Unless you are in the birth worker field, your own birth experiences may be the only time you have experienced supporting or being a part of a birth! This is likely also true for our partners. It can be overwhelming to know what to do to help you labor for our partners, especially when pushing begins since that is when the room begins to fill with a crowd to support.
Here are some tips for your partner to keep in mind when it comes to pushing!
1. Advocate for your preferred pushing position
Before your labor, it can be helpful to have a conversation with your partner on what pushing positions you would like to try out. You may switch positions a few times, but it can be helpful to have a few positions in mind before your birth. You can even practice beforehand on how you can be supported in each pushing position!
We find it helpful to have a printed-out PDF of different pushing positions, so if you do need more help getting into a position, you can show the image to the nurse who can help you adjust. It can also be helpful to discuss your preferred pushing position before it’s time to push. This could help you gauge how receptive your supporting staff members may be to pushing in a position that may or may not be different than a traditional lithotomy position (pushing on your back).
When it is time to push, I usually will ask my doula client out loud: “What position would you like to try pushing in first?” This can be something your partner does as well to advocate for you making the decision on how you would like to push. If there is pushback on the position you are trying by your supporting staff members, I will usually then follow up with: “We would like to try this position first. Can you support us in this position? After we try this position, we can adjust based on how pushing is going.”
If there is pushback, you may find that the staff member does not support pushing at all, or they may be encouraged to try something new. After about 30-45 minutes in position, it could be helpful to explore a new position.
2. Provide physical support in your preferred pushing position
Your partner can provide physical support while you are pushing! This is the most common way that your partner can support you. They can either hold your leg, support your back, play tug of war and so much more. It can be helpful to practice pushing positions prior to birth so that you both have an idea of what feels comfortable for each of you with physical support.
3. Count for you and cue you when its time to push
Your partner can count when you are pushing, usually a count of 6-8, and let you know when it’s time to push if you are feeling unsure.
But how can your partner know it’s time to push?? They can watch the monitor if there is one nearby! When looking at the monitor, typically we are looking for the two-digit number that increases when a contraction happens and decreases as the contraction fade. It can be a great question to ask your nurse while you are on the monitor, “which numbers mean what on this monitor?” When you see the number begin to increase, your partner can let you know it’s time to get ready to push. You can then try to correlate the sensation you are feeling with a contraction, such as an increase in pressure, hardening of the belly, or a feeling that you are pushing. If your baby is low enough, your partner can even see your baby’s head start to move down!
When it is time to push, either you feel the urge, or your partner cues you that it may be time to push, we want to focus on taking 3-4 pushes per contraction. You’ll take your big inhale, then begin to bear down either holding your breath or exhaling as you bear down.
As you begin to push, your partner can count out loud 1, 2, 3.. all the way to 6 or 8. Sometimes hearing someone count out loud can be helpful to motivate you during your push! We recommend a count of 6-8 because usually after 8 seconds, we are no longer pushing effectively and are wasting energy.
How do know how long to push?? When you are pushing, your partner can pay attention to the area of the perineum below the vaginal opening. This space will bulge outwards as you push, but there may be a point where the bulge fades away but you are still pushing. This can be a clue that you are not really pushing anymore, and it would be worth stopping the push and setting up for the next one! This may happen about 6 seconds, or it may be as long as 8 seconds. And it may vary from push to push!
The two-digit number (28) is the TOCO number, measuring the trend in contractions. If you are being externally monitored, the number does not mean anything in regard to pressure or contraction strength. The changes in that number correlate to when a contraction is happening, how long it lasts, and how often contractions are occurring; aka it is looking at the trend. If you have an internal monitor, then the number is measuring the actual pressure during a contraction.
4. Enhance your pushing position
After you have gotten into your preferred pushing position, your partner can do a quick scan to see if there was anything that could be enhanced with your setup. This could include putting a pillow along your back if you choose to push more supine so there is space for your sacrum (see supine pushing image in part 1), or setting up the bed so your bottom leg is also in internal rotation if you choose a side-lying position. There is a lot we can do to enhance pushing positions!
5. Advocate for your postpartum preferences after birth
After your baby has been born, your partner can advocate for your family’s postpartum preferences, such as delayed cord clamping and immediate skin to skin. Your partner can also be the one in charge of communicating with the baby nurse (sometimes called stork nurse) on what newborn procedures and medications you all have chosen for your baby (such as the Vitamin K shot, Erythromycin eye drops, and the Hepatitis B vaccine).
Your partner can play an active role in supporting you during your birth! It will require some preparation beforehand as a team, such as taking a childbirth education course or potentially hiring a birth doula, but together you can prepare for birth.