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.

Firstly, if you have an epidural, I do not encourage you to push until you can feel your bottom and move your legs. If you are completely frozen, it might take up to a few hours for the epidural to wear off before you start pushing.

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 baby enough room to come around the pubic bone.

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. It is also feasible for you to push lying on your side with your knees bent in once again up to your chest.

Will I tear when the baby is delivered?

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, which involves you stretching 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.

What is an episiotomy?

An episiotomy is a cut into your bottom done for a few reasons. Firstly, 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 include sitting 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.

What can I do to alleviate pain in my bottom?

A few remedies to help alleviate pain in your bottom include:

• Sitting in warm baths of water.
• Applying witch hazel solution that you can get from most pharmacies to your bottom on a small facecloth.
• Take some maxipads and wet them. Place the wet maxipads into the freezer. Once frozen the maxipads work very well as an ice pack for your bottom. You put these ice packs in your underwear and change them as often as needed.