Second stage: pushing naturally

When a woman’s cervix has opened to around 10 cm, her body starts transitioning into the pushing stage of labour. I say “around” 10 cm because I don’t advocate routine vaginal exams on mothers in labour, and I’m sure that some cervixes only open to 9 cm, and that’s enough, and some open bigger than 10...it’s all going to depend on what the baby needs to come out. I feel that the interference of making moms recline in order to check for full dilatation is unwarranted, causes discomfort at this important time in birth, and leads to more coached second stages. Instead, we need to trust that the mother will not harm herself by pushing as her body wants to.
Classic signs of transition, such as shaking and close, hard contractions, can help us to anticipate that a mom might start pushing soon. After this point, some mothers have a rest and their contractions space out for a little while. I find that most moms who have a physiological second stage have a short time of crisis just before their body starts its expulsive urges. They say things like, “I can’t do this” and “I don’t know what to do”. Sometimes they ask us to tell them what to do. I think the most appropriate thing to say to a mother at this point is, “I am here for you. You will figure it out.” If she can get through a couple of contractions like this, and surrender to the process, she’ll be pushing soon.
Some moms scream through their pushing, which is counter-intuitive to those of us who learned that moms must hold their breath and push in order to avoid “wasting” energy. I’ve learned that most moms who have a physiological third stage are loud, that they don’t put their chins to their chest but sometimes look like they are trying to pull themselves away. These are all things that the traditional medical community discourages or looks upon as unproductive, but again, if you leave these mothers alone and just BE PRESENT with them, they often push out their babies efficiently.
Some midwives advocate having mothers “breathe through” contractions as the baby crowns, in order to avoid tears. At my local hospital, the nurses encourage the mom to keep pushing through the burning. I think both approaches are harmful. Again, we need to allow the mom to do what her body is telling her. Trust me, most moms automatically slow down as the baby crowns, then get frustrated and push through the burning. I think it’s better for the mom to do what she feels like and that we need to let go of our thinking that we can, in all cases, prevent tears and perineal damage. Some moms are going to tear, but if we let the mom follow her body, I suggest we will see less tearing.
To sum it up, it’s important at this point to be hands-off and allow the mom to figure it out. If she’s looking to you for direction, she’s likely going to miss the subtle cues her body is giving her to help her baby descend and rotate. If she knows you trust her and her body, your presence will reassure her and let her surrender to her experience. It is a powerful feeling, pushing one’s baby into the world, and it’s made all the better by attendants who respect the amazing strength and ability of mothers.

For some great discussion of physiological second stages, please see the following:

Honoring Body Wisdom by Pamela Hines-Powell
Pushing for First Time Moms by Gloria Lemay
The "Rule of 10" Versus Women's Primal Wisdom by Lydi Owen
Michel Odent on the "fetus ejection reflex"
Pushing- leave it to the experts at Midwife Thinking's blog

Pic of the week

Postpartum Tips

This is BRILLIANT. Mamas-to-be out there, heed this advice! I've never taken enough time to rest after the births of my three children. Stay in bed, feed your baby, be in bliss. Have someone else look after YOU. Sleep and dream through those early weeks!

3 Steps to Recovery by Nicole D.

Why I do what I do....with a little ranting prelude

I'm so tired of hearing about ECing. I actually realized today that I avoid discussing how much I love my cloth diapers because I'm afraid of hearing the loud chorus of confident "advertisors" for ECing. Okay, maybe not afraid, but perhaps not interested in that much negative energy being flung my way, perhaps?

Maybe this is the way disposable diapering moms feel. Like, please fuck off, cloth diapering mothers, I don't want any reminders of how I'm spoiling the planet and poisoning my child, or to have one more person tell me how easy it is to wash stinky, disgusting diapers.

Interesting, eh? Now, I know I've been guilty of thrusting my views on people and they've probably suffered much indignation as a result. Just today I realized that all my pro-breastfeeding talks left some clients with the idea that I'd judge them for their decision to supplement with formula. I support them 100% (and please no comments, you don't know the story), but I am sad that they worried I'd tell them they were making bad choices, or judge them. I know I come across too harsh sometimes, and I apologize. Going forward I'm going to try to make sure that what I discuss resonates with me and that I share it in a way that enlightens and empowers people. So with that, I come to yet another statement on birth, the biggest calling of my life. I love, respect, adore it and want to know more about it. I realize it is a mystery, and probably always will be because:

It is the stuff of magic, those early months of silence. You know this child exists, but it seems such a long way off as to nearly not exist at all. Then you feel the stretch of your belly and little squirms are known to secret places within you. And on it goes. Until the day your baby comes through into this world from the only world he or she has ever known. THAT day is of utter importance. It is a day of thunder and festivals and the greatest of joys. A day of dropping to your knees in submission and awe. A raw, bright, fiery gentle day. For your baby, it is a day of squeezes and breezes and an explosion of sound, light and space. It is the first time your child loses his physical tether to you, and relies entirely on your emotional connection. A hard vulnerable lovely day. Though the logical brain in me analyzes, catalogues and evaluates, births make me weep. And so I plea with passion. Because I must. Someone is listening.

Belly Cast

I had the pleasure of making this belly cast for a client of mine. It has a silver tag on the belly with a quote from Mahatma Gandhi:

Where there is love, there is life.

Gratitude.

I've been sitting on the couch with my baby girl, 11 mos, watching her eat a slice of watermelon (American friends: "couch" = "sofa"). She's gnawing away with her one bottom tooth, loving the texture, the chill, the taste of that piece of fruit. Little rivers of juice stain the front of her white flannel diaper and pool on a receiving blanket. Some small pieces sneak past the blanket and she grinds them into the upholstery with her feet. I wipe them off with a baby washcloth with a little water on it. And I realize that I really love my couch. I love it because it's a solid piece of furniture and it was a free item, rescued from the side of the road. I couldn't believe what great shape it was in when my mom showed up with it- a large sofa-bed sectional in a lovely sage green. I'll never feel guilty about getting it dirty, and it's given us all such a comfy place to sit and hang with friends and family. We all fit here with room to breathe: two adults, an 11 year old, a seven year old and a baby, and often my cat. I love this couch.

I'm grateful for the clients who've brought me into their births. What an honour. I learn something new every time: something about myself, something about human strength and character, and something about how birth works.

I was at another birth last night. My darling partner/hubby/boyfriend (egads I wish we had better words to describe our significant others!) spent a sleepless night too, grabbing a few winks here and there when aforementioned 11 month old cried for her mama. He is a brilliant, supportive, fantastic, fascinating man, and I feel incredibly blessed to have him in my life.

I realize a little more each day how lucky I am to live in this place and time. I truly feel like I have freedom to do the things I want to do and be the person I want to be. I have the luxury of choice, from the mundane choice I made tonight to order in takeout, to the life altering choice of having my babies the way I want. I live in a small city with a low crime rate and an excellent quality of life, and I feel safe and secure. I have access to wonderful foods from all over the world. I have a good income. I can wear whatever I want. I am so lucky to have instant access to clean water, any time of day. I have free medical care should I need it. Wow.

Maybe I am just high on the experience of witnessing another beautiful little soul come into the world this morning, but I don't think so. Sometimes I just get overcome with wonderment and gratitude, and maybe sharing it will spread a little of that awesome feeling. So here's my little call out to the Universe: THANK YOU.

g