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  • Writer's pictureSuzanne Lim

PUSHING POSITIONS- WHO IS THE BOSS?


 




Birthing people often have visions of how they want to push their babies out.

There you are surrounded by an enthusiastic birth support team, squatting on the bed being supported by your loving partner, your body strong and working hard to push your baby out.

Or- you are in a semi-reclined position, calmly breathing your baby out, while your helpers stand around in awe of the birth goddess that you clearly are.

These are not silly fantasies. In my work as a birth doula, I have seen both of these scenarios play out. It is always fantastic when your visions match up with reality. At the same time, many folks do not live out their dream pushing vision. And that is actually OK!

The #1 criteria for a good birth experience is did you feel respected, included and supported? Was your and your baby’s safety, dignity and comfort kept a pritority? These big concepts will include specifics like- were your questions answered in a way that you understood? Were you given time to think things over? Was your consent requested before any and all procedures? Were your wishes discussed with you and did you FEEL that you and your care providers were on the same team? These are the foundations for a good birth. These are the things you will look back on, that will define whether you feel warm, fuzzy, empowered feelings about your birth or trauma!


Also remember it is a GOOD thing to dream, visualize and plan. Your chances of having the birth experience you want increases if you have laid out plans, garnenered support, practiced some things and are prepared for your big day.



PUSHING- there seems  to be the two big things that people fixate on when thinking about pushing – the position they want to be in and the way they wil breathe while pushing. Folks also care a lot about autonomy during pushing. Ie. Wanting to be in charge with as little outside “coaching” as possible. Again all of these desires are great. It is also always wise to add a dose of pragmatism to all plans.  Very often, lovely , personalized and detailed birth plans and visions are replaced by doing other things that are safe and practical. Your dreams and reality don't always intersect. You know I'm right! My advice is to always be aware of your surroundings and the things that are likely to come up (an experienced doula is GREAT at this). WEAVE that reality into your birth vision. Understand that you are only in control to a certain point. Remember, your body and baby are the ultimate bosses. These are forces beyond your control that determine whether or not a particular puhsing decision is a good one. Those forces are:


1. Your baby’s heart rate

2. Efficacy.


First off- Let’s talk about pushing positions. How are you going to hold your body while you push your baby out? There are several options and you can (IF you can) adopt any of them to deliver your baby. You can squat, be on hands and knees, side lying, semi reclining, sitting up as in a birthing chair, upright on knees. You can use tools such as the squat bar, the birth bed (as it is adjustable), your partner, stir ups, a rebozo for leverage….

The point is- you have options!! Your ability to change from one position to another depends largely on how you are feeing at the time of puhsing. Do you have an epidural on board? What are your energy levels at? So, go ahead and push in the position you want. Keep in mind that your care providers will probably have opinoins about what positions they feel are best for you. It is perfectly fine to go along with those ideas. AND it is perfectly fine to voice your desire to do something different.

Now apply your pushing position desires to the Bosses....






1.  Is your baby’s heart beat ok? Whatever position you are in IT NEEDS TO WORK FOR YOUR BABY. It would be fool hardy to keep pushing if baby's heart beat is dipping dangerously low during the push. Keep in mind that this can happen in any position. Your care provider will be monitoring your baby’s HR frequently during pushing; watching to see how it responds to your bearing down. If your baby is in a position that compromises it’s oxygen supply as you push- you will observe decelerations of the HR- an unwelcome sight in any birthing room. If his is  a constant thing- whaterver position you are in- you will need to change it. That’s right- even if it is your dreamed about squat. We do not have the ability to garner all the information we need about how your baby is doing in there. We can only rely on that FHR. That is our marker for how the baby is doing. Decelerating HR means something is going on. During pushing, this means- you might have to change position.

 

Then there is this…

2.  Is the position you are in working? The position you are in needs to actually be effective in moving your baby down. Sure it is good to give a certain position a fair chance before declairing that it isn’t working and if baby is fine and parent is fine- that trial may be a good long time. At some point though, reality/practicality has to take over and someone needs to call it and declre that this is not working. If at first  you don’t succeed, try try again. But if it still isn't working- quit. There are other positions to try. Your dream squat just may not be it at this very moment.



I want to encourage you to educate yourself on all the different ways that people have successfully pushed their babies out. The possibilities are endless. Not all of them will be appropriate or you but it is FINE to choose the ones you like and see how each of them work for you!

Plan, Prepare and be Practical- dream, envision, gather your supports and stuff- AND, keep a common sense, practical attitude always mixed in to all of that. Be willing to be flexible, to be able to switch plans and do what is best for you and your baby.. Pushing positions along with all the other detials of birth plans are all things that can change or may need to change. Those things are negotiable.  Keep in mind, the  criteria for a Good Birth Experience- safety, respect, support and dignity- those are your NON-NEGOTIABGLES. No matter the situation these things are the things you deserve and will colour your birth memories with warmth and happiness.





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