Latest / The Birth Lounge Podcast / Ep. 446: 4 Key Terms That Can Change How You Push Your Baby Out Solocast with HeHe Stewart

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Ep. 446: 4 Key Terms That Can Change How You Push Your Baby Out Solocast with HeHe Stewart · The Birth Lounge Podcast

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Hello and welcome back to another episode of The Birth Lounge podcast.
Alright, you guys a topic that comes up over and over and over again? No matter how long I have been doing this work is pushing your.
Baby out.
This is such a fun episode to do now that I'm back from having my own child, because before this, I always was speaking just from textbooks and knowledge and having witnessed hundreds of births and helping thousands of parents have their own baby.
But now I can actually speak from all of that, plus my own experience.
Now, this episode was actually inspired by a comment that I got on social media, and I'm gonna read it out to you and then we're gonna go through all the data and then I'm gonna circle back at the end and answer this question.
So here it goes.
This comment says.
I would love to hear more about the Ferguson reflex.
I didn't know it before, but I realized that that's the reflex that allowed my doctor to convince me to get an epidural because I was bearing down before I was 10 centimeters.
I had that reflex from like five centimeters on.
How can I figure out if I'm letting my body passively push or if I'm controlling it and pushing too early? Now this is a really awesome question, and I think before we dive into the.
Different things that might be going on in this scenario.
I would love to set some groundwork in the, um, understanding of what's going on actually in your body when we go to push out a baby.
One of the things that she mentioned is that she had this urge to push from five centimeters on.
Now this is what's called the EPU or the Early Pushing Urge, and when it comes to EPU, there are two different types of camp.
Typically, midwifery care and medical providers who have more of a physiological approach to birth are going to believe that the EPU, and there's some good data behind this, we can link it in the show notes that suggests that the EPU is actually very intentional and that the body is going to activate this early pushing urge when your cervix needs a little bit of an oomph.
So usually we see this early pushing urge.
Come about later in dilation.
I would definitely say that five centimeters is on the earlier side of what I as a doula have seen and what I've experienced supporting birds, but not unheard of.
Now the other camp of this EPU belief is that if you push too early on a cervix that's not fully dilated, you run the risk of tearing your cervix.
And you know me, I'm always here trying to be devil's advocate of being that neutral party in the middle.
And I think that both of these camps have a lot of validity in their thoughts, and I do think that there is this place that we can live in the middle, and it is going to be that when the EPU is activated by the body itself and it is this guttural kind of instinctual urge to push.
It is unlikely that you're going to tear your cervix even if you're not 10 centimeters, because the body is doing it.
It is this reflex that is causing you to push on a cervix that's not quite 10 centimeters, probably because the cervix needs a little bit of help.
Now, the validity in thinking that you run the risk and tear in your cervix is true if you are pushing, but you don't have that instinctual, reflexive push, right? So if you begin to really bear down without that muscle control behind it, then of course if you are pushing on a cervix, it's not quite ready to.
Be pushed on, of course it makes sense that we might run the risk of tearing your cervix.
A lot of times in the hospital system, and I say the hospital system because it is much more rare in the home birth to see this scenario, but a lot of times in the hospital system you may run into the scenario where, uh, a provider will come to you and say, I need to give you a cervical check in order to know whether you're ready to push or not and If that's okay with you.
And if you feel good in that choice, and if you feel like, yes, you want to know that you're 10 centimeters before you start pushing, then I think that's a really good option for you.
But I think a lot of times it's presented as the only option.
And further than that, sometimes it's presented as a non-negotiable, like you don't have any other choice but to have a cervical exam before you start pushing and obviously we know that's not true.
The reason that we know that's not true is because of something called the Ferguson reflex.
Now, this is our next thing that I think is really important for you to understand, and this is where your baby gets so low in your pelvis and they actually start to press on these receptors that are on your cervix, and this pressure is going to trigger an oxytocin release, which is going to coordinate your contractions to actually begin to bear down.
And this is going to be involuntary, right? You are not going to be actually physically trying to bear down and your body is going to be doing it without you actually trying.
It's really guttural and again, not intentional, without you trying, without you thinking, without you putting any sort of logic or mental.
