Directed Pushing vs. Mother Directed Pushing

Jenni laboring down at home. Photo by Evelyn Ojeda.

We have all seen women being shouted to “PUSH, PUSH, PUSH” in movies and TV shows. Someone other than the mother decides that it is time to get the baby out. This adrenaline laced environment is the opposite of what a woman and her baby require for an undisturbed, peaceful birth.

As long as mom and baby are doing well, there is no need to rush mom. Mother directed pushing, also called spontaneous pushing or laboring down can happen when a mother is supported to listen to her body. A supported mother will choose the position that feels more productive to her resulting in a more peaceful experience for mom and baby as well as greater potential for an intact perineum.

In her article PUSHING FOR FIRST TIME MOMS, Gloria Lemay, a Private Birth Attendant in Canada, teacher and a frequent contributor to Midwifery Today, emphasizes the importance of patience, encouraging the woman to listen to her own body and a hands off approach during second stage (the pushing stage) to protect the perineum and the birth experience for mom and baby.

The MIDWIFE’S GUIDE TO AN INTACT PERINEUM Gloria Lemay beautifully explains step by step the pushing stage to moms. – NOT just for midwives!

EFFECTS OF DELAYED PUSHING, a study of the differences in postpartum fatigue and birth outcomes between women who pushed immediately and those who delayed pushing concludes that by delaying pushing until the mother feels a strong physical pushing reflex, mothers’ feelings of fatigue are significantly reduced improving outcomes both for mom and baby.

In this study, the group that pushed immediately recorded higher cesarean and instrument-assisted birth rates.

Midwife Dr Rachel Reed in her great article Pushing: leave it to the experts, examines the implications of telling women when to push, how to push and not to push during birth. She also discusses in detail suggestions to support mothers before and during birth, and also mothers pushing with an epidural.

WHAT CAN I DO?

1. Read these articles and share them with your birth team.

2. Discuss with your care provider their approach to second stage.

3. Hire a doula and labor at home as long as possible.

4. If you have been sexually or physically abused, make sure you have an understanding and supportive care provider.

5. Watch movies of women “laboring down” their babies to re-program your brain. “Laboring Down” refers to the mother’s body moving the baby down into the birth canal without her voluntary effort of pushing.