Comfort Techniques for Second Stage Labor (Pushing)
Keeping Cool: Moms may get very warm during second stage, so may like having cool cloths on their forehead or the back of their necks (not ice cold, as this may cause a fever); being fanned, eating ice chips, or drinking cool water between contractions.
Help with Positions: Mom may need supported if she is standing and squatting, or if she is kneeling on her hands and knees. If she is in a semi-sitting position, or lying on her side, the caregiver may ask support people to help mom hold her legs open wide while pushing. This helps to increase the size of the pelvic outlet, making it easier for the baby to pass through. If mom has an epidural, it may be hard for her to tell when you are stretching her muscles too far for comfort, so try to be aware of what would normally be a comfortable, do-able position for mom’s level of flexibility.
Encouragement. Support people should tell mom what a great job she’s doing, and reinforce the idea that her baby will soon be in her arms. Sometimes support people get so excited that they are shouting at mom… remember to use a gentle, loving voice.
Learning How to Push: Some moms push very effectively from the very beginning. Some moms need guidance figuring out how to push. Here’s a few tips. Have mom cough or sneeze… she may feel her perineum bulge out when she does this. That tells her where to push. Placing a warm compress on her perineum, or perineal massage (see below) can give her a focus on where to push. For some moms, telling them that it’s kind of like having a bowel movement will help her figure out the logistics of how to open up and relax a sphincter muscle at the same time she’s pushing downward.
Perineal Massage. Some doctors or nurses will perform perineal massage during pushing. Using a lubricant, the caregiver places two fingers in the vagina, and sweeps them back and forth, gently stretching the perineum around baby’s head. Research is mixed on whether this will reduce the risk of tears or episiotomies, but it does not cause harm. It may also help mom focus her pushing efforts.
Warm compresses. The caregiver, nurse, or partner may be able to use warm wet washcloths on mom’s perineum. This may feel soothing, may help mom’s perineum to stretch more easily, and may help her to focus her pushing efforts.
Touching/Seeing Baby: For some moms, especially those who are discouraged at how long a labor has taken, really benefit by realizing how close baby is to being born. When baby’s head is crowning at the vaginal opening, mom can be encouraged to reach down and touch baby’s head. Or, a mirror can be brought in so mom can see the baby’s head being born. This can also help mom to push really effectively, if she can see or feel the results of each push.
Don’t Be Afraid of Poop. Many women worry that they will push out some stool during second stage, and thus are afraid to push. This may lead to a longer second stage. Know that it is not unusual at all to have a bowel movement during pushing, and it does not cause any concern to anyone other than expectant moms. Caregivers clean it up, and typically mom doesn’t even know it happened.
Janelle Durham, 2004. www.TransitionToParenthood.com