Thursday, 25 June 2009

Are we pushing too hard?

If I had to pinpoint one element of hypnobirthing that women have the most difficulty getting their heads around it is 'pushing' or to be more specific the lack of 'pushing'.

During hypnbirthing classes we teach 'mums' that there is no need to do lots of forced 'purple' pushing. This is a very outdated concept and comes from a time that women used to be anaesthetised, and unable to birth their babies, and so forceps were used to extract the baby from the vagina. As times changed, women were conscious when birthing their babies and forceps were no longer routinely used and so it was felt that if the babies were no longer being pulled out of their mothers then surely the mother would have to push them out (maybe as they get older there might be a need to push them out of the nest for their own good but not this young surely).

Yet again we find that doctors think they know more about birth than mother nature does. But for a women with no special circumstances there is absolutely no reason why both she and her baby cannot be left quietly alone and for the baby to gently makes its way down and ultimately out.


New midwives are now trained that forced pushing is not necessary, however, some old school midwives will still try and get you to start pushing just because you are fully dilated. You will want to ignore this instruction (put on your birth plan that you want to do mother-directed birth breathing and have no outside instruction from the midwife as your birth companion will be supporting you with this). For those who feel that it would be difficult to go against what a professional is telling them, please read the attached paper written by the Royal College of Midwives, which supports what we are saying during hypnobirthing classes.
(please note however that the prompts suggested for midwives are to support women who have not had hypnobirthing training and do not necessarily have the help of a knowledgeable birth companion)

Forced pushing is stressful on both the mother and the baby and can in fact slow things down as it closes the sphincters of the vagina ahead of the descending baby. It can be an overwhelmingly exhausting experience for a woman and is one of the reasons why doctors like to intervene if a woman isn't progressing at a pace they are happy with. Unfortunately, it is the fact that they want to intervene at the birthing stage and make the woman push that leads them to think they need to intervene earlier so that she has enough energy to push. Oh! I'm exhausted just writing about it.

However, there is no need. We have a natural expulsive reflex that will gently nudge the baby down and out.

Unlike other techniques you will learn on a hypnobirthing course you can't practise birthing your baby (I'm sure I don't have to explain why :-)). However, there is another function within the body that uses the natural expulsive reflex...... Have you guessed what it is yet? Of course you have - it is when we are having a 'poo'. Now don't ask me why but when my husband attended one of my hypnobirthing courses, when I was pregnant with Evan, and we got to this part of the course he got a little upset with me (not openly but afterwards he said "Dany do you have to mention poo so much can you not say when you open your bowels?" Oh please anyone reading my blog will know that I'm going to say poo - quicker, easier, more simple - actually just like birthing using hypnosis.

I digress back to pooing (not literally you understand)!

Think about it - you don't think to yourself "do you know at some point today I'm going to want to poo so I'll go and sit on the loo for the next few hours and push with all my might until one comes out". Of course you don't. You wait till you get a sensation that you are going to poo, you go and sit on the loo whilst your poo makes its way down and then maybe you might give a little push at the end.

Erm! I do say poo rather a lot don't I?

This is exactly what you want to do when you are birthing your baby and because you will be using the same natural expulsive reflex you can practise your birth humming technique whilst having a poo. This often becomes labeled by my 'dads' as 'poo humming' and is the first thing they love to share with people about hypnobirthing.

Right so if you are still with me let's focus on how you practice your 'poo/birth' humming. simply take a nice deep breath and hum down. As you hum you can imagine the opening of your vagina, like the petals of a lotus flower, folding outward as your baby moves toward the perineal rim.

Now as I was saying you can't for obvious reasons practise this until your baby is ready to be born. However, as you also have a natural expulsive reflex that helps you poo you can practise whilst on the loo.

But before I explain how I'm going to digress once more. If you had never done a poo. ever in your life before, and someone said to you that you were going to pass something relatively big out of a hole that appears quite a bit smaller than your poo you'd quite probably be scared. As it was making its way down you'd probably tense and tighten and be full of fear. In fact it is quite interesting watching my 2 year old daughter at the moment. Her poos are becoming more solid and we're not quite potty training yet but she's becoming very much more aware of what's going on down there. You can see the look of surprise sometimes just before she does a poo as she starts to feel her poo making its way down (and the look of surprise on mine when I find she's poo'd in my slipper but I won't go on about that again).

For your practice. When you are doing a poo, firstly become aware of how your poo feels as it is nudging its way down. Then take in a nice deep breath and hum down directing the breath around your poo and noticing how the muscles relax around it and help its progress. You can practice using the opening lotus flower described above too to imagine more space around and in front of your poo. This technique is also particularly useful for anyone suffering with constipation.

Just once you can also squeeze and tighten and notice how your poo pops back up. So often midwives will say that they could see the baby's head and then it popped back up again. This is a really useful way of appreciating how very clearly tightening and tension will not only stop the baby's descent but also potentially move him or her back the other way (talk about two steps forward and one step back).

