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Side-lying is a great position because there is no pressure on the sacrum, and it facilitates oxygen flow to the baby and great blood flow to the uterus (positive blood flow to the uterus results in coordinated, efficient contractions). The upper leg can easily be supported by care providers or partners.
Squatting low over a pillow, cushion, or mat is a wonderful way to birth, as the baby can slide right out and the mother can easily pick up her own baby after taking in the entire experience. (This, compared to babies that are “thrown” up on the mother’s belly, seems like a more gentle way for mothers to make the transition after such physical work.)
 Above all, just because the cervix is completely dilated does NOT mean a mother needs to push (it’s also normal to have small, involuntary pushes at the peak of a contraction to help with the last couple centimeters of dilation). The uterus will bring the baby down on the pelvic floor with contractions, while the mother breathes or copes with these contractions. After awhile, there will be an overwhelming action of the mother’s body to bear down. Active pushes on the part of the mother should only occur when the mother feels them, and not between contractions. Holding the breath while someone counts will only fatigue the mother, as well as create a risk of fetal distress due to the decreased oxygen. The whole idea is to listen to her body.
Some pushing stages take 20 minutes. Others may take 3 hours. These are all variations of normal and the mother should try a variety of positions that feel good for her, while staying hydrated and emptying her bladder (an empty bladder helps baby move down into the pelvis, as well as helping the uterus contract after the baby and placenta are delivered). Warm compresses over the perineum and rectum may offer some comfort, but hot compresses over a long period of time could swell the perineal tissues. Many midwives put herbs like grated ginger root into a crock-pot for compresses. Plain, boiled water works wonders, too.
For Partners: A hint for long pushing stages: cold cloths. Fill a small bowl with ice and a little bit of water. Get two or three washcloths and immerse them in the ice water, wring them out and use them to stroke the mother’s forehead or place on the back of the neck. These will warm up rather quickly, so replace them often with newly cooled cloths from the bowl. You can also add a little bit of essential oil to the water (lavender or clary sage are two labor favorites).
About the Author:
Pamela Hines-Powell, CPM, LM, is a homebirth midwife who resides in Salem, Oregon with her partner, Gabrielle and their three girls. Pamela’s priority as a midwife personalized, empowered care with a focus on unhindered freebirth. Her website is www.midwifemama.com
For references and additional information about the author and topic, please visit: http://pathwaystofamilywellness.org/references.html
 This article appeared in Pathways to Family Wellness magazine, Issue #13.
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