Uh, capacity behind it, your body is actually going to bear down.
It doesn't need your help.
Now, this is the Ferguson reflex.
Typically, at that point, you are 10 centimeters and you're fully dilated, and this would be the reason why you wouldn't always need a cervical exam.
Again, if it feels good to you and you want to know if you're 10 centimeters, then absolutely have a cervical exam, but if you are rocking and rolling and you're kind of in your birth brain and you're really in a rhythm and you don't need a cervical exam or you don't wanna get out of the position that you're in, or you just really, you don't have a desire to have a cervical exam in that time and space, there is a really reasonable and valid option to decline that cervical exam and also not be scared to push because much like that EPU, that early pushing urge, when the Ferguson reflex kicks in, it is almost like your body is telling you it's time to push.
I have this funny skit on social media, and if you're not following me on Instagram already, head over to IG and, and follow me on at Tranquility by HeHe and I put up these funny little skits sometimes, and I have one where a nurse calls and says, you know, um, your doula really interfered and it was time to push.
And the person on the other phone, on the other side of the phone says, well, what time was that? And she says, what? And the person says, well, if it was time to push, what time was it? And the nurse is like, what? And it's just a funny little skit to say like, there is no right time to push.
The right time to push is when that Ferguson reflex is activated and when your baby is low enough.
So with that being said.
On the opposite end of that spectrum of I need to give you a cervical exam to know that you're ready to push.
We can sometimes run into these scenarios in the hospital setting, and again, just much more rare in the home birth setting.
In the hospital, we sometimes have providers that will come in and say, okay, you're 10 centimeters.
I'm gonna go do X, Y, and Z, and when I come back it's gonna be time to push.
Now.
That's the opposite of checking in and telling someone that it's time to push for them without that pushing urge.
Right now we are saying even though you don't have the pushing urge, I still want you to push and.
Again, we're in this scenario where if that feels good to you and you're like, yep, I'm ready to get the show on the road, I'm ready to push.
I'm ready to do the thing, let's do it then go for it.
Absolutely.
Start pushing.
But I can give you a personal example that for me, I wanted to wait for I, I wanted to labor down.
I wanted to wait for my baby to get lower in my pelvis before I actually put some intentional bearing down and some intentional power behind that Ferguson reflex, and so.
For me, the discussion looked like, you know, my, my midwife came to me and said, um, I think that your body's really bearing down, and I think if you're ready, you can start pushing.
And I said, I'm not ready.
I don't want to.
I would rather just let my body do it and I want to nap.
And so that's what I did.
I spent some time in the birth tub, um, on a floaty pool, on a floaty, um, in the pool.
And I spent some time in the bed resting.
And then after a few hours of laboring down, I then intentionally started to push.
And so.
I want you to know that that also is a safe and reasonable option, even if your hospital staff is not presenting that to you.
Now, of course you wanna take into account personal factors.
So if we've got other things working against us, like, um, let's say your blood pressure is really not stable and time is of the essence, or maybe your baby isn't looking so hot on the monitors.
And again, time is of the essence.
Now we have to weigh the pros and the cons of laboring down versus those other factors that are at play.
In my case, I was really lucky and blessed that I didn't have anything playing against me, and so I had the luxury of being able to wait and labor down.
Um, that won't always be the case if you have other in individual influences that may make laboring down or waiting a little bit riskier.
So just keep that in mind as well.
So now you have a good idea of what the early pushing urge is.
It is that urge that you feel instinctually to push before you get to 10 centimeters.
And then we have that Ferguson reflex that is typically once you are 10 centimeters, your baby is low enough and it is this instinctual, guttural type of bearing down that you are not doing intentionally.
And then we have what I perceive, or I believe is probably the most common knowledge, the thing that most people are aware of, and that is the fetal ejection reflex.
Now, this is where the full body fully takes over and it's after that Ferguson reflex, right? And so.
The Ferguson reflex and the fetal ejection reflex often get lumped into one thing, and they are not.
They are two distinct reflexes depending on how fast things go for you.
It may seem as if they are one thing, but they are not.
So again, the fetal ejection reflux is actually once your baby is so low and they are already crowning, um, you get this powerful oxytocin surge.
