Crapping a watermelon. A pumpkin. A basketball. Vomiting in the other direction. Being torn in two. What have you heard?
Yesterday I wrote about what a contraction feels like. Today I’m going to attempt to explain what it feels like to push the baby out. As always, every woman’s experience is unique. But in my years of hearing and reading birth stories, there are some consistent themes. Here’s my best shot:
After the opening of the uterus (the cervix) has thinned out and opened (dilated) with the help of contractions for many/several hours, it’s time to actually push the baby out of the womb and into the world. The baby passes through the birth canal (vagina) and then “crowns” or emerges.
The pushing phase is typically much shorter than the dilating phase and can last, on average for first-time mothers, anywhere from 15 minutes to 4 hours. The length is determined by a few things including positioning, whether pain medications are used, how tired mom is, and how far apart the contractions are. Mom pushes during contractions, and the closer together they are, the faster the pushing phase. A super-fast pushing phase is not necessarily desirable; it’s nice to have some time for the perineum to stretch. In fact, a caregiver will likely ask mom to slow down her pushing if the baby is coming very quickly.
Okay, so what does it feel like?
Toward the end of the dilating phase, some women feel an incredible urge to “bear down.” It’s like the feeling of having to make a huge bowel movement (crap a watermelon). In fact, I’ve heard of women saying, “I have to go to the bathroom,” and it turns out that what they’re really feeling is a head in their vagina, pressing on the same muscles and nerve endings triggered when you’re ready to poop. (Women also can poop a little during birth, but it’s totally normal and cleaned away quickly without any fuss). So the poop analogy can be helpful.
Other women don’t feel this strong urge to push at all. Maybe it comes a little later, when her baby is further down, or if she has an epidural and can’t (totally) feel what’s happening. Sometimes a care-provider will instruct or encourage a woman to push because that urgent need just is not there, epidural or not. A few women feel that they are pushing spontaneously — that’s the vomiting-in-the-other-direction feeling. They aren’t doing a thing consciously, but the baby is moving down and out with strong contractions.
No matter when or how the feeling comes across, when you’re actually doing it and if you have no pain medication, there’s the feeling of the muscular contraction accompanied by a ton of pressure in the pelvic area. (Sitting down at this point would be highly unpleasant and basically impossible.) This is the part of labor when something big is literally going through something small. You can still feel the sensations up around the waist and in the lower back, but the bulk of intensity tends to be around the pelvic area. As the baby’s head crowns, there’s a third feeling to add: a burning, stinging sensation all around the vaginal opening as it stretches. So we’re talking muscle pain or “work” + lots of pressure + streeeeetching.
I know — all of this sounds hard. And I’m not going to say it’s easy. But keep in mind that for some mothers — not all, but a good percentage — pushing is actually a relief. By the end of the dilating phase, women can feel like they’ve been clobbered by contractions just coming and coming. To be able to engage in the pushing makes the whole experience less passive. You’re bearing down, taking deep breaths, and pushing that baby out! You also know you’re close to the end. Plus, the vagina is meant to stretch out and stretch back. It’s impressive what it can do.
Of course there are women for whom pushing is long and arduous and involves much more work on the part of mom than the previous stages. So you’ll have to see how it goes for you. And on that note, keep in mind that pushing tends to be more efficient if mom is able to get into a gravity-friendly position for at least part of the time. Birth works so well that women deliver on their backs all the time, but there’s less pressure on the perineum if mom is upright, and the pushing muscles are more effectively engaged when mom’s in a squat.
Research has shown that, if left to their own devices, women entering the pushing phase will get into some variation of a squat or on all fours. The impulse is to spread the legs, get in a gravity-friendly position, bend the knees, and push down. Much like, once again, what happens when you have to make a bowel movement.
Lots of my students want to know what it will feel like to push with an epidural. It’s basically a much milder version of what I described above, depending on how strong the epidural is. Moms usually feel some pressure or sensation in their pelvic area and even if they don’t, they’re still capable of pushing with each contraction. Doctors or midwives give more instructions to mom if she can’t feel everything and tell her when to bear down so she’s making the most of each contraction.
If you’ve pushed a baby out, tell us what it felt like for you! Was it like a massive bowel movement? Or something else entirely?
Read: What Does It Feel Like: The Milk Coming In here.