Idiot question about pushing

[BMorelli]

So I'm 39 plus 6, about to have DS1 after DD1 was born 16 months ago. Natural labour, fairly quick, only problem is I basically effed up the pushing stage and ended up with several second degree tears and some grazing to the back wall. Randomly I read a thing the other day about how you're not supposed to stop breathing when you push as you're more likely to tear (think it's a sign you're not pushing at the right time or that you're doing it wrong or something) and I'm absolutely sure that's what I was doing because I remember it so vividly. Question is, how the bloody hell else are you supposed to do it???? Really don't want a similar tear experience this time.

Because your body has done this before, you may well find you don’t tear this time, without having to change anything about the way you’re instinctively trying to push. I had tearing similar to yours, by the sounds of it, with DD1. When I had DS1 20 months later, even though it was a crazy fast birth (only 3 minutes of pushing?!!) there was no tear at all. I didn’t “practice” anything in particular beforehand, and while the midwives tried to coach me through pushing I honestly couldn’t tell you a word of what they said.

Congratulations and good luck!

not too sure about the breathing while pushing , makes sense though I suppose, but with ds1 I had a 3rd degree tear, because of this when I was having ds2 the midwife positioned me on the bed to prevent it happening again , it's a bit vague but she talked me through what to do to prevent it happening again and I only ended up with a 1st degree tear...

I was told on my first not to push until the rim is gone, you can be 10cm but still not fully dilated.Think the rim goes once the babies head is quite low.
I labored for a while after I was10cm before I started to push.
Not sure about the breathing, can’t remember. Just push down into your bottom, like you’re trying to poo lying down.

No stitches
Small graze

I think it depends on how the baby is reacting to labor. They can become distressed or tired and then you need to push ASAP. Luckily my babies didn’t mind labor and it is down to luck.

Hopefully you’ll have an easier time on no2

I have had 2 and did not tear but had an episiotomy both times. I thought the midwife did an episiotomy if it looked like a tear was likely no? I have never herd of using breathing to push in a better way and prevent a tear. But watching with interest to see if anyone knows. Good luck. For what's it's worth my second delivery was a million times easier than my first. Hopefully u are the same.

Thanks so much guys, I gave birth in the water so the midwife wasn't able to help in terms of episiotomy or anything. Spoke to community midwife about it this time and she said it's too dangerous in the water to interfere so as long as they can see you're progressing they leave you to it and deal with the consequence of sometimes slightly worse tears after. Thinking this time for that reason about getting out before pushing cause lying on your left side can help I think? Sounds like you guys all had an easier second time so fingers crossed I can join the club! Soon as well as I'm so over being pregnant lol x

Your midwife should lead you in this.

When at final pushing stage (as head coming out) you have to do lots of small outward breaths to ease them out. Reduces damage. So you blow out repeatedly for about 1 second at a time.

I did this with second child at the weekend.

Unfortunately there’s no way to prevent tearing, and everyone is different. You can however do things such as perineal message to help prevent severe tears.

Re pushing, I think you may have read something about directed pushing (the midwife directs the woman to push) which involves the woman taking a deep breath in and bearing down. Evidence shows that it can increase perineal trauma in comparison to spontaneous pushing.

Re giving birth in water you are less likely to have an episiotomy and less likely to have a severe tear, but may be more likely to have a minor tear (1st or second degree tear). So if you did get out there’s no guarantee that you won’t tear.

Best advice I can give is when it comes to pushing listen to your body, and place your hands gently on your vulva and feel for the baby’s head. This will encourage you to let your vagina stretch once baby’s head is visible, as you will gently push baby out (your fingers will gradually open as baby advances).

Are there any childbirth classes you can do? There are plenty of youtube videos too that explain the pushing process but obviously it's difficult to remember in the moment.

Could you hire a doula? I thought it was all hippy crap but mine is amazing and supportive of any choice I make.

You could also do as ColdCottage suggests and when the head is visible pant/breath and do little pushes to allow the vagina to stretch, however if you place your hands gently at your vulva and when you feel your baby’s head you’ll naturally do this as your fingers will start to widen/separate as baby advances.

Perineal massage - can be done after 34 weeks and helps the area of skin and muscle between your vagina and anus to become flexible and stretch during childbirth

www.rcog.org.uk/en/patients/tears/reducing-risk/

*meant to say vagina and perineum stretch when I’ve talked about baby’s head being visible

If it's an option, could you ask for a water birth? My second was and it was a totally different experience. The midwife literally told me what to do every step of the way - when to breath, push, exactly what position to be in. First time I was in a delivery suite and, although I was closely monitored, there was much less direct guidance. They let me decide what position to be in etc. I'd have preferred to just be told!

The water can help prevent some tearing apparently.

But I really wouldn't stress. Second time is usually a lot easier and you are much less likely to tear. Recovery is quicker too even if you do tear.

Sorry - unhelpful reply- just read rest of thread! I'm sure it will be easier for you this time.

I've been told by various midwives that you should use your breathing to help encourage baby to come out instead of actually pushing it.
It's part of hypnobirthing as well.
Think of when you do a poo, you quite often don't push much as your muscles are doing the work on their own. Even if you are constipated, it's worse if you try and force it by pushing hard, if you take breathes and sharply exhale in a downward motion it can help the downward muscles without you actually pushing.

The midwives have told me that the muscles when giving birth work in the same way. They want to push baby out and they will do a lot of it on their own and the breathing can support that.

