Laboring Down: WHY Wait to Push During Labor?!

Birth, Medical, Pregnancy, Pushing

Welcome to our discussion on a crucial aspect of childbirth—laboring down! In this video, we will discuss the concept of laboring down, its benefits, and potential risks. I’ll explain how laboring down allows the uterus to passively push the baby down without active pushing, thus reducing overall active pushing time and conserving energy. We will also touch on conflicting evidence regarding the outcomes of laboring down, and the importance of discussing it with healthcare providers. Factors to consider include the duration of laboring down, health status, personal preferences, and the baby’s position within the pelvis. To wrap things up, we will go over some practical guidance on positions during labor to facilitate laboring down.

What is Laboring Down?

Laboring down occurs when a birthing person reaches 10 centimeters of dilation but holds off on actively pushing. Instead, we allow the uterus to help guide the baby down the birth canal passively. This approach takes advantage of natural contractions to move the baby deeper into the pelvis without exerting additional effort through active pushing. The goal? To conserve energy and potentially reduce the overall duration of the pushing phase.

The Evidence on Laboring Down

The current research surrounding laboring down is mixed. Some studies suggest it can lead to a longer pushing time and may increase the risk of postpartum hemorrhage or adverse outcomes for the baby. Conversely, other studies indicate that laboring down can shorten pushing duration and promote better outcomes for both the baby and the birthing person’s pelvic floor.

This conflicting data underscores the importance of discussing laboring down with your healthcare provider during prenatal visits. It’s beneficial to ask them about their experiences and opinions on laboring down, as different practitioners may have varying practices and recommendations based on the latest research.

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Key Considerations for Laboring Down

As a Labor and Delivery nurse, I believe that laboring down can be a great option, but it’s not universally suitable. Here are several factors I consider when advising patients:

Time Frame: Ideally, we don’t want to labor down for longer than an hour. Research does not support extended periods of laboring down, as prolonged waiting could lead to poorer outcomes. If, after an hour, the baby has not descended further, we usually recommend starting to push.
Health Status: The health of both the birthing person and the baby is paramount. If there are signs of infection, fever, or if the baby is not tolerating labor well, we’ll prioritize moving toward delivery over laboring down.
Epidural Use: If you have an epidural, you may not experience the same intense urge to push that an unmedicated birth provides. In such cases, laboring down can be more feasible. Without an epidural, you may naturally feel compelled to push as the contractions occur.
Practice Pushing: During a cervical exam, I often suggest a “practice push.” This involves actively pushing with contractions to see how effectively the baby is descending. If progress is good, we might consider laboring down; otherwise, we may need to start pushing.

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Positions for Laboring Down

The position you assume during laboring down is critical and should depend on where the baby is in your pelvis:

Engaging the Inlet: For a baby that is not yet engaged, wide knee positions can help open the top of the pelvis. Side lying or sitting with a peanut ball can create the space needed for engagement.

Mid-Pelvis Positioning: If the baby is in the mid-pelvis stage (station minus one to plus one), asymmetrical positions, like exaggerated runners, can help. This involves using a peanut ball to encourage movement and assist the baby’s rotation.

Outlet Positions: If the baby is already in the outlet, we typically need to transition to active pushing to facilitate delivery.

Recap and Final Thoughts

Laboring down can be a beneficial approach when you reach 10 centimeters dilated, but it requires careful consideration of various factors:

Duration: Limit laboring down to about an hour to avoid potential complications.
Health Status: Ensure that delaying pushing is safe for both you and your baby.
Personal Preference: Some may prefer to push immediately—it’s your choice, and you can always reassess during labor.
Optimal Positioning: The ideal position during laboring down depends on the baby’s station in the pelvis.

If you’re interested in learning more about childbirth techniques, including laboring down and effective pushing positions, check out our online childbirth education course. We break down the science of labor and birth, and as a thank you for engaging with us today, you can use code YOUTUBE10 for a 10% discount on the course. This course pairs well with our prenatal fitness options, ensuring you’re prepared for a strong and healthy birth experience.

Thank you for joining me today, and I hope this information helps you feel more empowered in your birthing journey!

Roxanne Albert, BSN, RNC-OB