Once your labor is complete, you've graduated to the second stage of childbirth: It's time to push and deliver. You're almost there!
You're almost at the finish line (or more accurately, baby is) — but getting there is going to take a bit of pushing. Up until this point, you haven't been able to do much to speed along the process of childbirth, but things are about to change. With cervical dilation complete, it's time to help your baby through the birth canal by pushing.
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.
What will you feel when it's time to push during labor?
During this stage, your contractions should be more regular than the contractions in transitional (advanced) labor. They are still about 60 to 90 seconds each but are further apart (usually two to five minutes) and possibly less intense, though sometimes they’re more intense.
You should now notice a well-defined rest period between them, though you may still have trouble recognizing the onset of each contraction.
Common in the second stage (though you’ll definitely feel a lot less — and you may feel nothing at all — if you’ve had an epidural):
- Pain with the contractions, though possibly not as much
- An overwhelming urge to push (though not every woman feels it, especially if she’s had an epidural)
- Tremendous rectal pressure (ditto)
- A burst of renewed energy (a second wind) or fatigue
- Very visible contractions, with your uterus rising noticeably with each
- An increase in bloody show
- A tingling, stretching, burning or stinging sensation at the vagina as your baby’s head emerges
- A slippery wet feeling as your baby emerge
How to push during labor
You may now feel relieved that you can start pushing (though it’s totally normal to feel embarrassed, inhibited, scared or even frustrated, especially if it’s taking longer than you anticipated). It’s time to get this baby out.
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To get going, you'll move into the pushing position of your choice and, following the instructions of your practitioner or the hospital or birthing center staff, you'll push at regular intervals, usually three times with each contraction, or as you feel the urge. You might want to rest for one contraction if you're getting tired.
Here are some more pushing tips to try:
- Push as if you're having a bowel movement. Relax your body and thighs and push as if you’re having the biggest BM of your life. And speaking of bowel movements, put all your concentration and focus into the pushing — not into worrying about whether you'll be emptying your bowels or passing urine while you're at it (that happens to every delivering mom — and people who attend births for a living understand this, expect this and don't think twice about it).
- Tuck your chin to your chest. If you're propped up on your back, make sure you put your chin to your chest to push. This will help you focus your pushes to where they need to be. It might also help to look down below your navel so you remember where your pushes should originate from
- Give it all you’ve got. The more efficiently you push and the more energy you pack into the effort, the more quickly your baby will make the trip through the birth canal.
- Stay focused. Maintain control and try to avoid frantic pushing, too — you don't want to push with your upper body or strain your face.
- Change positions. Sometimes, if the pushing isn’t moving your baby down the birth canal, it may be helpful to change positions.
- Trust your instinct. Take a few deep breaths while the contraction is building so you can gear up for pushing. As the contraction peaks, take a deep breath and then push with all of your might — holding your breath or exhaling as you do... whatever feels right to you. If you’d like the nurses or your coach to guide you by counting to 10, that’s fine, or not — there’s no magic formula. Do what comes naturally. Follow the urges you feel to push, and you’ll deliver your baby. (Actually, you’ll deliver even if you don’t follow your urges or if you don’t have urges at all; if you’re concerned, ask your practitioner, nurse or doula to help direct your efforts.)
- Rest between contractions. You'll need to conserve your energy and rest up for the next round — pushing is labor (and delivery) intensive.
- Stop pushing as instructed. Your practitioner may suggest you stop pushing for a couple of contractions so you can regain some strength or to keep baby’s head from being born too rapidly. If you’re feeling the urge to push, pant or blow instead.
- Keep an eye on the mirror. Once there’s something to look at, watching your baby’s head crown (and reaching down and touching it) may give you the inspiration to push when it gets tough. Keep in mind, though, that pushing is a two steps forward one step backward process — so don't become frustrated when your baby's head crowns and then disappears again once you're within shouting distance of the finish line.
What is your medical team doing while you're pushing?
While you’re pushing, the nurses and/or practitioner will give you support and direction while continuing to monitor baby’s heartbeat (with a Doppler or fetal monitor). They’ll also prepare for delivery by spreading sterile drapes and arranging instruments, donning surgical garments and gloves, and sponging your perineal area with antiseptic.
If necessary — though these procedures are performed rarely these days — they’ll perform an episiotomy (fortunately only in very rare instances) or use vacuum extraction or forceps.
Once your baby's head is out:
- Your practitioner will suction mucus from the nose and mouth, then help guide the shoulders and torso out (you’ll usually only have to give one more small push to help with that).
- The umbilical cord will be clamped and cut — either by your practitioner or coach. Sometimes delayed cord clamping may be recommended.
- Your baby will be handed to you or placed on your stomach. Now’s a great time for skin-to-skin contact, so lift up your gown and bring your baby close (studies have shown that those who have that contact right after delivery sleep longer and are calmer hours later).
- If you’ve arranged for baby’s cord blood to be collected, that will be done now.
- You'll also have to prepare for one last push: delivering the placenta.
What happens after delivery?
The nurses and/or a pediatrician will evaluate your baby’s condition and rate it on the Apgar scale at one and five minutes after birth. Your baby will get a brisk rubdown, and both you and baby will receive an identifying band.
Baby will be weighed, have ointment placed in his or her eyes (to prevent infection) and wrapped to prevent heat loss. (In some hospitals and birthing centers, some of these procedures may be omitted; in others, many will be attended to later, so you can have more time to bond with your newborn.)
Then assuming all is well, you’ll get your baby back and you may, if you wish, begin breastfeeding (but don’t worry if you and/or your baby don’t catch on immediately. Later, it’s off to the nursery for baby for a more complete pediatric exam and some routine protective procedures (including a heel stick, vitamin K injection and a hepatitis B shot).
Once baby’s temperature is stable, he or she will get a first bath, which you may be able to help give. If you’re rooming-in, your baby will be returned to you as soon as possible and tucked into a bassinet next to your bed.
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