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Pushing in the second stage of labor

The pushing efforts should start when the cervix is fully dilated and the head is reasonably down in the pelvis. This is the second stage of labor.

Starting to push too early is a very bad idea. If pushing is commenced before the cervix is fully dilated, it can cause all sorts of problems. The cervix itself is likely to swell up and may be pushed out of the vaginal canal, with serious risk of damage to it, and bleeding.

These efforts will in fact not hasten delivery; instead, this will help to exhaust the mother, running the risk of her being unable to push when the appropriate moment arrives. This may mean an instrumental (forceps or ventouse) delivery which may have been otherwise unnecessary.

Irresistible urges to push in labor when not ready

Sometimes the mother may feel very strong; almost irresistible urges to push when she is clearly not ready. The reason for this is partly because the birth canal is right next to the rectum and back passage. Pressure from the leading part is inevitably transmitted across to this area and this produces the urge to bear down.

As part of parent-craft classes, which are widely available, expectant mothers are taught breathing exercises, which might help in dealing with this problem. Epidural analgesia is, of course, much more effective in preventing premature pushing.

Second stage: Doing the pushing correctly

The correct and therefore effective way of pushing in labor is also taught in parent-craft classes. It is vital to push only when there is a uterine contraction. Pushing at any other time is ineffective and only serves to sap precious energy.

The push should be as hard and as long as possible during the contraction. A good "push" lasts 30 to 40 seconds.

As the mother feels a contraction building up, she should take a deep breath, hold it (this is very important) and bear down. It is OK to take snatches of breath very quickly in the middle of a push without relaxing.

Shouting, screaming or expressing an opinion during a push may be irresistible but serves no useful purpose. All it does is blunt the effort and in effect prolongs the second stage. It should be resisted.

In between pushing, the mother should try to let go and relax as much as possible - breathing deeply in and out, preparing for the next contraction and effort.

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