And again, it is involuntary bearing down, and it is almost like the vomit reflex where you cannot stop it, even if you tried, where the Ferguson reflex, you may not be able to stop it, but you can certainly relax through it and not not give into it.
This is not true of the fetal ejection reflex.
The fetal ejection reflex.
Even if you are trying to re relax through it and to not give into it, it the FER is happening.
It is.
We're, we're there.
Your baby is going to be birthed out of your body with the FER.
Now, one thing that I did experience in my birth, and it was something that I learned new, um, was that not everybody has the FER.
Not everybody is going to experience fetal ejection reflex.
And that's super unfortunate because for me.
I kept making the decision to wait, to push, to wait to push, to wait to push, and I did this for many hours and I wanted so badly to experience FER.
I wanted so badly for that fetal ejection reflex to be part of my story, and it truly never came.
I had to push my son out.
Uh, for it, it took me many hours to push him out, first of all, and, and second of all, I had to push even after his head and his shoulders were out.
Most people, once your baby's head is out, typically get, they go through that restitution.
Right? And you've heard me talk about it a lot, both on the podcast and on Instagram and, and TikTok if you follow me on social media.
But it is that period where.
Your baby's head pops out and they're kind of in between two worlds.
So their head is on the outside of you and their neck is actually in your vagina, and they're wearing your vagina almost like a necklace.
And then their shoulders and the rest of their body is still in the inside of you, and your baby is going to do a little twisting motion.
They're gonna restitute.
That's why it's called restitution.
And you're gonna actually be able to watch their face and their head turn, and it's going to help align their body with your vagina so that they can, um, they can come out.
Now I was under the impression, and I had this deep belief that every birthing person and every single labor, every woman was going to experience fetal ejection reflex.
And much to my surprise in my birth, that is just simply not true.
Now, you could not have convinced me of that otherwise.
And even, you know, my midwife sat me down and even said, not everybody experiences this.
And I looked her dead in her eyeballs as if she had not been a midwife for 30 years and said, I don't believe you.
And she said, okay, but I'm, I'm telling you, like I'm telling you, HeHe not everybody experiences this.
And you know, it was really a moment in my birth where.
I dug my heels in and I said, but I am going to experience it, it is gonna be part of my birth experience.
And you know, she, she really reasoned with me and she said, but it may not be.
And so, where are you going to draw the line? Where you decide that you're ready to actually push your baby out, because you really may not.
And I was just, hell bent, I just knew because I had gone into spontaneous labor, I had gotten to 10 centimeters easily on my own.
I had labored down.
I was unmedicated.
I was utilizing.
Different movements and positions, and we had our second story and our third story all decked out in a birth space, and I was going up and downstairs.
I was getting on and off the bed.
I was getting on and off the toilet.
I had my doulas here, I had my midwifery team here.
Everything was right.
We had low lights, I was supported and I felt safe and I just knew that fetal ejection reflex was gonna be part of my story, and it wasn't.
It absolutely was not.
I can say, um, I've never felt fetal ejection reflex it, it just never showed up for me.
Unfortunately, I had to push my child's head out and I was able to feel him turn in my body.
And then I even had to push really hard to get his shoulders out and I had to give a final push to get his body out.
Um, for me, it was just not something that was part of my story.
Um, and again, pre having my baby, you would not have convinced me otherwise.
I would've just fought you tooth and nail that you were wrong.
I would've said if someone goes into spontaneous labor and they have an un augmented labor and they are utilizing the right positions, quote unquote, the right, right, um, the right positions, and, and they feel safe, and they feel supported, and they're unmedicated.
Absolutely they're gonna have fetal ejection reflex.
Their, their body will just spit that baby out.
And, you know, silly me, you're always so naive on that, on that side of things, until you experience things for yourself, it's always so easy to have these beliefs that you are just really, really committed to.
Um, but the fetal ejection reflex is not gonna always be part of the story.
Now, I do think that's super rare, especially, especially in people who do have a spontaneous labor and un augmented and, um, you know, unmedicated and you have upright labor.
I think that nine times outta 10 you probably will experience fetal ejection reflex, but.
