I Have to Push! Should I Try Not to Push Before 10cm Dilated?
If you’re planning a vaginal birth and it’s your first - it may have crossed your mind how you’ll know when to push your baby out. It can be hard to wrap your head around people repeatedly saying “oh you’ll know”! You will absolutely recognize it when you feel it - you just can’t NOT push. For many it’s a gradual feeling of a LOT of pressure (and no pain) as your body starts pushing with or without you. When you’re getting close to 10 cm dilated there’s an expulsive sensation that you can’t deny.
What Causes the Uncontrollable Urge to Push During Labor?
Take a look at this video of how the uterus does the amazing job of getting your baby into your arms without needing much assistance from you. You don’t need to know how to push during labor - you can’t NOT do it. You don’t need to learn how to push the baby out.
Once your baby’s head is low enough to come into contact with very sensitive nerve receptors located in the pelvic floor, the cervix and vagina that irresistible, overwhelming urge to bear down is triggered.
Spontaneous pushing by your body usually happens when you’re fully dilated but it’s estimated that around 7-8% of women start to experience that urge to push before being fully dilated and quite often are told to stop pushing due to the fear of bruising or even tearing the cervix When you have that urge to bear down - being told to wait for your Doctor or wait until you’re fully dilated can be incredibly distressing. Although the pushing urge is a lot more intense and powerful imagine the feeling of needing to poop and you’re in a public place and you’re trying to hold it in - have you ever had to wait to get into the bathroom at home? So imagine you finally get into the bathroom and sweet relief is seconds away and you’re told you have to wait for a little while longer. You might be perspiring just imagining this scenario and there’s no baby involved in this fictitious example…so throw that into the mix and you can see how telling someone NOT to push when that train has already left the station can be so traumatising. Frequent vaginal examinations and aggressive pressure inside the vagina from careproviders fingers add to the stress - but you can decide if and when you’ll have a vaginal exam or do it yourself (usually easier in early labor).
Midwife Carla Hartley who sadly passed in 2020 used to describe the feeling of pushing like the feeling of ‘throwing up’ - but your body starts to ‘throw down’. But if you’ve ever experienced vomiting you’ll know that telling someone NOT to throw up will have no impact on that heaving sensation and will just cause you to feel even more stressed than you already are.
Imagine knowing you are going to throw up, knowing that there is nothing you can do about it and someone getting into your face telling you to ‘breathe through it’ and if you do throw up you risk tearing your esophagus…
Yes staff will commiserate with you and tell you how terrible it feels to NOT push before you’re fully dilated. The medical model tells you when you are ‘allowed’ to push instead of trusting the physiology that grew your baby from two cells…and knew where to put each eyelash…each fingernail (the medical model suggests that this wisdom isn’t to be trusted). Pushing happens whether you agree with it or want it or not and there’s a big difference between how your optimally your body is working when you are spontaneously pushing with your urges and when you’re starting and stopping with staff directed pushing. This video demonstrates this quite clearly.
Pushing Before 10 Centimeters Dilated - Am I Likely To Damage Myself or Hurt My Baby?
Are you likely to damage yourself or your baby by following your body’s lead? The same body that has grown your baby from 2 cells, grew a placenta, enlarged your heart, almost doubled your blood volume - without any conscious input from you or baby growing classes? That’s highly unlikely.
If you’re 4cm dilated and feeling a strong continuous urge to push (very unlikely) - then that’s not ideal…often any pushing urge this early passes if you change position. But if you’re close to 10 centimeters dilated the research suggests it’s not an issue. Evidence suggests it’s more of a theoretical fear that just adds additional stress and in some cases results in an epidural (or a higher dose of epidural) to mask that urge. Epidurals can be a useful resource in labor and knowing how to get the most out of one for you and your baby can be reassuring.
Why Do Some Women Experience The Urge to Push Before Being Fully Dilated?
Sometimes an early urge to push happens if baby is OP (the back of baby’s head puts extra pressure on the rectum) and sometimes it’s perfectly normal for even a well positioned baby. Some careproviders believe it happens with an epidural due to the lack of mobility. Sometimes a change in position can be helpful for these babies.
In Nancy Tsao’s research on this topic she concluded that ‘Pushing with the early urge before full dilation did not seem to increase the risk of cervical edema or any other adverse maternal or neonatal outcomes’.
How Many cm Dilated Before Pushing?
The current available research suggests that the optimum way to manage an early pushing urge hasn’t been established. Tsao recommends an individualized approach to be taken based on your unique circumstances - dilation, station of baby (how low in the pelvis baby is), how stretchy your cervix is and if this is a first vaginal birth. Isn’t that what every person wants for their labor and birth - an individualized care plan?
Some studies suggest controlled breathing, position changes, or epidurals can be used to prevent premature pushing but is it really premature if you’re 8cm dilated with a stretchy cervix and it’s your 2nd baby? Even though there doesn’t seem to be any evidence of harm and no well conducted studies on optimal management unfortunately the majority of care providers will actively prevent women from pushing before full dilation. Careproviders reading this and maybe some parents will have had the experience of being 5cm and (stretchy) one minute and fully dilated 15 minutes later. (This is more common with 2nd/subsequent vaginal births).
I hope this is helpful for you if you experience this phenomena - it might be worth asking your careprovider about their approach to pushing and care of your perineum too (just so there’s no surprises on the big day).