Working as a Team to Support a Long Pushing Phase
The second stage of labor is also known as the pushing phase. Second stage occurs after full dilation in labor. Firstly, early labor contractions begin the process of preparing for birth. Secondly, active labor works to thin, pull back, and dilate the cervix to move baby through the pelvis. Then, transition occurs between 7-10 cm dilation, which is often the hardest part of labor. There is often a pause from the time of full dilation until the mother feels an urge to push. This is a time of rest before pushing. The second stage of labor then involves the fetal ejection reflex and pushing after the time of full dilation. The average length of the pushing phase for first time moms without an epidural is about 1-2 hours. With an epidural, the average is a little longer. It’s not uncommon to have a long pushing phase.
The second stage of labor can be challenging. Many people find that they are afraid of the sensations of pushing. These are really huge and foreign sensations that a first time mother has never experienced before. There can also be a feeling of a loss of control. In a long pushing phase, the birthing person can feel extreme fatigue and struggle to cope with the immense physical requirements.
As a doula, I have provided support at a number of births lately with a very long second stage labor. For a first time mother, these pushing phases could be 4-6 hours and still be physiologically normal births. It’s not the most common situation, but it does happen. Long pushing phases need some extra special support to help the family through this journey.
How can you provide support during a long pushing phase?
There are a variety of ways that a partner or a doula can provide support during this time. Firstly, let’s talk about pushing positions. Suggesting positional changes throughout this long phase can be incredibly beneficial. Movement can help shift baby into a better position and open the pelvis.
In my experience as a doula, the majority of the long pushing phases I have seen involve positional challenges with baby or a hand or arm up by the head. If mom is pushing on her back, switching to a more upright position such as squatting or hands and knees can be beneficial. Another technique that is highly beneficial is to play “tug of war.” The birthing person can pull on a sheet or towel that is securely attached to a squat bar or held by a support person. They can pull on the sheet while pushing with each contraction, creating extra pressure in the core muscles for extra strong pushes.
Another important aspect of supporting a long pushing phase is providing comfort. You can provide comfort using warm or cool compresses, calming touch, massage, offering water or food, or using whatever comfort items requested by the mother(essential oils, herbs, personal items, etc.).
Emotional support is crucial in a long pushing phase. After a while, it can be very discouraging to the birthing person when they have been working hard to meet their baby. As a birth partner, offering encouragement, praise, and reassurance can be incredibly beneficial. You can encourage the mother to embrace and explore the sensations felt during birth.
Research on Prolonged Second Stage Labor
Recent research reveals that allowing for an extra hour of pushing time lowered the cesarean rate from 43% to 20% in one study. The risks to mom and baby increased very slightly in some studies with prolonged pushing phases. However, these risks were ultimately very low in both groups studied. Research reveals that having a patient provider who understands physiologic birth and views long pushing phases as a variation of normal can reduce the rate of interventions such as cesarean section.