Pushing baby out
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                                                                                    Dilation of the Cervix

Dilation of cervix must be complete before baby can be pushed out. Complete dilation is 10 centimeters, this is when the cervix is fully open and the baby can further descend into the birth canal (vagina) during the pushing (second stage) of labor.


                                                                     Pushing
One is the commonly practiced method of pushing is called coached or directed pushing,where you are directed to begin pushing as soon as you're fully dilated, whether or not you feel an urge to.
Women who birth with a doctor are most likely to be directed in pushing, they are often told when to push or not to push and how to breathe or how hard to push etc. It is normal to be told to stop pushing because of a cervical lip, or  because you aren't dilated enough, or to check for an umbilical cord as baby is coming out. 
So most women go into birth thinking that they will need to be told how and when to push and for how long etc. Movies and TV shows also cause this, with birthing scenes of controlled breathing and pushing, and women panting, blowing and screaming as they push their babies out. 

The argument for being told when to push, goes along with the idea that once you are fully dilated it is just time to push and mothers aren't told to listen to their bodies or how they feel. They think that since women can't possibly know how dilated their cervix are without being told, then they need to be told to push too. This is common in medical births where epidurals are used because this intervention causes woman not to be able to feel what is happening in their bodies.
There is research showing directed pushing has negative outcomes on oxygenation to the baby and trauma/injury to the mom. Fetal and maternal distress can also be negative consequences of such pushing. The alternative approach, often favored by midwives, is known as spontaneous pushing.


So the cervix are now completely opened and the baby's head is in position. The baby will now start to leave the uterus. You may feel the urge to push right away or sometimes the mother doesn't feel it for a while. Some women find that they have to learn to push. It takes time and concentration. You will find yourself holding your breath and bearing down, similar to when you have a bowel movement, but much more intense. Relaxing the vaginal area as you bear down is especially important to remember, because by tensing the muscles in this area, you will actually be fighting against the birth of your baby. It will also be more painful if you tense up!
The contractions will be different now. The muscle of the mothers chest and belly contract along with the uterus now, pushing the baby down the birth canal. Often with the beginning of a contraction you will feel pressure in your bottom and vagina, which is the urge to push. As you feel your baby move down you my feel anxious to get the baby out and try to push between contractions, but you don't want to do this! It will wear you out to quickly. So just try to go with your body and what it is tell you to do.
With the urge to push most women feel the need to make noise. Which can be good, as long as you keep the sounds low and your mouth loose. Some midwives believe that there is a connection between the mothers mouth are her cervix. So the theory is, that if her mouth stays relaxed then her cervix will also.
You will feel your baby slowly move down a little at a time and then slip back up a little and then moving down a little further again. Don't panic when you feel baby move back up, this is a normal process to keep the baby from coming to fast.
As baby's head moves down you will probably start feeling some pressure and a burning sensation. This is you baby's head starting to crown. At this point you may want to hold back, as you feel burning or like you might tear. This is when the hot towels on your perineum help so much! The warmth will help you relax and work through this feeling. Just remembering that a few more pushes and your baby's head will be out.
You might also now feel like, if you push again that you may have a bowel movement. Many women will stop pushing because of this. Don't let that hold you back, it may happen. I know it sounds crazy, but it is a normal part of birth and in that moment you just have to focus on your baby. It may or may not happen to you, everyone is different. It will be cleaned up quickly and no one will hardly notice.
Many women have diarrhea just before you go into labor, it is natures way of cleaning you out for this stage. You also have the option of having an doing an enema in early stages of labor if you want.
At this point the only way to end the burning is to get it out, so really try to concentrate on bearing down. Once the head is out your dr. or midwife will have you quit pushing for a few minute as they check for the cord around the baby's neck. Then you baby should be out in a few more pushes.




Here are some pushing tips:

1. Push as if you're having a bowel movement. Try to relax your body and thighs! Put all your concentration and focus into the pushing  not into worrying about anything accept getting baby out. For some women it helps to tuck your chin to your chest. 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. Really try and go with what your body wants to do. 

2. Stay focused on feeling your baby. Maintain control and try to avoid frantic pushing, you don't want to push with your upper body or strain your face. Listen to when you get the urge to push and go with it.

3. Change positions, this not only can help you but it can also help baby get in a better position for birth.

4. Sometimes, if the pushing isn’t moving your baby down effectively, it may be helpful to change positions. Trust your instincts! Take a few deep breaths while the contraction is building so you can get plenty oxygen to baby. As the contraction builds, take a deep breath and then push with all of your might, holding your breath as you do. There’s no magic formula to pushing. Do what comes naturally.

5. Follow the urges you feel to push, and your baby will be born. 

6. Rest between contractions as much as you can, even dosing if you feel like it. You'll need to save up your energy and rest up for the next round of pushing, is hard and intense work.

7. Looking in a mirror can help. Once your babies head starts to be visible, watching and reaching down and touching it, may give you the inspiration you need to push when it gets tough. Keep in mind though, that pushing is a two steps forward one step backward process, so don't be surprised when your baby's head crowns and then slides back in again. This is your body's way of protecting your body by allowing it to stretch a little at a time.

8. It can help to encourage you to keep pushing, if you reach down to feel your baby's head. It's so close now!

​We often think of the mother as doing all of the work during labor. This is actually not true. During the first stage of labor the baby is twisting and turning trying to find the path of least resistance to allow themselves to be born. During the second stage as the uterus is pushing the baby, and mom is working on pushing, many times the baby is also pushing itself out through the birth canal. Choosing positions to enhance this stage also help.