This is the part of the labour where you actually get to do work.
A lot of women find this part of the labour quite satisfying as they get to work with their contractions, especially if they don’t have an epidural.
First, if you have an epidural, I do not encourage you to push until you can feel pressure in your bottom as if you want to empty your bowels. You should also be able to move your legs. If you are completely frozen, it might take up to a few hours for the epidural to wear down before you start pushing. If you start to push and you are still too frozen, you will not be able to coordinate your muscles and so the pushing will not be strong enough in order to help you deliver your baby. You will tire and this may lead to you needing assistance in order to help you deliver the baby in the form of a forceps assisted delivery or a c.section.
Pushing to have a baby is very similar to going to the washroom. A lot of women are embarrassed when they start to push as they feel that they may have a bowel movement when pushing. Have no fear, we do not care about this and do not feel embarrassed about having a bowel movement when you push. If you are feeling very uptight about this, you can request an enema to empty your bowels when you are admitted to hospital.
There are many positions for you to push in but I feel the most effective position is the one with you lying almost flat on your back with your knees brought to your chest. Your partner and the nurse might need to support your legs and push your knees up to your chest. This helps open up the pelvis and give the baby enough room to come around the pubic bone. You can also lie on your side with your legs in this position.
Squatting is also a very useful position but much more tiring as you have to support your weight on your arms and your legs. You can alternate between lying flat on your back and the squatting position if you so wish.
We will get to push only when you have a contraction. You should be able to feel when you have a contraction as mentioned earlier. If you can’t feel when you’re having a contraction then stop pushing and go back to sleep.
When you push, take a deep breath, hold it and push for 10 seconds. Push like you are going to the washroom. After 10 seconds of pushing let the air out of your lungs, take another deep breath in and push for another 10 seconds. We want 3 or 4 pushes per contraction. Your partner can count to 10 for the first few contractions so you get an idea of how long to push for. Remember: push into your bum and not into your face. This will only make your eyes bulge and burst the blood vessels in your cheeks. It won’t move the baby.
The pushing stage or the second stage of labour usually takes anywhere from one to three hours. You push for a minute or so and then you have a 3- to 5-minute break. During the break have sips of water. Ask the nurse for a cold cloth to put on your forehead. Your partner can also fan you with the fan you brought with you or they can use one of the cardboard trays call “save a day” trays. Ask your nurse for it.
Once we can see the baby’s head at the opening of the birth canal the nurse will call for the doctors and the pediatrician. Dads, if you want to help deliver the baby or cut the umbilical cord, let us know.
The doctors will instruct you on how to control your pushing so as to try and minimize the amount of tearing at delivery.
As we see more of the baby’s head deliver through the opening (crowning) of the head we will support your perineum with a warm cloth. We will also instruct you on how to push. What we will usually tell you to do is to push for a few seconds and then stop. Then push for a few more seconds and stop. As the head is about to deliver we will tell you to stop pushing and to start panting. Panting is taking short shallow breaths. The aim is to let the baby’s head deliver as slowly as possible and to support the perineum so as to prevent or minimize the tearing.
As soon as the baby is born we will put the baby directly onto your skin. We want the baby to have skin-to-skin contact with you as soon as possible. This will happen only if the baby is pink and crying. The baby lies on your chest for at least 2 minutes before we cut the baby’s umbilical cord. This is what we call delayed cord clamping. Dads, we will usually ask you at this point if you want to cut the cord or not. There is not pressure on you if you feel you do not want to cut the cord.If you do, we’ll will give you the scissors and tell you where to cut. The cord feels like calamari when you cut it.
If the baby is not crying or is not pink at the time of delivery then we usually hand the baby over to the pediatrician who will be in the room at the time of the delivery.The pediatrician will attend to the baby, and once the baby is crying and pink, the baby comes back to you and has skin-to-skin contact.
We usually dry the baby on your skin. We usually leave the baby in direct contact with you for at least 5 minutes. Dads, you can also have the baby on your skin. We get you to take off your shirt and put the baby on your chest if you want.
