So, you are in labor and you make it all the way to 10 centimeters, or complete dilation. Is it now time to push? Once you have reached complete dilation (10 centimeters), you have now entered the Second Stage of Labor. The Second Stage of Labor lasts from when you are completely dilated until your baby is born. In labor and delivery units, there are many techniques that nurses, midwives and doctors use to direct women through this challenging portion of childbirth. Some techniques have to do with how you actually push. Some techniques have to do with your body position during the second stage of labor. But one question precedes them all: When is it really time to push?
The term ‘laboring down’ means that a woman is not directed to push until she actually feels the ‘urge’ to push. So, for us in healthcare, laboring down is actually an inaction versus an action. It is waiting until the woman says ‘OK, I have to push.’ I am sure you have seen this many times on TV: a woman is usually screaming, “I have to PUSH!” Yes, Hollywood can over-sensationalize this very real sensation. The urge to push is medically known as Ferguson’s reflex. Ferguson’s reflex occurs when the baby’s head gets low enough in the birth canal to stretch several pelvic nerves. The stretching of these nerves causes the woman to feel the urge to push.
Benefits of Laboring Down
What are the benefits laboring down? Medical research has shown that laboring down is associated with fewer ‘difficult’ deliveries, fewer perineal lacerations and fewer episiotomies. Laboring down also decreases your fatigue level, as you spend less time actually pushing. The Association of Women’s Health, Obstetric and Neonatal Nurses (or AWHONN, for short – pronounced ” A-1″, like the steak sauce!) publishes evidence-based practice guidelines that help nurses and other healthcare providers to provide the safest care using the most up-to-date research. There have been two editions of AWHONN’s Evidence Based Practice Guideline: Second Stage Labor Management and both tout the use of laboring down and its many benefits for women.
Are there any drawbacks to laboring down?
Time is of the essence in some cases. Research has shown that when laboring down is used, it can extend the length of the second stage of labor. Some studies have shown that using laboring down may extend the length of the second stage of labor by an hour, on average. In the United States, some healthcare providers may be reluctant to extend the second stage of labor past two hours. Nonetheless, research has shown a time limit does not necessarily need to be set, as long as mom and baby are doing well. Epidural anesthesia may also diminish the urge to push, making the use of laboring down challenging in a few select cases.
If you are pregnant, talk to your provider about your choices for labor and birth as your delivery date draws near. Consider including laboring down as one portion of your birth plan. When you come to the hospital, share your wishes and plans for your birth experience with your registered nurse. Together, a team approach that focuses on your individual needs is the best way to bring your new little bundle of joy into the world!
Jennifer Doyle, RN, MSN, WHNP-B C
Jennifer is the Perinatal Outreach Educator/Advance Practice Nurse for Summa, Akron City’s Women’s Health Service Line. She has been an OB/Neonatal nurse for nearly 20 years. Jennifer is a past recipient of the Greater Chamber of Akron’s ’30 For The Future’. Jennifer is also very active at the state and national level through AWHONN. She has served as a Chapter Coordinator, Ohio Section Secretary-Treasurer and is now in her second and final elected term as Section Chair, AWHONN Ohio.