Labor and delivery practices

Labor is the process that prepares a woman to deliver her baby into the world. Doctors tell a woman not to push during labor because she is not ready, there may be a problem with the baby or she may have had an epidural.
Labor is the process that prepares a woman to deliver her baby into the world. Doctors tell a woman not to push during labor because she is not ready, there may be a problem with the baby or she may have had an epidural.

Your doctor might tell you not to push during labor if you’re not ready, there’s a problem with your baby, or if you’ve had an epidural. However, some of those practices have changed over the years.

Lots of women have been told not to push at certain times during labor and delivery. As research has evolved, though, it’s now clear that advice is not always better for you and your baby. However, there are still times you might be told not to push.

When you don’t have the urge to bear down

Doctors used to say you should start pushing as soon as your cervix reaches 10 centimeters dilation even if you don’t have the urge to push. This is usually combined with a technique called closed glottis pushing where you are told to take a deep breath while a nurse counts down from 10. You push about three times in each contraction and must push through the entire count even if you are uncomfortable.

Research shows that this method could lead to shorter pushing times, but it also leads to higher risks of fatigue, tearing, and blood flow changes.

The best labor practice now for a healthy pregnancy is to start pushing only when you feel the urge to bear down. Your doctor might tell you not to push until you feel this bearing down. Sometimes you can be fully dilated, but it might take some time before you feel the urge.

They might also tell you not to hold your breath unless you want to because it can lower blood flow to your placenta, leading to problems for your baby. The best practice is for your doctor to encourage you to do whatever comes naturally.

When your cervix isn’t fully dilated

On the other hand, sometimes you might have the urge to push when your cervix is still only eight or nine centimeters. Even though the best practice is to start pushing when you feel the urge, many doctors still might tell you not to push if your cervix hasn’t reached 10 centimeters.

It used to be thought that early pushing could cause injury to your cervix, a longer active labor stage, and more fatigue, but studies now show this isn’t the case.

Waiting until you’re 10 centimeters is generally an outdated practice, though some doctors might still recommend it. You can talk to your doctor about their view on these practices.

When your baby goes into distress as you push

Sometimes during pushing, your baby’s heart rate might change or drop. This can happen for different reasons, but sometimes it’s a sign your baby isn’t getting enough oxygen. This is called distress and is an uncommon labor complication.

Your baby’s heart rate is monitored continuously through labor either with a machine or handheld Doppler. If your baby’s heart rate starts to change as you push, your doctor might tell you to stop and only to push every other contraction. This can allow your baby to recover in between.

When the cord Is around your baby’s neck

As your baby moves around in your womb, the umbilical cord can get twisted and wrapped around their neck. This is called a nuchal cord. Sometimes your doctor will find this early on in your pregnancy, but it almost always isn’t a problem unless the cord is short and tight during birth.

Sometimes your doctor or midwife might not know there’s a nuchal cord until you’re in the middle of pushing. This is very common in birth, but a tight cord can be squeezed, leading to oxygen loss to your baby.

Your doctor or midwife might tell you to stop pushing and to breathe through the urge so they can turn your baby and slip the cord off their neck.

When you have an epidural and need instructions

An epidural is a type of medication that numbs your nerves and the pain signals going from your uterus to your brain. Depending on the epidural, you might not feel as much pressure or the urge to bear down.

Once you’re dilated to 10 centimeters, you might need instructions for pushing. Your doctor will tell you when to start and stop pushing, and they might use counting. This is when counting and breath-holding might be effective since you can’t feel any of your natural urges and need guidance.

Check with your doctor

While some practices have changed over the years, there are some times when your doctor or midwife might ask you not to push for your baby’s safety or as a helpful guide for you. During your pregnancy, ask about labor and pushing practices with your doctor.

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Medically Reviewed on 8/27/2021
References
SOURCES:

American College of Nurse Midwives: "Second Stage of Labor: Pushing Your Baby Out."

Merck Manuals Consumer Version: "Fetal Distress."

NHS: "Pain relief in labour."

Perspective: "A nuchal cord is rarely a problem: dispelling a common myth."

Sutter Health: "Pushing: The Second Stage of Labor."

The Journal of Perinatal Education: "When and How to Push: Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education."

University of British Columbia: "Early pushing urge before full dilation: a scoping review."