Preparing for the birth of your baby is an exciting time! Gathering information, considering your options and creating a birth plan and labor strategies will help you feel more at ease. At Treasure Valley Pelvic Health we help you do just that.
We believe the use of your breath in relationship to your pelvic floor is key. Mindful breathing has long been known to have health benefits and is known to calm the nervous system. According to Harvard Medical School, diaphragmatic breathing encourages full oxygen exchange, slows the heart rate and lowers or stabilizes blood pressure. This can play a key role in your ability to relax and focus during labor and facilitate the birth of your baby. Your breath can support you to “ride the waves” of your contractions and encourage your cervix, vaginal canal, pelvis and pelvic floor to expand and relax.
With a good diaphragmatic inhale there is an expansion of your diaphragm and other muscles, tissues and organs. With the inhale, your diaphragm expands and lowers in the abdominal cavity, your abdomen and ribs move outward, your abdominal organs shift slightly southward and your pelvic floor descends and lengthens to accommodate for this shifting. Additionally, your sacrum and tailbone lift back and out slightly, and your “sits bones” at the bottom of your pelvis move out and away from each other. This coordinated movement in the body and specifically the pelvis helps to create space for your baby to pass down and out of your body and into the world.
Your Pelvic Floor During Labor
Many of us know that we have a pelvic floor and have a rough idea of where it is. We even roughly understand that it plays a role in pregnancy and childbirth, but sometimes the details are a little vague after that. Your pelvic floor muscles attach to the bones of your pelvis and create a hammock like sling that supports your organs. When contracted, the muscles draw in and upward, like a drawstring bag. When fully relaxed, as then ideally should be for labor, they lengthen down and out like an umbrella or a flower opening. In the clinic, we often get questions from an expecting Mama on how to strengthen the pelvic floor to prepare for pushing for labor. This is actually not the ideal approach in preparing for labor. In labor, the main role of the pelvic floor is to get out of the way and fully open so that your baby can move down with each contraction of the uterus. If the pelvic floor does not do this, there is more resistance to baby descending in the vaginal canal and can increase stress to both of you.
Types of Pushing
When it comes time for your baby to be born, there are two general types of pushing that might be utilized- coached and uncoached.
Coached Pushing
“Coached” pushing is a valsalva-type pushing. Valsalva-type pushing is generally defined as pushing while bearing down for 10 seconds at a time, repeatedly, while holding the breath. It is generally begun as soon as a woman is fully dilated, and medical personnel are there to attend to her. Its timing is determined by the onset of a contraction and initiated by the doctor, midwife or nurse who coaches the woman when to push. This type of pushing became common at the same time epidural anesthesia was introduced in hospitals because women who had epidurals were sometimes unable to feel any sensation in the lower half of their bodies and so had difficulty knowing when or how to push. Today, epidurals are usually administered in a way that most women can still feel when they have the urge to push, and an epidural just provides pain relief. This puts in question the need for coached pushing.
Possible negative effects of coached pushing/Valsalva are:
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exhaustion and discomfort
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possibility of reduced oxygen supply to baby
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more stress and pressure on mom and her bony structures, pelvic floor and perineal tissues
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more risk of tearing, episiotomy, mechanical intervention during birth, and possible prolapse.
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increased pain severity and persistent low back and SI joint pain
Uncoached Pushing
This is the method that we teach at TVPH. It is a gentle, relaxed style of pushing or “opening” which is often referred to as “spontaneous” or “maternal” pushing because its timing and duration are determined by the mother and her body’s urges. It begins at some point after your cervix is fully dilated, when you feel the urge rather than being guided by another person. The pressure of your baby’s head against your pelvic floor often stimulates an urge to push, and when women follow their own instincts, they don’t always begin pushing until sometime after the cervix is fully dilated and their pushes tend to be shorter in duration.
Pushing in this manner allows the vaginal tissues to gently spread out around the baby’s descending head. It decreases stress and pressure on you, decreases stress on your body and improves your ability to conserve energy. It may also decrease the chance of over stretching the pelvic floor ligaments and muscles further decreasing the risk of prolapsed organs, damage to pelvic floor and perineal tissues or bony structures. It can support better fetal oxygenation, decrease overall pain severity and risk of persistent pain after labor and the need for mechanical intervention. (Osborne and Hanson, 2014).
Roberts et al.,(2007) found that spontaneous pushing led to greater release of oxytocin, more effective uterine contractions, better rotation and descent of the fetal head in the maternal pelvis, rapid progress of labor, and, as a result, an increase in spontaneous vaginal delivery.
As not everyone is familiar with how to work with their pelvic floor in this way, we recommend you begin practicing how to relax the pelvic floor and coordinate your breathing effectively at the beginning of your 3rd trimester of pregnancy. This gives you 10 weeks to practice before your birth, so that it becomes familiar and more automatic. This way, during labor you can be relaxed, confident and prepared without having to think through the steps of how to fully relax the pelvic floor. If someone struggles with chronic constipation, pelvic pain or particularly anxious about their birth, it can be beneficial to begin practicing earlier in the pregnancy.
If you would like to work one-on-one with a pelvic health specialist to prepare for your labor, we are happy to see in our Eagle clinic. You can call the clinic at 208.629.1030.
We also have an online option as well! In our online Push Prep course, we teach you everything you need to know to be prepared and confident on your “birth-day.” You will learn how to work more effectively with your breath and the pelvic floor so that these muscles can move out of the way and allow the uterus to work its magic with each contraction. We have recently expanded and improved this course! Now in addition to nearly 3 hours of guidance from Dr. Chelsea in how to work with your body and your pelvic floor, we added additional valuable resources including:
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6 expert interviews with an OBGYN, midwife, doula, chiropractor, lactation specialist and nutritional therapist,
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Addressing the most common questions we receive about early postnatal care,
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6 guides helping you navigate questions about interventions through labor, what if a cesarean should be needed, tips for staying in effective labor positions for extended periods, resources to help you have a smoother pregnancy and more.
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And LIFETIME ACCESS.
The next enrollment for our Push Prep class will be from 12/04-12/11. Follow the LINK to learn more.
References
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Lemos, A., Amorim, M.M., Dornelas de Andrade, A., de Souza, A.I., Cabral Filho, J.E., & Correia, J.B. (2015). Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews, 10 (CD009124).
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Osborne, Kathryn, and Lisa Hanson. “Labor Down Or Bear Down.” The Journal of Perinatal & Neonatal Nursing 28.2 (2014): 117–126. Brancato et al.
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Relaxation techniques: Breath control helps quell errant stress response, Harvard Health Publishing. https://www.health.harvard.edu/mind-and-mood/relaxationtechniques-breath-control-helps-quell-errant-stress-response. Updated: July 6, 2020, Published: January, 2015.
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Roberts, J, and L Hanson. “Best Practices In Second Stage Labor Care: Maternal Bearing Down and Positioning.” Journal of Midwifery & Women’s Health 52.3 (2007): 238–245.
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Vaziri F, Arzhe A, Asadi N, Pourahmad S, Moshfeghy Z. Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial. Iran Red Crescent Med J. 2016;18(10):e29279. Published 2016 Aug 10. doi:10.5812/ ircmj.29279
