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.
(The last part of active labor, when the cervix dilates fully from 8 to 10 cm, is called transition.) This process takes about 5 to 7 hours if you're a first-time mom, or between 2 and 4 hours if you've had a baby before. The exact duration of this stage is different for everyone.
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.
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.
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.
Stage two: full dilation and pushing
Once the cervix has reached 10 cm, it is time to push the baby out. Contractions continue but also produce a strong urge to push. This urge might feel like an intense need to have a bowel movement. This stage can last anywhere from a few minutes to a few hours.
Some women will instinctively push before their cervix is fully dilated. This is often treated as a complication, and a common approach is to encourage the woman to stop pushing due to fear that cervical damage will occur. However, there is no evidence to support this concern.
"As soon as someone is admitted to the hospital, they're kind of on the clock," Caughey said. -If women aren't too tired, allow them to push at least two hours if they have delivered before, three hours if it's their first baby. They may push longer if they had an epidural as long as the doctor can see progress.
Although it is the shortest phase, the transition phase is the most challenging. Transition typically lasts 30 minutes to 2 hours as your cervix fully dilates from 8 cm to 10 cm.
Your cervix needs to open about 10cm for your baby to pass through it. This is what's called being fully dilated. In a 1st pregnancy, the time from the start of established labour to being fully dilated is usually 8 to 18 hours. It's often quicker (around 5 to 12 hours), in a 2nd or 3rd pregnancy.
It usually takes from 15 minutes to an hour for the cervix to dilate from 8 to 10 centimeters. Contractions are 2 to 3 minutes apart and last about 1 minute. You may feel pressure on your rectum and your backache may feel worse.
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.
Pushing Can Feel Like Relief
Some even say it feels good, similar to orgasm. Pushing is often described as relief from active labor contractions because it's a natural urge you can give in to. For many, it feels more active than passive.
Getting up and moving around may help speed dilation by increasing blood flow. Walking around the room, doing simple movements in bed or chair, or even changing positions may encourage dilation. This is because the weight of the baby applies pressure to the cervix.
The most common reason for telling a women not to push is that her cervix is not fully dilated. Often when a baby is in an occipito posterior position the woman will feel the urge to push before the cervix is completely open.
During active labor, your cervix will dilate from 6 centimeters (cm) to 10 cm. Your contractions will become stronger, closer together and regular. Your legs might cramp, and you might feel nauseated. You might feel your water break — if it hasn't already — and experience increasing pressure in your back.
Delayed pushing had some adverse consequences. Four percent of women who waited to push had excessive bleeding after delivery compared with 2.3 percent who pushed right away. The delayed pushers had more bacterial infections: 9.1 percent versus 6.7 percent of the women who pushed immediately.
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).
Some women don't feel the urge to push right away after they're fully dilated. Laboring down means taking a pause – for as long as an hour or two. This gives time for the sensation to develop as the baby descends. Your contractions will be doing the work of moving your baby down the birth canal without your pushing.
Joanna was forced to remain in the tilted position 24 hours a day for two and a half months. After 75 days – and what is believed to be the longest labour ever recorded – Joanna gave birth to a healthy girl, Iga, and boy, Ignacy. The two babies were delivered by caesarean at a neo-natal clinic in Wroclaw, Poland.
An epidural can generally be performed at any stage; it is never too late. This is, however, not the case if baby's head is crowning (within the birth canal).
Typically, you can receive an epidural as early as when you are 4 to 5 centimeters dilated and in active labor. Normally, it takes about 15 minutes to place the epidural catheter and for the pain to start subsiding and another 20 minutes to go into full effect.
The active phase
Your cervix is also dilated around 4 to 7 centimeters. Someone who has never given birth before may be in active labor for around three to six hours; a person who's done it before might take one to three hours.