You’ve finally made it to 10cm!! It’s time to meet our baby, but then an hour passes… and another… and you’re still pushing and pushing. Sometimes, it can be normal even with the best pushing techniques to push for a few hours (especially if it’s your first baby), but let’s explore a few pushing strategies to make your pushing more efficient!
4 Techniques to Speed Up Pushing
When approach pushing, we can consider biomechanics and pressure management to better enhance our pushing techniques and strategies.
Each of these techniques will utilize a different concept to help you push more efficiently!
But please note that the best pushing position and technique is the one that YOU CHOOSE. Research supports that the best technique is always the one that the birther intuitively chooses to do without outside support dictating their method.
It can be helpful to still understand a few concepts so pushing is less confusing! Let’s explore four techniques to speed up pushing.
1) Neutral Spine: Push from the Top with the Diaphragm and Uterus
First, it is important to understand that pushing is a pressure management activity: we increase pressure in our abdominal cavity so that it becomes a high-pressure gradient, and thus baby wants to move to a lower pressure gradient (aka outside the body).
The best way to manage pressure within the abdominal cavity is by stacking the diaphragm over the pelvic floor. In this stacked position, the diaphragm can move directly down and better increase pressure in the abdominal cavity.
How can we stack the diaphragm? By finding a neutral spine position where the rib cage is aligned with the pelvis.
I tend to find that when my clients are pushing, they intuitively find a more neutral position until they are told to curl around their baby. This is important! Remember, the best pushing position is the one that YOU CHOOSE, and most folks seem to choose a neutral spine position because it allows you to better manage pressure and push your baby out.
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Watch the video below for more of an explanation of diaphragmatic breathing! We break down finding a neutral spine and ways to prepare for pushing in neutral in our childbirth education courses, pushing webinars, and fitness programs.
2) Breathing Strategies: Inhale to Start the Push, Exhale to Finish It
After we have stacked the diaphragm so it can work with our uterus to push baby DOWN from the top, let’s explore some breathing techniques!
There are two main ones:
- Open Glottis: Inhale to Prep, then Exhale to Push (gentle pushing, less commonly coached, more common with spontaneous pushing)
- Closed Glottis: Inhale, then hold breath to push (purple pushing, more commonly coached)
The benefits of exhaling as you push are it is less stressful on the pelvic floor, less fatiguing, and stressful on you as the pusher. Cons are that it may be an unfamiliar technique with the staff, so they may not know how to coach you to do this technique effectively, or maybe dismissive of it altogether.
The benefits of holding your breath as you push is that it can help you direct your effort a little more, since you have one less thing to focus on; it is a more familiar technique in a hospital setting and easier to teach to someone in the moment. But cons are that it is definitely more fatiguing to hold your breath, can stress you and baby out a bit more, and could put more pressure on the pelvic floor and cause some issues postpartum.
Ultimately, you may find that you do a combination of both breathing techniques or find that one or the other resonates more with you. Both are great options!
3) Lat Engagement: Add Power!
If we need a little oomph to get baby under the pubic bone or lower in the pelvis, adding some pulling or tug of war techniques can add some power!
There are a few different tug of war techniques that we can do during labor to add some extra power to pushing.
- Pull a long fabric from below
- Pull a long fabric from overhead
And there are numerous ways to attach the long fabric, such as your partner holding it or attaching it to the bed.
As you push, think pull the fabric to YOU to find more of that neutral spine position. This lat engagement can help direct the effort DOWN as you push!
4) Internal Rotation of the Femur: Open the Bottom of the Pelvis
And then finally, we want to focus on creating more space in the pelvic level baby is at: the bottom of the pelvis.
The pelvic outlet opens more with internal rotation of the femurs, or knees in, ankles out. This prompts the ischial tuberosities, or sitz bones, to move further apart.
Another consideration is to get off your back! Lying flat on your back can decrease the movement of the sacrum, which decreases overall space in the pelvic outlet.
There are so many pushing positions you can do that create this internal rotation! We break down a few in the reel in this blog and will discuss a ton more in our childbirth education courses and pushing webinar.
You Won't Push Forever... And You Don't Need To!
There are several techniques that we can use to increase the effectiveness of our pushing! Commonly coached pushing techniques may not be as effective as we would like, so use these tips to speed up your pushing so you can meet your baby faster!