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How to push out a baby. Guided or spontaneous pushing?

Pushing labour woman

6 Feb, 2023

How to push out a baby – guided or spontaneous pushing?

When it comes to giving birth, watch any film or television programme or read any sensationalist newspaper article and you will come across the same thing.

Firstly, the medical professional, or in some extreme circumstances the birth partner, is deemed the hero for safely delivering the baby. Does this not contrast with our knowledge of giving birth? The knowledge that people can give birth vaginally whilst in a coma. That the human body is perfectly capable and successful at giving birth without a doctor or coaching team taking all the credit?

Secondly, a coach (either medical professional or birth partner) sets about instructing the person in labour to push at directed intervals. Is this guided or spontaneous pushing?

The picture is always, somebody deems it is time, an instruction is given to get on your back. Then tucking your chin to your chest, tightening your abs, pulling back your knees, taking a deep breath, holding it and pushing for a count of 10. Before bearing down in this manner two or three times during each contraction.

This is what is called “coached” or guided pushing, as if someone giving birth, despite doing the work of labour themselves rather successfully up to this point, is unable to do the last bit of labour without external instruction.

Whilst being exhausting, holding your breath, tensing your muscles, and pushing with all your might can have a negative impact on you and baby. Evidently, pushing on command may also contribute to fetal heart rate abnormalities, lower blood oxygen levels in babies, and an increased need for such medical interventions as instrument-assisted delivery. Moreover, the evidence also suggests increased chance of perineal trauma and longer-term pelvic floor dysfunction.

Isn’t there another way?

A growing body of research suggests the conventional and popularist wisdom of coached pushing may be wrong. (In most circumstances – there are some, particularly with the use of epidural when a person is unable to feel contractions.)

Therefore all being well, the healthier strategy is to follow your body’s cues and push spontaneously. The term “spontaneous” pushing refers to following your body’s instinct to push.

A small but recent study in 2021 found that spontaneous pushing equalled:

  • a shorter 2nd stage of labour
  • less need for analgesia
  • reduced postpartum haemorrhage
  • reduced the risk of tearing
  • decreased perineal pain during birth
  • more babies having better apgar scores
  • fewer admissions to neonatal intensive care 

What is spontaneous pushing and how do you do it?

 Relaxing muscles

Breathing, relaxing muscles, and keeping the oxygen flowing is important at this final stage before delivery. Moreover, making the process easier and less stressful for everyone. Continuing to listen to your body and staying relaxed and open as you may well have been doing during labour up to now.

Keeping your jaw, pelvic floor and stomach muscles relaxed you give baby the most room to move down and find their position. Letting your body do what it naturally wants to do will produce much less stress for you and will likely result in an easier time for baby.

Keep breathing

All you have to do is breathe and your uterus will do its job of expelling the baby earthside. If you feel the need to give some assistance, then direct the oxygen downwards – feel your abdomen moving downwards with each exhale, adding an extra force to your uterus bearing down too.

Just as the uterus will have done its hard work up until this point, it will continue to work as it needs to until baby is safely delivered.

Listen to your body

Each person will feel their contractions and urges differently, and even as baby moves down all contractions may result in different urges.

Spontaneous pushes tend to occur in shorter but more recurrent bursts during contractions. As the baby lowers and exerts greater pressure on your pelvic floor, you may begin to push harder and more frequently during contractions. People who aren’t being instructed usually let a contraction grow before putting pressure – very much like the urge to do a poo…it is a very similar process.

Make noise

You will most likely make noise, so it makes sense to try and harness it for a purpose.

Make a high-pitched sound and feel where you feel this most in your body. Mostly likely it will come from your throat and back of your mouth. Everything from your throat to your tummy will feel tense and tight, and the energy is moving out and away from your body.

Now try making a low mooing sound. What differences can you feel? This time your throat feels open, your diaphragm moves, and your tummy feels relaxed.

Which one feels positive? Even if you don’t feel the urge to make noise, follow the same principles of keeping everything low, relaxed and sent downwards towards baby.

Want to know more important tips for confidently approaching labour and birth? Check out my weekly classes or antenatal workshops.


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