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Birthing Your Baby's Head

As your baby's head is being born, your health care provider may ask you to stop pushing. This allows your perineum to stretch more gradually, and may help avoid an episiotomy. If you are told to not push, relax, put your head back, and breathe lightly and quickly, saying "we-we-we." This will not take away the urge to push, but it will reduce your pushing efforts while your uterus births your baby gradually, reducing the chance of a tear in your tissues.

External Fetal Monitoring

To assess your baby's well-being during and between contractions an ultrasound device is used to record your baby's heartbeat. A pressure-sensitive device is used to record the contraction pattern. Both are held in place on your abdomen by bands or belts. This may be done constantly or on-and-off during labor. The birth center staff may also monitor your baby's heart rate with a doptone, which is a hand-held monitor used from time to time, rather than constantly.

Internal Fetal Monitoring

When your baby or your contractions are difficult to monitor externally or when more accurate information about your baby's heart rate and reaction to contractions is needed, a small coiled wire electrode is placed on your baby's scalp to record the heartbeat. A small tube may be placed inside the uterus to measure the strength of your contractions or add fluids inside your uterus.

IV (Intravenous Infusion of Fluids or Medicines)

To give fluids, induce labor, or give medicines, a needle is used to guide the placement of a small tube into a vein in the arm or hand. The needle used to start the IV is removed.

Pain Medication

Medicines may be a valuable aid in labor, helping to reduce or relieve pain and allowing you to rest. But they are only one tool available to you. The choice of what to use for pain relief and relaxation is up to you and your health care provider. You are free to request or refuse medicines (but remember that some medicines can only be given at certain times during labor, so they may not always be appropriate). Suggestions from your health care provider and nurse about medicines are just that suggestions. Weigh their advice with your own choices. Many parents find it helpful to discuss pain medicine with their health care provider ahead of time.

Because some kinds of medicines may slow down labor, it's generally a good idea to put off taking them until you feel that the progress of labor will be slowed by the exhaustion of the pain and you can no longer rest between contractions. On the other hand, tensing and fighting the contractions can slow your progress.

When you take pain medicine can be as important as what you take. Babies are affected by medicine taken by the mother, but the extent to which babies are affected depends on the timing and the type of medicine. If enough time passes between the time you receive pain medicine and the time your baby is born, your body will process the drug and your baby will have minimal effects from the medicine.

Your health care provider wants your baby to be as healthy and as active as possible. Your health care provider is familiar with the advantages and disadvantages of each medicine option and will share his or her knowledge with you. Your health care provider can tell you when it is safe and when it is not safe to take medicines and will carefully review with you the pros and cons of each.

Episiotomy

To prevent tearing and to speed up birth, an incision may be made to enlarge the vaginal opening. It is made straight back toward the rectum, or off to one side. A local anesthetic or block is used to numb the perineal area, if needed. Some health care providers regularly perform episiotomies. Others do so less often. Talk to your health care provider about why an episiotomy might be performed, and express your preferences.

Vacuum Extractor

To help move your baby down the birth canal or to speed up birth, a vacuum extractor may be used. A small plastic suction cup is placed on your baby's head. As you push, your baby is guided out of the birth canal. This is used when the health care provider wishes to help lift your baby out. Your baby may have swelling and/or bruising where the extractor was applied.

Forceps

When pushing is not helping to bring your baby down the birth canal, or to facilitate a speedier birth, forceps may be used. Forceps look like two large, metal spoons. This pair of metal instruments may be used to guide your baby out of the birth canal. Your baby may have some bruising that will last for a few days.

Wait to start pushing until you feel the urge to push or until your health care provider asks you to try to push. Sometimes your body will rest after your cervix is fully dilated and before trying to push your baby out. This resting phase may last several minutes to an hour. It is usually all right to wait. If you need to start pushing before you have an urge to do so, try squatting or kneeling. This will widen the pelvic outlet and add gravity and pressure. As the second stage of labor progresses, your urge to push will probably get stronger.

Some women don't feel an overwhelming urge to push (medicines can sometimes inhibit or mask this, too). Your nurse or health care provider may tell you when a contraction is coming and instruct you when to push.

Many women have the urge to push as a feeling of "bearing down" or a feeling like having a bowel movement. To get used to the feeling of how to push, think of directing your pushing toward pressure on your perineum. Ask your nurse or health care provider to hold a warm washcloth on your perineum or place two fingers in your vagina and press toward your rectum. That can help you "aim" your pushing.

Your nurses and health care provider will suggest positions and ways you can adjust the bed and pillows to make yourself more comfortable and to make your pushing most effective. Try tilting the bed slightly downward and using pillows behind your back. Try holding your legs apart yourself or pulling back on them when you push.

1. Cervix thins and dilates during labor. As your baby moves through your pelvis, her head usually rotates to face down.
2. As your uterus pushes your baby through your pelvis, her head begins to show, or "crown."
3. Most of your baby's head is born. As her shoulders move through your pelvis, she begins to rotate again.
4. Your baby's head and shoulders are born, and the rest of her body slips out.

Tips for Pushing

Relax your perineum. This will reduce the chance of tearing and the need for an episiotomy. Warm compresses and gentle perineal massage may increase your comfort and help stretch your perineum. Relax your mouth this helps your pelvic floor relax. When you clench your jaw, your perineum automatically tenses.

Trying to use your abdominal muscles - only, push down, out and away. While you do this, relax your pelvic floor, the way you do when you are trying to urinate faster.

You may find it helpful to lift and hold your legs back while you push. Be mindful of any medications you may be taking, as they may reduce your awareness of just how far you're stretching your muscles. Talk with your nurse about this.

Everyone around you understands that you're experiencing some pain, so it's perfectly acceptable to grunt, moan, yell and even scream. If you can, try to convert any high pitched, throat-based sounds into low, deeper, belly-based sounds that "aim" your pushing efforts.