I can tell you on, on this side of things, don't be like me.
Just know that not everybody experiences FER and it's akay.
If you don't, you will still be able to push your baby out.
Um.
So I wanted to just have kind of some clear definitions going into this conversation about that comment on Instagram that, you know, the early pushing urge is one thing.
The Ferguson reflex is one thing, and the fetal ejection reflex is another.
You guys, I know that making decisions around your birth can feel so overwhelming.
And then once you get to a place of having made a decision, you go into your prenatal appointment or you go into labor, and then if you're.
Faced with any sort of resistance or pushback from your hospital team, it can kind of feel like you are coming up against a roadblock or a brick wall, or kind of like a WTF moment.
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Now you just heard me talk about laboring down.
Now that's not.
The early pushing urge, right laboring down is where you are just simply waiting for your baby to passively descend into your pelvis.
And so, um, a good example of this would be the scenario where you are 10 centimeters, but your baby is still really high in your pelvis.
Now obviously there's no way for us to know this without a cervical exam, and so.
Um, you know, if you, if you're making the decision to labor down, I think there are two different ways that you can tell whether you should labor down or not, or whether you should consider laboring down or not.
One of those is gonna be a cervical exam where they confirm that yes, you are 10 centimeters and hypothetically you could push if you were ready and you wanted to, but that your baby is still really high in your pelvis.
This is going to be a scenario where you could take a nap, you could walk around, you could get in the birth tub like I did.
You could get in different positions, hands and knees, captain Morgan, use a step stool, sit on the toilet.
There are a lot of ways that we can do, or a lot of ways that we can encourage your baby to drop into your pelvis a little bit further.
The other thing that I'll say is using a peanut ball in a scenario where you are 10 centimeters, but your baby is really high, is a really awesome choice at that point.
Depending on how high your baby is, is going to dictate whether your peanut ball should be between your knees or between your ankles.
If your baby is higher than neutral, which is zero station.
So the numbers that are above that neutralization is gonna be negative, right? So negative one, negative two, negative three.
If you hear negative numbers.
We want that peanut ball in between your knees because that's going to keep the top of your pelvis open.
If you hear plus numbers and your baby is at zero or plus one or plus two, depending on who is giving you your cervical exam, you want your peanut ball at your ankles.
In between your ankles.
'cause that's actually gonna open up the bottom of your pelvis, which is called the outlet.
So.
Plus two or plus three, depending on who gives you your cervical exam, is crowning.
That is where we can actually see your baby.
And again, if you're using a peanut ball, we really want the outlet to be open.
So you want that peanut ball at your ankles Now the second way that you can tell if you should consider laboring down or not is if you have reached 10 centimeters and you're not feeling that urge to push.
So let's say you get a cervical exam and you don't really have the urge to push.
Your body's just like rocking and rolling, but you're not having any sort of urge to push.
That would indeed tell us that your body is just letting you know that your baby's not quite there yet.
They're, they're still really high in the instance that you don't get a cervical exam to, confirm that you are 10 centimeters.
In a lot of cases, you can assume that someone is 10 centimeters based on how they sound, what they're coping like the things that they're experiencing, where they are experiencing those sensations.
Other things on their body, like the rhombus of Michaelis, it is a diamond shape that is going to appear on the sacrum.
Again, not everybody is gonna have this, but if you are so lucky to have it, it typically is a good indicator that.
You are 10 centimeters and or you are in transition.
So 10 centimeters is coming very soon.
Another thing is that purple line, so in a lot of women, and again not everybody, but in a lot of women, you will see this line actually from the sacrum down through your butt crack, and it will be nice and purple when someone is 10 centimeters and it will be long.
So the closer that you get to 10 centimeters and the closer that you get through transition, that purple line down your butt crack is actually gonna grow.
And it typically gets darker as well.
So you don't always need a cervical exam to confirm that you are 10 centimeters.
And so if that's the case, and we are using all of these other indicators to assume that you're 10 centimeters, but you have not yet felt the urge to push down.
This would be a case where you might consider laboring down.
Again, going back to the things I just mentioned, movement, different positions, getting on and off the toilet, doing a Captain Morgan using the birth stool, being in hands and knees, walking, spending time on the birth ball, hanging out in the birth tub.
