Did you feel the urge? I certainly did! The memory of it is still deeply imprinted in my body. It felt so primal, so passionate, so irresistible. It moved me… moved through me… seemingly unstoppable. At times I could and did feel out of control, but when I aligned with it, I felt so powerful and totally in sync with the force of Nature.
I have always been in awe of the incredible beauty and power of Nature, her ability to create the most exquisite and intricate life forms, as well as her power to unleash a tidal wave that can remove everything in her way in seconds.
During my births I have felt a part of Her, a partner with Her, my body skilfully responding to increasingly intense waves of energy, demanding that I let myself be stretched… and stretched… and stretched even further… beyond what I thought I could do… beyond who I thought I could be… until I was fully opened, fully surrendered. And then, the dance changed, asking me to join with this incredible instinctual urge and release my babies from their soft safe nest into the vastness of our world.
And when I did, it was such a satisfying experience, and in a way effortless, despite the intense physicality.
Yet for some mothers, birthing their baby into the world is a very different experience, requiring of them to artificially match the force of nature with human effort, orchestrated by human timing – sometimes successfully, often not.
This directed pushing can be necessary when there is no urge to push, or no awareness of the urge to push due to the numbing effect of an epidural. But often women are required to push without their body signalling its readiness, because it is part of the routine or protocol of their birthing team.
According to the authors of the Doula Guide to Birth: “Although many caregivers instruct women to start pushing even if they do not feel the urge, this will be about as effective as if you try to push out a bowel movement that is too high up; your body is just not able to perform this action yet. They mention studies in Nursing research and the American Journal of Obstetrics and Gynecology that confirm that “pushing too soon is more likely to drain the mother of energy, cause fetal distress, and lead to the use of forceps or a cesarean section.”
Could ‘failure to progress’ during pushing be the result of mothers being denied the opportunity to follow the natural impulses and timing of their body and their baby?
Reaching full dilation doesn’t necessary mean it is now time to start pushing baby out. It may actually herald the start of the resting or latent second stage phase as described by Penny Simkin, in her classic book Pregnancy, Childbirth and the Newborn: “The latent or resting phase of the second stage is characterised by a lull in uterine activity, a brief rest for you, a pause after the intensity and confusion of transition, and excitement over your baby’s imminent arrival. Contractions may be weak and farther apart for ten or twenty minutes, descent may be slow or stop temporarily, and your urge to push may be nonexistent or easily satisfied with slight bearing down efforts.”
Not all women will experience this pause in labour, but it is important that the mother and support team are ready for it and aware of what may be happening during this important ‘rest and be thankful stage’, as it has been called by Sheila Kitzinger. So what is the body wisdom behind it?
- It’s a chance for a “catch up break (1)”, for mother and baby to rest and recuperate and prepare for the next phase of the birthing journey.
- It is the time to let the mother’s body get used to the sensations and increasing pressure of the baby moving down towards her pelvic floor.
- It is a time of physical adjustment:
– As the baby’s head passes through the cervix into the birth canal, leaving the baby’s body inside the uterus, the uterus which has been stretched tightly around the baby, becomes a bit slack. During the resting phase, the muscle fibers in the uterus shorten and tighten around the rest of the baby’s body.
– Baby needs time to get himself into the best-fitting position for birth, wriggling and rotating until he achieves it, with his head moulded and his chin tucked down.
All this may need to take a considerable amount of time, a challenge when most institutions only allow an average of 2 hours from full dilation before starting interventions. Why 2 hours? Is there evidence to prove the necessity to intervene at this point? From the results of a nationwide survey in 2004 (2), it was concluded that women could push safely for up to 8 hours. ” While the idea of pushing forcefully for that long sounds very unappealing, it is completely possible that a mother might not feel any urge to push until several hours after full dilation: then it could take several more hours for the baby’s head to rotate, descend and mould, and for the urge to build to full strength. Being patient and encouraging the mother to rest (not push forcefully) is key to success during this phase.”
- It is a time of emotional adjustment, the final part of the bridge between pregnancy and motherhood. A time to say good bye to the baby safely nestled in the womb, to her life as a woman and embrace the next step. It is also the time for the mother to release her fears and anxiety. Is she scared of tearing, of releasing her bowels in public, concerned about the baby’s wellbeing or of being a mother? Ina May Gaskin, a midwife whose team attended more than 2200 births, has written extensively about the powerful mind/body connection in birth. Her experience confirms that ‘ like all female mammals we have a programmed-in-protection process during the vulnerable process of labour and birth. Female animals in labour in the wild, such as gazelles and wildebeests, can be on the point of giving birth and yet suddenly reverse the process if surprised by a predator. In humans this fight or flight reaction is not only a response to “real” threats but also to perceived threats or imaginary fears. Whilst being in a state of anxiety or feeling exposed and unsafe, a woman’s body may block the urge to push.
As educators and members of the birthing team we can make a difference and create a more woman-centred birthing environment.
During the second stage we can:
- Support mothers to listen to and respond to their body signals.
- Inform mothers and their partners about the resting phase and the blessing it can be for all, if the mothers are supported to rest.
- Encourage mothers to relax through the early mild or moderate bearing-down urges, neither resisting them nor adding extra force to them, but relaxing through them just as they have done during the opening contractions, until baby reaches it’s mother’s pubic bone and the urge to push become overwhelming – and then work together with this powerful force. Research(3) has shown that once the baby has reached the pubic bone most babies are born within half an hour. This approach would prevent a lot of exhaustion and possible interventions.
- If malposition is suspected as a reason for a lack of pushing urge, encourage the mother to change position, walk around or try pelvis rocking.
- If you think there is a need to, encourage the mother to open up and express her fears by asking gentle questions such as “Is there anything bothering you right now? or ” I wonder if there is something on your mind that’s holding you up?” with an attitude of loving acceptance.
- Give her time… As long as baby is healthy throughout the process, all that a mother may need is patience, time and sensitivity to the uniqueness of her birth process.
- If the natural urge to push needs to be jump-started (for whatever reason), try Pam England’s advice and have the partner (or do it yourself) stimulate the pushing reflex by placing his/her fingers in the mother’s vagina and pushing downwards during a contraction.
Sheila Kintzinger suggests that the energy of the second stage comes in waves, much as women experience sexual energy in making love. The male model of tension, tension, tension, explosion, which has been used until now, is not one that fits the female body or feminine images (3).
Now is the time for us all to reclaim the feminine in Birth and support women to flow with the natural rhythms and the impulses of their body!
Olivia Seck is a holistic birth practitioner, a doula and trainer and the founder of Birthing Wisdom. She also facilitates Holistic Hypnobirthing retreats in a beautiful setting in Devon.
There is much more that could be said about the 2nd stage but this article has particularly addressed working with the natural rhythms of the body, and I hope it is of benefit. I have had something of a bee in my bonnet about this particular topic for many years, struggling to explain with the mind and in words something which I felt clearly and instinctively in my body when giving birth to my 4 children, naturally at home. This article is an attempt to put this across.
Feel free to email me your feedback. I have been involved with birth and birthing women for many years now, learning and training others and I am aware of the importance of dialoguing and the continuing process of learning and sharing, which is how we will eventually build a comprehensive body of knowledge.
- Penny Simkin: The Birth partner
- Ananda Lowe and Rachel Zimmerman: The Doula Guide to Birth
- Rahima Baldwin and Terra Palmarini: Pregnant feelings