doesn’t handout gold stars for an intact perineum but you will be more comfortable afterwards.

The biggest takeaway is this: You have options during pushing. Ask questions. Change positions. Speak up when something isn’t working. Whether you have an epidural or not, pushing doesn’t have to look one specific way.

Want to feel more prepared and confident heading into labor? Join us for Uptown Doula’s Preparing for Birth Series, with both weekday and weekend class options available. Visit Uptown Doula to learn more and find a class that works for you. If you’re ready to register for one of our classes, you can find that on our website.