Pushing Positions During Childbirth
by Jennifer Campbell
There is no one correct position for pushing. There are several, each with advantages and disadvantages. I hope that by the time you are finished reading this, you will have a good idea of what the more common positions are, and when they might be used. It is highly recommended that you practice each one, through a couple of practice contractions, just to see for yourself whether you find them comfortable, or practical. Do not actually practice pushing, as this can put unnecessary strain on your cervix.
The first position we'll talk about is sitting. The major advantage here is that it is comfortable for the mother and for most birth practitioners, and it is easy to assume. It is very practical in that it is easy to move from active pushing during a contraction, to resting between contractions. For example, if you were sitting up in a hospital birthing bed, all you would have to do is lean forward to push, then when the contraction is over, lean back against the raised half of the bed. Another important advantage of this position is that the pushing is with gravity. Gravity pulling on the baby is a helper in pushing, and it is often wise to use it to advantage. The disadvantage here is that you are sitting on your tailbone so it has less freedom to move. This might make it harder for the baby to move down and out. It is also possible that the pressure on the vagina caused by the baby's head may be uneven, which could increase the likelihood of a tear, or the need for an episiotomy.
Another comfortable, easy to assume position is side lying. With this position, pushing is simply a matter of raising up on one elbow, while the other arm holds the top leg open, with the knee bent. Resting then simply means letting go of the top leg and rolling slightly backwards, off your elbow. This position is often good for women with back pain. Because the pushing does not make use of gravity, it can also help slow a baby who is coming too fast, which gives the perineum more time to stretch naturally, thereby avoiding a tear. The down side is if your baby is not coming too fast, you may have a slightly longer pushing stage than you would without the help of gravity. Some caregivers might find this position unfamiliar.
One position that many women find comfortable but that some caregivers might find unfamiliar is hands and knees. Some women instinctively choose this position and find it perfect for them. It can be challenging to move from active pushing, to a resting position between contractions from all fours, and it is highly recommended that you practice this before you try it in labour. Specifically keep this position in mind if you suspect a posterior presentation during your labor, because this position might just encourage the baby to turn around. This position may also relieve some of the pain of back labor, as well as being the ideal position to resolve shoulder dystocia. Pushing from this position uses gravity.
The best position for pushing a baby out, in terms of maximizing gravity and how your body works, is the squat. Unfortunately, it is also the most difficult to assume. Squatting opens the outlet of the pelvis, it stretches the perineum, it evens out the pressure of the baby's head against the vagina and it uses gravity. It is uncomfortable to stay in this position for long periods of time, however, and moving from active pushing to a resting position can be difficult.
In U.S. hospitals the most common and familiar position is on your back with your feet in stirrups. This is the most convenient position for caregivers, as they have freer access to the perineum, making it easier for them to do an episiotomy, or use forceps and/or a vacuum extractor. The disadvantages for the mother are that most women find it uncomfortable, the tailbone has less freedom of movement, pressure of baby's head against the vagina is uneven, and pushing is against gravity.
As with any decision regarding the birth of your baby, the key is to make the choice that is right for you and your baby. Now that you have a clear idea of what your options are with regards to pushing positions, you should feel comfortable and confident about what you are doing and why you are doing it.
The Delivery of the Placenta
No one talks about this much. Still, it's one of the more risky parts of your delivery. Once you have delivered your baby, the placenta will continue to pump oxygenated blood into the baby until your baby's breathing has been well-established. Prematurely cutting the cord can cause respiratory complications and also is linked to infant anemia. Your baby's body chemistry will signal to the placenta that it's job is done and it is no longer needed. The cord, exposed to the air will begin to constrict and harden. The arteries within the cord will clamp down and the blood flow between baby and placenta will stop and the cord will turn white. This may take an hour after birth before your uterus detaches the placenta from it's wall. Often it's sooner. This is normal, and a natural process. Waiting on this intelligent design benefits both mom and baby.
In delivery rooms around the US, doctors and sometimes even midwives are in a hurry to get the birth done and over with. So, early cord clamping and cutting has become a norm. However, when a mother's uterus has not yet released the placenta (which as we said, can take up to an hour), and her care giver pulls on the cord to deliver the placenta expediently, you run many risks including death. If the placenta is manually detached, it's much more likely to leave pieces behind, which can cause fatal hemorrhage then, or even months later. Often pitocin is administered either by injection or IV so as to prevent a hemorrhage from happening, or to stop one once it's been caused.
You also run the risk of experiencing a uterine prolapse. This is where the uterus turns inside out and begins to fall out of the vagina. This may happen if the placenta is firmly attached still and the practitioner pulls so hard that the uterus begins to come out with the placenta. This pulling and manually extracting is excruciatingly painful and unnecessary. It even puts you at risk, and one study suggests that it interferes with the bonding process that immediately follows birth.
So when you're writing your birth plan, make sure you specify and have someone with you to enforce the fact that you do not want early clamping and cutting of the cord, and that you want to deliver the placenta naturally.
Your healthcare provider will usually orchestrate this part of labor and discuss with you the options she is most comfortable with. You can choose to avoid pitocin, to wait till the cord has stopped pulsing to cut the cord, and more.
What to Expect on the Big Day...
