Push Prep 101: Strategies to Prepare for Pushing

Are you afraid of pushing your baby out? Unsure what to even expect? Well, let’s chat about what to think with pushing a baby out and how to best prepare.

When it comes to pushing a baby out during childbirth, many people assume that the pelvic floor muscles are doing the pushing. However, that’s not actually the case. The real work of moving the baby down the birth canal is done by primarily the uterus and with the abdominal muscles. The pelvic floor muscles don’t push, instead, they stretch and lengthen to allow the baby to pass through. Preparing these muscles to elongate effectively can make the delivery process smoother and reduce the risk of pelvic floor injury.

Learning how to relax and stretch the pelvic floor is key. This preparation can help mommas have an easier and safer birth experience. In this post, we’ll go through everything you need to know to prepare your pelvic floor for delivery, including pushing strategies, breathing techniques, and optimal pushing positions.

Understanding the Pelvic Floor’s Role in Labor

The pelvic floor undergoes significant stretching and lengthening as a baby moves down the birth canal. By the end of the second stage of labor, the pelvic floor stretches up to three times its normal length to accommodate the baby. This stretching, however, can push the pelvic floor nerves, specifically around the anal sphincter, beyond their normal range, potentially leading to injury.

The muscles most at risk for injury are the levator ani muscles, which support the pelvic organs and help maintain control of the bladder and bowels. They are getting stretched the most during birth and are mostly at risk for injury with any instrument assisted delivery.

The pelvic floor muscles has three main functions: contraction (to stabilize and support), relaxation (to allow for urination, bowel movements, and sexual function), and bulging (to allow the baby to pass through). Understanding these different roles can help in learning how to safely lengthen and prepare the pelvic floor for delivery.

During labor, it’s essential for the pelvic floor muscles to relax and elongate rather than contract or lift. Many mommas tend to instinctively tighten their pelvic floor muscles due to pain, which can work against the natural process of labor. Instead, a relaxed, elongated pelvic floor can create the ideal pathway for the baby, reducing the need for medical interventions and lessening the risk of injury.

Breathing Techniques for Pelvic Floor Preparation

The pelvic floor and diaphragm are interconnected and work together to support the core. When you inhale, the diaphragm moves downward, and the pelvic floor naturally elongates or stretches. When you exhale, the diaphragm moves back up, and the pelvic floor contracts. Understanding this relationship can help you practice pushing techniques that utilize both your diaphragm and pelvic floor effectively.

One of the best ways to practice this is to focus on breathing techniques that encourage pelvic floor elongation. Think of inhaling to open through your vagina and anus and exhaling like pressing down on a coffee press as you are keeping the bottom of that press (your pelvic floor muscles) open. When you exhale with this kind of downward pressure, it helps to keep the pelvic floor elongated and open while building up intra-abdominal pressure to push baby out.

There are three main breathing techniques for pushing during labor:

1. Open Glottis Breathing: This technique involves taking deep breaths and letting out a gentle “ahh,” “ohh,” or “uhh” sound on the exhale. Open glottis breathing allows the pelvic floor to elongate fully with minimal buildup of intra-abdominal pressure, which reduces strain and helps the baby move down more naturally.

2. Slightly Forced Exhale with Pursed Lips: With this technique, you exhale slightly more forcefully through pursed lips, while keeping the pelvic floor elongated. This controlled exhale helps create a bit more intra-abdominal pressure, which aids in moving the baby down without straining.

3. Closed Glottis Pushing (Purple Pushing): This technique is sometimes called the Valsalva maneuver and involves holding your breath and bearing down. Closed glottis pushing is typically used to increase and sustain abdominal pressure for longer periods, which can be helpful when spontaneous pushing isn’t effective or if there’s a safety concern for the mother or baby. Here’s a simplified explanation: During this type of pushing, a healthcare provider might direct you to take a deep breath, hold it, and bear down for about 10 seconds, doing this two to four times in a row or throughout a contraction.

Each technique has its own advantages, and using a combination can help mommas respond to what feels best in the moment. Practicing these techniques before labor can help you become comfortable with the different levels of pressure and relaxation they provide.

Practicing Pushing Techniques

Now that we’ve covered breathing techniques, here are a few exercises you can practice to get familiar with these techniques and prepare your pelvic floor for labor.

1. Open Glottis Breathing: Sit in a comfortable position, place one hand on your belly, and practice taking a deep breath. As you exhale, make an “ahh” sound and visualize your pelvic floor lengthening. This technique works well for managing pressure with minimal strain and is ideal for early-stage pushing.

2. Slightly Forced Exhale with Pursed Lips: In a similar position, take a deep breath and purse your lips as you exhale, applying slight downward pressure in your abdomen while keeping your pelvic floor relaxed. One strategy is thinking “belly big, belly hard.” Imagine that you’re blowing through a straw. This approach is a bit more powerful than open glottis breathing and can help if more pressure is needed.

3. Closed Glottis or Valsalva Pushing: To practice this, take a deep breath, hold it, and bear down with your abdominal muscles for up to 10 seconds. Then relax and breathe normally. This is the most intense of the three techniques and may be useful in situations where sustained pressure is required to get the head or shoulder of your baby out. However, it’s best to practice this sparingly and consult your healthcare provider about its use in labor.

Preparing Positions for Pushing

Different positions can also help facilitate pushing. Try practicing these positions before labor to see which ones feel the most comfortable:

• Squatting: Squatting widens the pelvic outlet and allows gravity to assist, which can help the baby descend.

• Hands and Knees: This position takes pressure off the back and allows more room in the pelvis, making it easier for the baby to move down.

• Side-Lying: Lying on your side can help conserve energy, which can be especially helpful in a long labor. This position also reduces pressure on the perineum, which can decrease the risk of tearing.

• Upright Positions: Sitting on a birthing stool, standing, or leaning forward can also be effective, as gravity aids in the baby’s descent. These positions allow for active pushing while relieving pressure on the lower back.

Practice these positions at home to become comfortable with them, and when labor begins, choose what feels best. Using a mirror To practice pushing in these positions can also be helpful to visually see perineal bulging, which is the movement of the pelvic floor as it opens and lengthens. Seeing this can provide reassurance and help you understand what’s happening during the pushing phase. 

Using the Toilet for Practice

One way to practice these pushing and breathing techniques is during bowel movements. The sensation of releasing the pelvic floor during a bowel movement mimics the release needed for pushing in labor. When you’re on the toilet, use open glottis breathing or slightly forced exhale breathing, focusing on relaxing your pelvic floor muscles and letting them stretch and elongate as you bear down.

Lastly

Preparing for childbirth isn’t just about understanding what your body will go through but actively preparing your pelvic floor for the pushing process. By learning to relax, elongate, and stretch these muscles, you can support your body’s natural efforts during labor and reduce the risk of pelvic floor injury.

By practicing breathing techniques, testing out pushing positions, and understanding the role of your pelvic floor in the birthing process, you can approach labor with confidence. As you prepare for this exciting moment, remember that every birth is unique. Having these tools in your toolbox can make a real difference, helping you feel more empowered and ready to bring your baby into the world.

Resources:

• https://www.michiganmedicine.org/health-lab/pelvic-floor-injury-during-vaginal-birth-life-altering-and-preventable-experts-say

• https://www.annualreviews.org/content/journals/10.1146/annurev-bioeng-061008-124823

• https://www.glowm.com/section-view/heading/Presentation%20and%20Mechanisms%20of%20Labor/item/126#

• https://pmc.ncbi.nlm.nih.gov/articles/PMC9308631/