Take a little nap if you want.
This is truly the time where your body is passively descending your baby.
You are not intentionally pushing, and in fact, you may not actually appear as if you are pushing or having any downward movement at all.
But we do know that if you're still contracting, obviously your contractions are bringing your baby further and further down into your pelvis.
So circling back to this question that I got on Instagram, her question is, how can I figure out if I'm just letting my body passively push or if I'm controlling it and I'm pushing too early? Well, I think that that comes down to whether you are intentionally putting some oomph behind.
Those urges to bear down, right? Remember that the difference between early pushing urge in the Ferguson reflex is dilation.
In EPU, you're not quite 10 centimeters and your body is bearing down on its own.
And in the Ferguson reflex you are 10 centimeters and your body is bearing down on its own.
Both of those are kind of passive until you start to put some energy behind it, some power behind it until you actually start to take a deep breath and bear down behind that unintentional bearing down that your body is doing by itself.
Now when we think about those two, the EPU and the Ferguson reflex, and setting those apart from the fetal ejection reflex, don't forget that with the EPU and Ferguson, you can actually almost stop it.
You're not gonna stop your body from bearing down, but.
What you will find is that you don't actually have to add to it.
Your body's just gonna do it on its own, but you can still relax through it with the fetal ejection reflex, it is this unstoppable pushing sensation is how a lot of women describe it.
That even if they wanted to stop it, even if they wanted to be passive and not put any energy behind it.
Their body doesn't allow it.
And so I think to answer your question, when we think about, you know, not not being in control and really letting your body do it, I think that any time your body is bearing down on its own and you feel like you still have control to almost resist that.
Then you're probably letting your body do it by itself.
And if that feels good to you, then go for it.
But at any point you can also take a deep breath and put some energy behind that and really, um, make that a powerful push.
Whenever you're ready with the fetal ejection reflex, that just isn't going to be.
An option because it is so unstoppable and because it's so powerful, your body is just gonna take over.
And even if you wanted to resist it, most people will say, um, unfortunately, you just, you can't resist it no matter how hard you try.
One final point that I do wanna make before we wrap this episode up is that laboring down has some really, um, unclear data behind it.
And so I think that, again, with this, much like the EPU, you find two different camps of beliefs here, and I wanted to break that down for you.
When it comes to laboring down, the real benefit is that you usually have a shorter pushing time after laboring down, this won't always be the case.
And I'm a really great example of that.
I labor down for many hours and then in addition to that, I pushed for many hours.
Um, so I think that if you are trying to reduce your pushing time and you get into one of those situations that we previously laid out where you are ready to push and you're either confirmed or assumed 10 centimeters, but you don't have the urge to push yet and you want to labor down.
There's probably no harm.
So I did wanna break down what the data actually shows from the research that we do have.
Even though in large it's kind of considered inconclusive, and right now I think there.
There are these two camps.
And so that leaves you in a really beautiful position that both options are really valid.
If you decide that you want to labor down, that is a super safe, reasonable, valid option.
And then the opposite is also true.
It is safe and reasonable and valid to want to go ahead and start pushing.
But here is what the research says.
So in terms of benefit, we do see people that labor down.
They have less active pushing by about 20 minutes.
We also see that the studies show that there is a higher chance of spontaneous vaginal birth rates, meaning that these people are going to have less chances of having a C-section or some sort of operative delivery, like a vacuum or forceps.
There are also some studies that says it extends the second stage of labor by one hour.
Now there are two stages of labor, which means that the first stage is that passive pushing.
It's that laboring down and that active pushing phase, which is that spontaneous urge to push where you're actually pushing behind that urge to push.
Um, some, some studies show that it can actually be ex.
Extended.
So I think again, this is where that inconclusiveness comes from.
I also just mentioned that there are studies that show higher spontaneous vaginal rates.
On the opposite end of that, there are some research, although it's small, small research, and they saw small increases.
So it's not a huge increase.
Um, but.
Some of the studies, not all of them, they did show that there was a small increase in cesarean birth and that operative delivery, so that assisted birth with the forceps and the vacuum.
