When pushing, we recommend the following as general guidance:
Neutral Spine Position
Space for the sacrum to move
If you have followed us long enough, you will know that we recommend neutral positioning of the spine for pushing. This may be different than your typical pushing guidance in the labor room but let us examine rational behind each pushing concept. It is important to remember that other cues you may hear in the labor room are not necessarily wrong, as babies are still born vaginally even with different cueing and approaches.
When pushing, we manage the pressure within the abdominal cavity to push baby down and out. Think of baby like a fluid; fluid wants to move from places of high pressure to low pressure. If we increase the pressure in the abdominal cavity, it becomes higher than the pressure in our environment, and baby will move outwards. So how can we increase pressure most effectively while pushing??
Curl Around Your Baby?
A common cue you may hear is to curl around your baby, but let us explore this concept. Curling around the baby adds abdominal compression, which in theory would help to push your baby out. Your partner may even be encouraged to place their arm behind your shoulders, and assist in rounding your upper body towards your baby.
While this may be helpful, it can be more effective to use an increase in pressure to push baby out. Breath is utilized during pushing to aid in the effectiveness of pushes, but diaphragm angle is important when trying to increase pressure in the abdominal cavity. When we curl around baby, the diaphragm is angled forward, and the majority of the pressure increase will be towards the back as opposed to towards the pelvic floor.
Baby will likely still be born vaginally, even while curling around your baby, but may potentially take longer.
Shoulders Down and Back?
Our recommended cue is to focus on a neutral spine position. We usually find when someone is asked to push, they intuitively move into a neutral spine position with their shoulders down and back. Then, they are cued to curl, and adjust their pushing position.
Why do we recommend neutral spine position for pushing? The diaphragm angle is directly over the pelvic floor in a neutral spine position, which generates the most direct pressure/force to the pelvic floor (aka where baby is trying to exit).
How do we cue this? There are a number of ways that will resonate differently with birthing persons.
Think like you are deadlifting; lats are engaged, and rib cage is stacked with the pelvis.
Shoulders down and back; there may be tendency to lift in the shoulders, so cueing to bring the shoulders down and back helps in finding a neutral position, and directing the effort DOWN as opposed to up.
Pull towards you, as opposed to yourself towards [legs, scarf, sheet, etc]. This will encourage the back to engage, and usually brings someone into a neutral spine position.
Touching the back or shoulders and cueing to focus here/bring these down.
Arching??
There may be a tendency to arch in the back as someone is trying to find neutral. If there is too much engagement in the back, there may end up being an arch in the back. Now, arching may be an intuitive movement that can be especially helpful for posterior positioned babies, but also may be a side effect of attempting to maintain a neutral position.
If there is arching after being cued to remain neutral, cueing to tuck the chin can usually help someone return back to neutral without curling.
We recommend neutral spine pushing due to the more direct line of force from the diaphragm to the pelvic floor. This direct line of force helps make pushing more efficient, and increase the strength of your pushes, as opposed to curling around your baby. Pay attention to your intuitive movement patterns, as they can be a huge clue to baby’s position! There may be a reason you are choosing to naturally move into a specific position while pushing or laboring!