Natural Birth

Pushing Positions

I've had two natural births and am beginning to think about the third one- I'm due in July.  With the first two, I pushed in bed on my back.  My doctors and I had discussed pushing positions in advance, and they said they would let me lead the way and find a comfortable pushing position.  However, in both births I was already on my back for an internal exam, they told me I could push, and I just pushed where I was- it didn't even occur to me to change position!  I didn't push for very long (20 minutes with the first, about 2 minutes with the second), and I had second degree tears both times. I've read that different positions might decrease my chances of tearing.  How did you find the right pushing position? Did your OB or midwife suggest anything?

Re: Pushing Positions

  • I pushed in the position I had been in for my entire labor hands and knees. They had me move onto my back for the internal to check I was complete and it felt so awful. When they gave me the okay to push, I went right back to all fours, lol. I don't have any other births to compare, and I did have a small labial tear when I passed her shoulders.
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  • My Bradley instructor suggested pushing in the squatting position because the pelvis is really open and the shortens the depth of your birth canal.  I had every intention of delivering in the squatting position.  However, in labor I pushed on my hands and knees and finally delivered in the side position.  Those positions were what I felt most comfortable in and what I instinctively went to.  My LO had a nuchal hand so I did have a pretty bad internal second degree tear.  According to my OB I would have torn no matter what position I was in because of LOs hands.  From what I learned in my Bradley class, slow controlled pushing is the most effective at preventing tears.
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  • With my first I pushed on my hands and knees.. The second baby i was laying down when they told me i could push.. I immediately stood up at the end of my bed and used my bed post and pushed in the squatting position.. 
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  • Your second one came pretty fast, that alone could have contributed to the tear. Was anyone using a compress with warm water or oil against your perineum? If you're able to have a doula in there with you that will tell you when to change your breathing to slow the baby down to help you stretch better, the position may not matter as much.

    Depending on the quality of the stitching and how your body heals, there is always a chance that you'll tear along a previous scar. Though scars feel tough, they are a weak spot that is more susceptible to repeat damage.

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  • I pushed in the tub but couldn't get enough strength behind it (was my first so you might have more success by the third), the birthing stool and eventually on the bed where she was born. If it was left up to me I wouldn't have move but I had great support from my midwife and doula who just insisted, which I'm very glad about. Would you consider getting a doula for support (the back position is always more convenient for the doctor but they can check you in other positions)  

  • I always planned to push on all fours, but with both births my MWs said they could better help me to not tear if I were in a semi sitting position. I conceded both times and had no issues and no tearing. No regrets here.
  • With my third I pushed on my back in the tub . I pushed for an hour and a half and ended up tearing but that's because I pushed passed a contraction and my daughters head came out sideways. I ended u bruising my tailbone so with my second I was adamant about not being on my back so when I got into the tub my second labor was fast only four hours I just got on my knees and leaned over the tub. My daughter came with only two real pushes no tearing or nothing . I didn't even feel the ring of fire or the contractions it was bliss. With my third I agian pushed on my knees leaning over the tub. I pushed for about five minutes and agian no tearing . For me I labor best on my hands and knees to its pretty easy to just stay there, I also don't get vaginal checks while I'm in labor so I'm rarely not in the position.
  • I laboured on my hands and knees, so I pushed on my hands and knees and rested in child's pose between contractions. My doctor didn't suggest it, but she didn't ask me to move either. It didn't help me with tearing (I had a third degree tear), but my baby was posterior. I do believe that if I'd been on my back, I'd probably have had a c-section. I pushed for 90 minutes as it was, and I think they were starting to get a bit anxious that I get him out.
  • I pushed on my knees, leaning over the edge of the tub into my husband's shoulder. That was just what felt natural. I had wanted to lean on my husband for support and that was the only position that made sense. I did not have any tearing. I pushed for over an hour, but when I had my first baby, pushing him on my back in the hospital, I ended up with a csection after pushing for three hours with no progress so that was an improvement. I did NOT like pushing on my back in the hospital. It felt all kinds of wrong but they insisted that on my back with my knees by my ears was the only way too push out a baby. I knew better but I did not feel able to argue. I could barely string two words together at that point.

    I think you will find what feels right. Don't go into it with a set idea, just listen to your body and try a few different things. You will know when it feels right.
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  • I pushed on my back with Ds and ended up with an episiotomy on my perineum. With Dd, I pushed standing up bracing on my H and needed 1 stitch on my labia. 
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  • I pushed in every possible position with DS1 (I ended up having a c/s with him). I ended up reclined, but on my back, with DS2. I think I tried the squat bar for a minute, and I may have tried hands and knees, too. But honestly, both times I was so out of it by the time I got to pushing that I didn't really care what position I was in. But! I pushed multiple hours with both of them.

    You might just be prone to tearing, but I would also consider refusing internal exams and keeping yourself upright, and looking fora  provider who really supports physiological birth. hth

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    DS2 - Oct 2010 (my VBAC baby!)

  • I had really bad back labor and the only position that was tolerable was laying on my back. I had one small superficial tear. I pushed for almost 2 hours though. That was the worst part of my 45+ hour labor.

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  • Had it not been for my MWs and nurse, I'd have spent my entire labor curled up against the side rail holding on for dear life, ha! They made a lot of suggestions and I eventually ended up delivering DD while standing and squatting, but I did also get a second degree tear, so...

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