Push Prep
Almost without exception, when I ask clients what they worry about with labor and delivery, it is pushing and their pelvic floor recovery.
As a pelvic floor physical therapist, I love to help you arm yourself with knowledge and tools to take away the fear.
The ABC’s of Pushing: How to Prepare for Pushing During Your Pregnancy
A: Awareness
The truth about push prep and postpartum recovery is that the foundation starts during pregnancy.
It is important to build awareness around:
Knowledge Awareness: think participating in childbirth classes, or working with a physical or occupational pelvic floor therapist
Self Awareness: think identifying factors that may contribute to stress, bring a sense of calm, or may come up for you during the labor process
Lifestyle Awareness: think awareness of how you tend to respond stress, and what helps your body feel supported
Body Awareness: think knowing your body, guiding yourself through movement throughout pregnancy, building trust with your body
B: Biomechanics
Knowledge around your body’s biomechanical and physiological processes during the labor process helps to prepare for labor and deliver.
This includes:
Perineal massage
Pressure management
The work of the uterus
Positioning of your body to support the process
C: Contexts
Your beliefs, biases, experiences, and environment can all have a big impact on your birthing experience.
Consider:
Your beliefs and biases
What things you can control throughout the process
Focusing on mindfulness, resilience, finding your voice, and self compassion
Understanding Active vs Passive Pushing
Passive Pushing
Your uterus is contracting top to bottom to help move the baby down and out.
Passive pushing is the involuntary work of the uterus.
This may be a pushing strategy in a medicated birth with an epidural, where you are “laboring down” and conserving energy while your uterus is working to move the baby downward.
In an unmedicated delivery, this may look like using movement and breath to ride out the contractions and support the involuntary work of the uterus without active pushing strategies.
Active Pushing : Open Glottis
With a contraction you will inhale expanding into the pelvis, and think of:
Exhaling with a passive sigh OR
Exhale through the mouth and think of keeping the pelvic floor open/expanded
Pros:
Will help you to conserve energy during the pushing phase
Complements the passive contraction of the uterus well
Cons:
May be less forceful than closed glottis pushing
Active Pushing: Closed Glottis
This is sometimes called purple pushing, as it is associated with the valsalva maneuver (breath holding).
Pros:
May provide more force than open glottis pushing which can be helpful when delivery is urgent
Cons:
May increase blood pressure and heart rate for the birthing person
May increase risk of pelvic floor injury
Considerations for Pushing with an Epidural:
If appropriate consider turning the epidural down
Be aware of the different positions available to you
Ideally wait until 10cm, full effaced, and baby’s head is visible
Consider use of tactile feeding like tapping or pressure on your vulva
Use external feedback such as mirror, or reaching for baby’s head
Limit active pushing to 5-6 seconds at a time to conserve energy
If appropriate, use open glottis pushing first to conserve energy
Being Mindful of the Pelvic Floor
Direct energy to the vagina, not anus
Vocalize, grunt, or exhale to allow the core muscles to naturally aid pushing
Think about downward energy (curl forward from the upper ribs)
Focus on softness, ease, melting, surrender
Focus on positions that open the pelvic outlet (knees in, feet out)
Focus on positions that allow the sacrum to stay flexible
Use gravity and movement to your advantage
Use a mirror for visual feedback
Push Prep Boot Camp: Preparing for the Pushing Phase of Labor
Push Prep Boot Camp can help you gain confidence around how to prepare for labor and delivery.
You will start with a prenatal yoga class to create space and mobility throughout your pelvis and hips, and move towards discussion about birth and push prep strategies including: labor and birth positions, breathing techniques, demystifying perineal massage, and addressing early postpartum pelvic floor care.
Local to Massachusetts? The next Push Prep Boot Camp is on Saturday, September 28th from 12-2pm. Join us at the Root to Bloom studio in Wakefield, MA!