Please bare in mind, this is just what my midwives have advised after a speedy prior birth with significant tearing. I'm still waiting for labour so can't tell you from experience if it works or not, but it's what im hoping to try.

frizzy I was told similar, that actually pushing is not necessary and is what causes the tearing. The only reason they do it is to speed things along because not pushing will take longer but be less painful and damaging.

Obviously no idea if it's true or not but what I heard.

After reading some of the comments, there sounds to be some confusion about pushing and the mechanism of labour and birth.

Birth is an extremely complex physiological process but very simplistically 4 main things occur:

• Engagement of the baby’s head at the brim of the pelvis
• Descent of the baby through the pelvis
• Rotation of the baby through the pelvis
• Dilatation of the cervix

But this is not a step-by-step process – it’s all happening at the same time, and at different rates. So whilst the cervix is dilating the baby is also rotating and descending.

Spontaneous pushing
The urge to push is initiated by the position of the baby’s head within the pelvis. The urge to push which is generally spontaneous unstoppable pushing, is triggered when the presenting part descends into the vagina and applies pressure to the rectum and pelvic floor. This is sometimes called the ‘Ferguson reflex’. Instinctive pushing does not commence at the start of contractions, and women do not take a deep breath before pushing: women alter their pushing behaviours, and use a mixture of closed glottis and open glottis pushing. The number of pushes per contraction also varies, with women not pushing at all during some contractions. Women also instinctively alter pushes according to their contraction pattern. For example, if contractions are infrequent women tend to use more pushes per contraction, and if contractions are frequent they push less often. This individual and instinctive pattern of pushing helps to oxygenate the baby more effectively than Valsalva (directed) pushing.

directed pushing
Directed pushing is when the midwife directs the woman to push in an attempt shorten the duration of the second stage of labour. It involves taking a deep breath as a contraction begins; holding the breath by closing the glottis; bearing down forcefully for eight to ten seconds (into the bottom); quickly releasing the breath; taking another deep breath and repeating this sequence until the contraction has ended. It’s usually done if the woman has an epidural, there’s a delay in the second stage or the baby is distressed, they will also be instructed to push if it’s an instrumental birth (forceps/ventouse)

Crowning
This is where the head is emerging and is visible. Some midwives will encourage women not to push as the baby’s head is crowning (when the stinging and burning sensation happens) The rationale of this is to minimise the chance of perineal trauma/tears by slowing down the birth of the baby’s head. A slow birth of the head reduces the chance of tearing as it allows the perineal tissues to gently stretch over time. Some midwives will also use this technique whilst placing one of their hands on the baby’s head whilst using the other hand to guard your perineum in an attempt to slow down the birth of the head, and to reduce the risk of perineal tears/trauma.

However, the intense sensations experienced during crowning usually result in the woman ‘holding back’ themselves so there’s no need for the midwife to use directed pushing on hands on techniques as the uterus continues to push the baby out slowly and gently. In addition, women will often hold their baby’s head and/or their vulva during crowning. Some women will bring their legs closer together, not only slowing the birth but also providing more ‘give’ in the perineal tissues.

So, in a nutshell there’s no need for the midwife to direct you to push or hold back pushing when the baby is crowning, unless the baby needs to be born quickly due to being distressed or if you’ve had an epidural. You can help protect your own perineum by placing your hands gently to feel for baby’s head and you’ll instinctively let the muscles gently push the baby out. You do however have to do some pushing to get the baby to crowning stage as the baby needs to decent through the pelvis and through the birth canal (cervix and vagina)

Here are some good articles to understand the mechanism of pushing and perineal tears, and why midwives/obstetricians use certain techniques to try and prevent tearing.

www.google.co.uk/amp/s/midwifethinking.com/2015/09/09/supporting-womens-instinctive-pushing-behaviour-during-birth/amp/

midwifethinking.com/?s=Ferguson+reflex&submit=Search

Fyi I was in the water.

Also agree I didn't always push when the midwife told me to, listen to your body.

I gave birth 9 weeks ago with no pushing and no tears. I used breathing to manage the labour and when the surges started in force my focus was to keep oxygen flowing to the muscles which stops them over tensing and causing a lot of pain - hence breathing. Instead of pushing just breath and let your muscles do what they need to. Used gas and air during the surge to focus breaths. When she crowned, made the breaths slightly shorter to slow her down, and then she was born. Yes I'm very lucky... but it worked. Was home 4 hrs afterwards. Good luck!

On ds2
I had an epidural but asked the anesthesiologist to give only enough to dull the pain so I could still feel the contractions.

My pains were very severe from oxytocin.
My waters had gone a 24hours with no progression, had no option to wait.
It worked and I feel I had the best of both.

Never heard about the breathing thing.
I was pushing for about 3 hours in the end and at one point thought I was going to burst a bloody blood vessel in my head 😂. Done it eventually with no interventions (thankfully) did have some 2nd degree tearing but it was minimal. I honestly expected to tear a lot more

When someone chooses to push, they generally instinctively hold their breath. Contractions will push the baby out without you actively pushing, and you should be trying to breathe through contractions.

To prevent tearing you want to not push, if you're one who gets an unstoppable urge to then breathing will make you less effective at pushing. There was a thread about gas being taken away during pushing to make women push harder.

Depending on your midwife, her training, and any number of medical reasons, they/you may prefer a quicker birth even with the higher risk of tearing. But for an easy labour pushing is optional. I didn't because I didn't have the urge and our trust has a policy of not telling women to, the rate of tears reduced significantly after they bought that policy in.

Blah said it more technically but that's the idea.