One thing that we do kind of see in many of the studies is that there is an increased chance of postpartum hemorrhage and therefore needing a transfusion.
However, in all of the studies, without a doubt, it does show that laboring down does not increase risk for the baby.
There's one other important nuance that I want to share with you is that in these studies that you know, showed that there could be an extension of pushing and there could be a increase in C-section or operative delivery, they never accounted for why pushing was delayed, nor did they look at baby's positioning.
So those are two things that I think may be really interesting a, to look at in future research, but B, for you to kind of think about when it comes to your own individual circumstances.
So if you know that you are otherwise unmedicated, un augmented, so your uterus is not under any sort of additional duress from an epidural or Pitocin.
And your baby is really high.
Therefore, your baby's position is not quite low enough to be pushing.
You might be a really great candidate to labor down if that's something that feels good to you and aligned to you, and you want to do that.
The other thing is, you know, if you, let's say you have an epidural and you are on a little bit of pitocin, but you are feeling so exhausted from the labor that you have had and you are a little worried about being able to fully push your baby out and you instead would like to take an hour or so nap before you actively push.
That's a discussion to have and something to consider is, you know, do I labor down and allow my body to push my baby down further into my pelvis while I rest and recover some of my energy.
So that I can be a more effective and efficient pusher.
Right? Now with that, you have the increased risk of hemorrhage with both Pitocin and an epidural, so there's a trade off there.
However, if with that trade off you are getting a shorter pushing time.
Does that mitigate your risk for postpartum hemorrhage in some way? I don't think that there's any way for us to know for sure, but I think that these are interesting questions for not only the, for you to discuss with your medical providers, but for you to consider for your self of what is important to you.
Is it more important for you to go ahead and push even though you know that you may push longer because your baby is higher up and hypothetically decrease that risk of postpartum hemorrhage, even though pushing for extended periods of time comes with a risk of postpartum hemorrhage? Right.
Obviously births is not one size fits all.
It's really about making informed decisions in real time based on your circumstances, your scenarios, and your birth goals.
I think what really matters is that full clinical picture.
What are your birth goals? What's important to you? What is your why? You know, and where is your baby? What is your body doing? What are both of your vitals looking like? Is everyone in this scenario looking healthy? And is laboring down a safe and reasonable choice for you in this birth? I also think that.
If you didn't labor down in your last birth and you wanna try it this birth that's really safe and reasonable and the opposite If you labor down last time, but you get into this birth and you decide that you don't want to, again, very safe and reasonable and super valid not to wanna do what you did last time.
If it doesn't feel aligned to you in this birth, every single birth is very different.
Whether you are looking at two different people or you're looking at two different births within the same person.
I think that it's really important to look at.
The labor that is in front of you and laboring down is not right or wrong.
It doesn't make or break a situation.
It is simply a tool that you can use at your disposal if it feels aligned to you and it's appropriate for your situation that you're in, in this labor.
So there you have it.
For some people waiting and laboring down is absolutely the right choice.
And then for others, going ahead and pushing and foregoing laboring down is the right choice for them, and that's where I will leave you today when it comes to pushing out your baby.
If you wanna learn more about the secret sauce to pushing, which for me helped me have the stamina and learn how to push for many hours, and I had zero pelvic floor issues following many hours of pushing and I did not tear in my labor, you can check out the secret sauce to pushing head to the birth lounge.com/secret
sauce to pushing and learn how to push your baby out efficient and effectively and with ease.
Right? Even.
It isn't quick.
It will absolutely help you do it in a way that preserves your body and uses the right muscles and helps you have the stamina to do it for as long as your baby needs.
Because I'm a big believer that your baby determines.
So much of your labor, including how fast they want to be pushed out.
All right, you guys.
I'll see you in the next episode.
Be sure to follow me on social media and you can find me at Tranquility by Hehe and at the Birth lounge.
Until next time, head to your app store and download the Birth lounge app for evidence-based childbirth education, and datadriven postpartum support delivered straight to your phone.
Bye.
Thank you so much for tuning in today.
I love hanging out with you, and it is an honor to be your go-to gal when it comes to preparing for your baby.
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I'm Hei and this is the Birth Launch podcast.