The baby is usually wet and bloody when it is delivered and so if you want us to we can clean the baby before we put it up against your skin.
After a few minutes of skin-to-skin contact, we will sit you up in the bed. If you are feeling strong enough, we will help you try to breastfeed your baby.
We usually wait a few minutes after the birth before we deliver the placenta. At the time of birth the nurse will give you an injection of oxytocin in your thigh. You will not feel this. This helps the uterus contract after the delivery and helps the placenta to separate from your uterus and deliver. The doctor delivers the placenta by pulling on the umbilical cord so there is very little effort required on your part to deliver the placenta. We usually rub the uterus after we deliver the placenta to ensure that we remove all the blood clots that may have formed in the uterus after the delivery. This may cause you some discomfort but only lasts a few moments.
The doctor will examine your perineum and assess if there are any tears from the delivery and, if so, whether they need repairing. If a repair is needed, we make sure that you will not feel it. If you have an epidural it should ensure that you do not feel the repair. If you do not have an epidural the doctor will give you a local anesthetic beforehand so you should not feel the repair.
The suture material we use will dissolve on its own. The stitches do not need to be removed!
If your bottom is very swollen after the delivery or if you are quite frozen after the delivery it may be difficult for you to empty your bladder. If so, the nurse may insert a catheter into your bladder to help keep it empty. The catheter will be removed the next day or even later that day if you feel you can go to the washroom.
The correct and honest answer is yes. The bottom is designed to tear. The bottom usually tears along natural lines and it heals quicker than compared to a cut made by a physician. No amount of perineal massage, in which you stretch your vagina prior to the birth, will help prevent tearing. When the baby’s head is being delivered, we try and control the speed of the delivery and support your bottom to prevent tearing.
An episiotomy is a cut into your bottom, and it is done for a few reasons. First, I must state that we do not cut episiotomies routinely. It is better for your bottom to tear than for it to be cut. Episiotomies are usually cut to prevent you tearing into your rectum. This could cause incontinence later on and this is not a good thing.
Common circumstances for requiring an episiotomy are if you need a forceps delivery. The forceps can increase the risk of tearing into your bottom. We also use episiotomies if we think there is going to be a big uncontrollable tear, especially in circumstances where we think you have a very big baby.
We may also cut an episiotomy if your baby needs to be delivered a little sooner. This may be in situations where the baby may be stressed or if you have been pushing for a long time and you are getting exhausted.
When we repair a cut or a tear, we use dissolving stitches that do not need to be removed. When we repair a cut or a tear, we do it in a number of layers, as we know that you are going to sit on your bottom and it is very common for some of the stitches to break.
Every woman fears the first bowel movement after having a baby. We give you stool softeners after the baby is born to prevent constipation and most women say that the first bowel movement wasn’t as bad as they thought it would be.
Your bottom has a very good blood supply and does not get infected. Ways of keeping it clean are to sit in a warm bath of water. This could be done many times in the day as it helps keep your bottom clean and also is very comforting. If you want to you can add Epsom salts to the water but this is optional.
We will also give you a little squeegee bottle to rinse your bottom off after going to the washroom. Applying icepacks soon after the birth alleviates the pain. We also give you regular pain medication in the form of an anti-inflammatory and an analgesic, which should be taken on a regular basis for the first few days after the delivery to prevent pain.
A few remedies to help alleviate pain in your bottom include:
The pediatrician will be in the room at the time of delivery, but if your baby is well and not distressed, the pediatrician will delay the exam as we want the baby to go skin-to-skin with you first. The pediatrician will check your baby after you have had a cuddle with your baby.
If the baby is floppy and not crying after the delivery, the pediatrician will examine the baby immediately. Once the baby is pink and happy, the baby will be given back to you as soon as possible.
The pediatrician who examines your baby at the time of birth will see your baby during its stay in the hospital.
Once your baby goes home, take your baby to your family doctor or the local health unit for routine check ups.