Don't Push the River, It Flows By Itself

By Laura Shanley
Excerpted from Shanley's book, Unassisted Childbirth
Learn more from Shanley and subscribe to her newsletter at UnassistedChildbirth.com

It is a little known fact that aside from a slight push or two in the last seconds of labor, forced pushing (pushing when a woman has no impulse to do so) is not necessary, or even desirable, for the laboring woman. The saying, "Don't push the river, it flows by itself," definitely applies to labor. Nancy Tatje-Broussard writes in her article, Second Stage Labor: You Don't Have to Push, "The birth process need not be a pushing affair. It can be a gentle unfolding, in harmony with the natural rhythms of life." (Mothering, #57)

Tatje-Broussard began studying the concept of pushing after an older friend of hers shared her story of a medicated flat-on-your-back birth 20 years earlier. The friend had been given general anesthesia which had rendered her unconscious through most of her labor, but she woke up in time to see her daughter's head emerging. Quickly she called to the nurses who were playing cards at a nearby table.

Tatje-Broussard wondered, if women were able to give birth easily while unconscious, why must they exert tremendous effort while awake? She found that up until the 1920s women were not instructed to push during the second stage of labor. (The second stage is the time between the full dilation of the cervix and the delivery of the baby.) Around that time, doctors "determined" that the second stage was dangerous to the unborn baby. Pushing, they hoped, would get the baby out faster. At one time, mothers were even told to begin pushing at the onset of labor.

By the mid 1950s many people had begun to realize the importance of relaxation during the first stage of labor. The second stage however, was, and continues to be, associated with great physical effort. Doctors, nurses, midwives and "birth coaches" often encourage a woman to push even when she has no impulse to do so.

By the 1980s scientific evidence showed that the second stage of labor was not dangerous for the baby, but actually helped to stimulate her digestive, eliminatory and respiratory systems. Pushing, on the other hand, can be dangerous to both a mother and her baby. When a woman is pushing she is holding her breath. Oxygen therefore, is not going to her uterus, which makes contracting more difficult and painful. It is also not going to her baby. This can lead to a drop in the fetal heart rate and possible brain damage.

Susan McKay agrees. In her paper, Humanizing Birth in a Technological Society, she writes, "Urging a woman to push harder and longer may, in fact, make things worse as the baby's head and umbilical cord are compressed through the mother's intensive effort, leading to (heart rate) decelerations and fetal hypoxia (oxygen deprivation)." (Quoted in Birth as an American Rite of Passage by Robbie Davis-Floyd)

Tearing of the perineum is more common for women who have pushed over a long period of time and studies show that pushing does not necessarily get a baby out faster.

Midwife and author, Ina May Gaskin, wrote about a birth she attended in an Amish community in her article, Childbirth the Amish Way:

"Just as soon as there was any sign of pushing, the baby was crowning. The only sign of her pushing was a slight catch of her breath. She did not make a sound or grimace. Eighteen other births had obviously taught her how to let her uterus do the work, while the rest of her took it as easy as possible." (Mothering, #43)

Jan Fletcher told of her labor experiences in a letter to Mothering titled, "No More Professional Pushers."

"My first birthing experience was accompanied by a frantic chorus of "Push! Push! Push!" for at least 30 minutes. Being an inexperienced "birther," I took their exhortations seriously.  ...Five people were yelling at me to PUSH!, and in my efforts to appease this throng, I pushed so hard that I broke my tailbone. For my second birthing, I made up my mind that I wasn't going to push at all. If the baby took a while to come out, so be it. Sure enough, the second birth was also accompanied by a chorus of "Push! Push! Push!"-- only this time I ignored it. Breathing quietly, relaxing, and hesitating ever so slightly with each breath was all it took. Jessica came out leaving my tailbone in one piece and thereby sparing me six weeks of postpartum pain." (Mothering, #49)

Giving birth is not unlike having a bowel movement. In a normal bowel movement one allows the body to do its work. Once the feces has entered the rectum only a slight push is necessary to excrete it. The concept that labor must be "hard work! The hardest work I've ever done in my life," (as I've often heard women say) is simply a fallacy. In fact, author Pat Carter believes neither the woman nor her uterus need to work hard to produce a baby:

"It only takes a little bit of effort from the fundus to send a baby merrily and successfully on its way, provided pain inhibition has not set up opposition to its efforts. Little, if any, more power than the walls of the colon have to exert to perform its function of ejection - actually less power than it takes to sneeze." (Come Gently Sweet Lucina)

On a more aesthetically pleasing level, giving birth can be compared to painting a picture or having an orgasm. It is more a matter of "allowing" it to happen rather than "making" it happen.

Of course, this isn't to say that if a woman has the urge to push, she should ignore the feeling. But certainly, she shouldn't feel she has to push just because she's been told that this is the way babies are born.

Giving birth is a creative act, and like all creative acts it cannot be forced to conform to society's unnatural time constraints. The insistence on pushing in labor is simply a reflection of our cultural attitude that force and haste are superior to trust and patience.

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