TRAINING FOR TWO

Move Confidently in Pregnancy!

Order Our BOOK!
NEW COURSE! ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ Pelvic Biomechanics ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ for Pregnancy and Birth. ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ NEW COURSE! ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ Pelvic Biomechanics ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ for Pregnancy and Birth. ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ NEW COURSE! ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ Pelvic Biomechanics ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ for Pregnancy and Birth. ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎◆ ‎ ‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎
Login
GET STARTED
Written by

Gina Conley, MS

Understand Laboring Down: Wait to Push!

  • Birth, Birth Options, Pushing

Undestanding Laboring Down

So, you’re 10cm!! Completely dilated! It’s time to push! Wait… not so fast. There is more to labor than just dilation. We can decrease pushing time and conserve energy levels if we allow your body to labor down.

What is laboring down? First, we need to explore a few concepts.

The Fetal Ejection Reflex: Spontaneous Pushing

The fetal ejection reflex is when the body spontaneous bears down and starts pushing. This may be more obvious if you are unmedicated, or laboring without pain medication, but can still be felt or noticed even with an epidural. This reflex cannot be stopped, and may produce anxiety if you are cued to stop pushing.

If you are unsure if you should be pushing, but you are spontaneously bearing down without control, focus on relaxing and releasing tension with your exhalations. Allow the reflex to happen without fighting it, but don’t add to the push.

If you are bearing down, but you are not yet 10cm, an inversion may be helpful to take some pressure off the cervix. This may reduce the reflex.

It is important to note that the fetal ejection reflex will eventually push your baby out for you. So, there may not be a need to actively push for a prolonged period of time. Patience may be the answer to easier pushing.

Childbirth Education Review
Everything! You guys provided lots of information/recommendations especially for myself that’s becoming a first-time mom. Definitely helped prepare me for labor and made me more comfortable prior to needing to go to the hospital while feeling more confident in my decision making for my birth plan; while also accepting that things may not entirely go as planned.
Childbirth Education Review
I loved how you provided very unbiased, evidence based research regarding both vbac and repeat csections. You normalized elective csections for me and made me realize that it is not a failure if it becomes the route that I take.
Childbirth Education Review
I would share this training from the mountaintops if I could! I'm a FTM and have had to work 15-hour days for most of my pregnancy so wasn't feeling as prepared as I wanted to. This training though has changed that, I feel more prepared for what to expect and how to handle the unexpected. Even my husband feels like he's ready! THANK YOU!!!!!
childbirth education courses

Laboring Down

Laboring down is allowing this fetal ejection reflex to push your baby down for you, even after you’ve reached 10cm. This is also called delaying the second stage or delaying pushing. We may want to delay active pushing until baby is at a lower station to decrease the overall time of active pushing efforts.

If baby is still above +2 station (0, +1 station for example), it may be beneficial to allow the fetal ejection reflex to passively push baby to a lower station. In some of us, the difference between +1 and +2 station could be an entire knuckle! +2 may only be one finger tip or digit away from the vaginal opening, while +1 may be two finger digits away.

Station is measured from baby’s presenting part (usually the head) in relation to the ischial spine, a bony prominence in the back of the pelvis. The further down baby is from the ischial spine, the closer they are to the vaginal opening. The closer baby is to the ischial spine or even above it, the further baby is from the vaginal opening.

If you start actively pushing when baby is higher, there is more distance that baby has to be pushed before birth. As opposed to pushing when baby is +2 or lower (sometimes only a finger tip distance).

Waiting to actively push when baby is at a lower station can decrease overall active pushing time, conserve energy (pushing requires a lot of energy and effort in most cases, and can be the most overwhelming part of labor with both visceral and somatic pain being stimulated), and can be less stressful on both mother and baby.

In the Cochrane Review by Lemos et al, they found that laboring down may increase the length of the second stage of labor (once you hit 10cm), but decreases the active pushing portion. This also seems to increase the occurrence of vaginal delivery.

Is Laboring Down Dangerous??

In one study by Yee et al, they found that delaying pushing 60 minutes versus immediate pushing (pushing with 30 minutes) after being 10cm to increase the length of active pushing, increase the risk of c-section delivery, and increase the risk of instrument assisted delivery. These results seem to contradict the results of the Cochrane review, that included 21 studies.

In both reviews, baby’s station did not seem to be a determining factor of when active pushing should begin (at least it was not indicated as a variable to study). Both seem to agree that the greater the length of active pushing, the increased risk of c-section.

But, could the increase in active pushing length be rather a factor of baby’s position as opposed to when pushing was initiated? If baby is in a malposition, making it difficult to rotate and extend under the pubic arch, then active pushing would be prolonged regardless of when pushing was initiated.

Conclusion

Laboring down, or delaying pushing, til baby is at a lower station could increase the overall second stage (10cm and beyond) but decrease active pushing time. This could decrease the amount of effort and energy required to actively pushing baby out of the vagina, decrease risk of c-section and instrument assisted delivery, and increase the occurrence of vaginal delivery.

Whether or not you should be laboring down is up to you! You may not have a choice if you are unmedicated and spontaneously bearing down! Ultimately, birth outcomes seem to improve when YOU choose how to push and when to push!

Learn more in our upcoming pushing webinar and in our childbirth education courses, where we break down pushing techniques and cues to help you be more efficient in bringing your baby into the world!

childbirth education courses

View All Courses 
REFERENCES:

Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev. 2017 Mar 26;3(3):CD009124. doi: 10.1002/14651858.CD009124.pub3. PMID: 28349526; PMCID: PMC6464699.

Yee LM, Sandoval G, Bailit J, Reddy UM, Wapner RJ, Varner MW, Caritis SN, Prasad M, Tita ATN, Saade G, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Maternal and Neonatal Outcomes With Early Compared With Delayed Pushing Among Nulliparous Women. Obstet Gynecol. 2016 Nov;128(5):1039-1047. doi: 10.1097/AOG.0000000000001683. PMID: 27741203; PMCID: PMC5119640.