The more you practice 'poo' humming the more you are learning how to tune into the natural expulsive reflex of your body and experiencing how your breath and focused attention can enable everything to remain relaxed and open easily. When it comes time to have your baby you will be fully prepared to work with your natural expulsive reflex to help nudge your baby down and out.

If you are interested in finding out more about how hypnosis can support you through pregnancy, labour and birth check out my hypnobirthing classes and home study programmes at

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  1. Very interesting and informative blog!

    Angela - Hypnobirth Board Admin (babycentre)

  2. Dany-Thanks for this fab blog. It is so so true who would sit on the toilet all day pushing to have a poo if they were not ready? So simple once pointed out- I am sure that I will NOT be encouraged to push by my midwives but if they do, forget the paper I may just direct them straight to your blog!!

  3. I suppose if the midwife tries to direct you to start pushing you could ask "do you want a poo?" If she says no say "well why don't you go and sit on the loo and start pushing until one comes because I'm sure you'll want to do one at some time in the near future". Tee hee - I'm in a silly mood today.

  4. What a brilliant and humorous bit about birth breathing! Well done!

  5. Hi there - hope it's ok to ask a question here. Enjoyed your blog and your well informed viewpoint on this. I found hypnobirthing hugely beneficial with my first child, but didn't manage to get anywhere with the birth breathing bit as I didn't seem to have a very strong NER. Midwife supportive of me trying birth breathing for an hour, before becoming keener to get me to push, which (not being sure of myself) I did - an exhausting further one hour which culminated in an episotemy due to distressed baby. A very good birth experience overall and I rave about hypnobirthing to all who sit still long enough, but I wonder if you have any advice re what to do when the expulsive reflex doesn't seem to be moving the baby down at all (second baby coming soon for me)...

    Best wishes, A :)

    1. I can't believe that I never saw the comments on this post. I must check how blogspot inform me of comments. I am sorry as this is waaaaay too late for you but I will reply for others. In a word patience. The thing with pushing is it looks like something is happening even when it is not. Breathing down looks like nothing is happening but really what we need is the patience to allow the natural expulsive reflex to work. When I hear stories of women pushing for hours and then needing an assisted delivery I always think surely it would have been more comfortable for mum and baby if she'd breathed down for hours and then needed an assisted delivery. Unfortunately in the latter example the breathing would have been blamed.

  6. Thanks so much for this. I gave birth to my DD in March 2009 and have been distressed since then that I never had the urge to push. I was told to stop using my breathing techniques and push like mad but I didn't want to - it seemed wrong somehow. I ended up with forceps delivery and wondered if it was because I didn't comply with the MW's instructions but now I think maybe that was irrelevant.

  7. Sorry but I can't help feeling like i want to say something. I have been a midwife for 16 years, supporting women giving birth to their babies in all sorts of settings in all sorts of ways. I find the general tone of condescension towards midwives as ignorant robotic harm-doers very grating. When labour progresses normally no intervention is necessary, women follow their instincts and babies come out. Many labours do not. If you want to see what NO intervention,NO monitoring, all natural maternity in humans looks like, look at Liberian or Afghan statistics of maternal and fetal morbidity and mortality. Birth, in any mammal, bird or reptile is not always pretty and undisputedly carries risks. Most midwives are thoughtful, conscientious practitioners who have seen the many faces of birth, and are mothers themselves. Frightening women into distrusting them while at the same time asking for their care is not helpful.

    1. Monique I have only just seen your comment unfortunately but would reply that actually during my classes and on forums I am always very supportive of doctors and midwives saying that when there is a true need for medical intervention that we are incredibly lucky to have them. I also believe that on the whole both very much want to support women in the birth that they want. Unfortunately and I think in your heart you will know this to be true, there is too much intervention in birth. To get a woman to push for the sake of pushing is counterproductive. The article written by the RCM supports this and trainee midwives and midwives who come on my courses agree with this. Unfortunately, however this is the part of hypnobirthing that many midwives do not give patience for. A little bit of humour in the post does not imply that I think all midwives are ignorant robotic harm doers. We certainly do not frighten women to distrust midwives and doctors merely to be seen as part of the team with regards to the birth of their babies. If you would like to understand more about the way we teach I would suggest contacting your local HypnoBirthing practitioner who I am sure will be very happy to have you come along and observe her course.

  8. Thank you so much for this post. I have been using the Marie Mongan Hypnobirthing book and CD to help me with my baby's birth (first baby, due in two weeks). I found this post really helpful and easier to understand than the book. Hopefully I will be able to put it into practice in a couple of weeks' time! xoxo

  9. Sorry Mummy Michelle I have only just picked up your message. I'd love to know how your birth went :-)