Until recently, women have been asked to start pushing as soon as the cervix has dilated to 10 centimeters, but as long as you do not have a fever and your baby's heart rate is normal, there are many benefits to waiting to push until you feel the need to push.
The cervix must be 100% effaced and 10 cm dilated before a vaginal delivery.
But if you're close to 10 centimeters dilated the research suggests it's not an issue. Evidence suggests it's more of a theoretical fear that just adds additional stress and in some cases results in an epidural (or a higher dose of epidural) to mask that urge.
The urge to push is initiated by the position of the baby's head within the pelvis (Roberts et al 1987). Therefore, the cervix can be fully dilated without the baby descending deep enough to initiate an urge to push. Alternatively, spontaneous pushing can begin before the cervix is fully dilated.
The Active Phase of Labor
The second, pushing phase of labor continues after the cervix is fully dilated (open) to 10 cm until the delivery of your baby. It averages 4 to 8 hours but can be as short as several minutes.
Laboring down is the process of not actively pushing once the second stage of labor and intense contractions begin. Some people wait one to two hours before pushing, which allows the baby to naturally move down the birth canal. Laboring down has risks and benefits.
For first-time mothers the average length of pushing is one-to-two hours. In some instances, pushing can last longer than two hours if mother and baby are tolerating it. Normally, the baby is born with his face looking toward mother's back (referred to as an anterior position).
Pushing sooner during childbirth is just as safe for most women and babies as pushing later, researchers report. The best time to start pushing during labor has been a matter of debate. Many U.S. hospitals recommend delaying pushing, but evidence has been inconclusive.
Early pushing urge (EPU) is defined as the perception of the irresistible urge to push by the labouring woman before full cervical dilatation, confirmed by vaginal examination.
Three to four pushing efforts of 6 to 8 seconds in length per contraction are physiologically appropriate (AWHONN, 2000; Roberts, 2002; Simpson & James, 2005). When the time is right for pushing, the best approach based on current evidence is to encourage the woman to do whatever comes naturally.
When your baby is ready to begin the journey through the birth canal, your cervix dilates from fully closed to 10 centimeters. This process can take hours, days, or even weeks. But once you hit active labor – about 6 cm dilated – it's usually just a matter of hours before you reach full dilation.
However, there are still times you might be told not to push. Labor is the process that prepares a woman to deliver her baby into the world. Doctors tell a woman not to push during labor because she is not ready, there may be a problem with the baby or she may have had an epidural.
Doctors have to wait until the cervix is at least 4 centimeters dilated before doing an epidural. Otherwise, the epidural will slow the process down too much. However, once the cervix becomes fully dilated it is too late for an epidural to be given.
In general, once the active stage of labor kicks in, it's a safe bet to expect a steady cervical dilation every hour. Many women don't start really dilating more regularly until closer to around 6 cm. The first stage of labor ends when a woman's cervix is fully dilated to 10 cm and fully effaced (thinned out).
Maternal height of 178–179 cm was associated with the lowest risk of CS (OR = 0.76, CI95% 0.71–0.81), whereas height below 160 cm explained 7% of CS cases.
95% of women took less than 2 hours to dilate one centimetre during active labour. Most hospitals and health care providers have now updated guidelines to acknowledge these new findings.
Purple pushing, coached pushing, holding your breath, all mean basically the same thing. Mothers being instructed on pushing causes them to hold their breath and push down into their bottom. Another more normal and less exhausting option would be “breathing or bearing down” working with the contractions.
Pushing Can Feel Like Relief
Your baby's head may press on nerves that desensitize the pelvis, and many people report feeling a numb sensation before the "ring of fire" (when the baby's head begins to emerge from the vaginal opening, a stage known as "crowning"). Some even say it feels good, similar to orgasm.
Problems with the uterus, cervix or placenta. Smoking cigarettes or using illicit drugs. Some infections, particularly of the amniotic fluid and lower genital tract. Some chronic conditions, such as high blood pressure and diabetes.
While slightly more than half said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. Moms 18 to 39 were more likely to say post-delivery pain was the most painful aspect than those 40 and older.
How long does it take to push baby out? In all, delivery generally takes 30 minutes to an hour, but it could take as long as three hours, especially in first babies (second and subsequent babies usually pop out a lot faster), or as short as a few minutes.
Pushing your baby out
You may not feel the urge to push immediately. If you have had an epidural, you may not feel an urge to push at all. If you're having your 1st baby, this pushing stage should last no longer than 3 hours. If you've had a baby before, it should take no more than 2 hours.
Does delivering the placenta hurt? Delivering the placenta feels like having a few mild contractions though fortunately, it doesn't usually hurt when it comes out. Your doctor will likely give you some Pitocin (oxytocin) via injection or in your IV if you already have one.
Doctors now know that newly born babies probably feel pain. But exactly how much they feel during labor and delivery is still debatable. "If you performed a medical procedure on a baby shortly after birth, she would certainly feel pain," says Christopher E.
There shouldn't be any problems in delaying pushing until the woman feels the need to bear down. Delayed pushing might take a few contractions or there could be a time when contractions seem to stop for a short while.