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What Is The Meaning of Pushing During Labor? Introduction To The Idea That Pushing Must Be Clearly Defined The author set out, initially, to answer one simple question: What, precisely, is meant by "pushing" during labor? The author realized that they did not know, and that everyone presumes that one already has an understanding of this, when the topic is discussed. This is especially important to the author of this article because they work as a perinatal LMT focusing on the Pelvic Floor. Knowing exactly which muscles and ligaments a prenatal woman might want to strengthen, prior to labor, would certainly be of benefit. The author began with their academically-acquired knowledge from Certified coursework focusing on the Pelvic Floor. Thge author of this article then compiled a list of possible meanings for "pushing" based solely on their understanding of the Pelvic Floor, and the ways in which movement can happen. Next, the author penned their own hypotheses, expanding on these basic possibilities. Upon checking the scientific literature, we found that some researchers had been pointing in similar directions, and so the author's ideas are not without a framework of existing studies on the topic, though they are distinct and novel. This is a well-developed idea about menstrual cramps, birthing contractions, and the author's explication of pushing, detailed in this article. Next, the author checked online to see what people had said on public forums on the topic of pushing, as well as what official websites for hospitals and medical centers had to say about what pushing was. Apparently, both women and perinatal medical professionals have a diverse set of beliefs and views on what pushing meant. Only one definition was added to the initial list, gleaned from a reputable medical information source on the Internet. In this article, the reader shall find a detailed discussion of the term "push." The style of this piece is informal and meant to be accessible to even women who are not familiar with the Pelvic Floor. If you would like us to add your own feelings or thoughts on pushing, please e-mail us at [email protected]. Please state that you grant permission to publish. Thank you. Push That Baby Out! It's no secret that women are often told to "push" the baby out when giving birth. It's rather common advice during the second stage of labor. And, it may well be instinctive, just as we don't have to consider which muscles to use when defecating. Some think that we just know. We've all seen our share of a birth scenes in Hollywood movies and TV shows, with a doctor/spouse/coach screaming, "push!" and the pregnant woman responding with a loud roar, and a few seconds later, a very cute, and way too clean, swaddled baby appears. This sanitized version of reality is akin to buying vegetables at the grocery store, pre-washed in a neat and clean package, as opposed to growing them yourself, having to shake off the dirt, and washing with the garden hose. (Always wash, even the pre-washed packages of veggies!) In reality, birthing may not be so neat (or clean!), and the pushing is often not quite so dramatic, sometimes going on for quite some time; probably, that would not make for such good entertainment, and hence all the overly dramatic short and succinct scenes. When We Think Of Childbirth We Think: PUSH! Pushing is what we probably most associate with birth and a new baby coming into the world. In this article, we shall enumerate the different possible definitions of what pushing means in labor. You may be a birthing professional, and the topic is old hat to you. Perhaps you're a woman in the postnatal phase, and the experience of pushing is still fresh in your mind; it's equally possible you've delivered some years ago and it's all a blur by now. Or, you may well be pregnant right now, and ended up on this page because you, like the author, have no idea what pushing actually means, and you have an inquiring mind that must understand directions. In any case, the ideas presented are worthy of your consideration, as the questions raised are relevant when considering pushing during labor. And, some ideas are the author's own, and so they will certainly be new to you, regardless of your background. We're keenly interested in expanding on this article, and we're at the initial stages of working with a nonprofit to begin conducting research to answer some of the simpler questions raised in this same article, as well investigating whether we might provide quantitative proof that our signature Pelvic Core Awareness exercises are effective, in at least some of the ways they're intended to be of benefit. Wait! Don't Push! A Contrarian Viewpoint There's a growing "no push" movement, a contrarian viewpoint that holds the position that "pushing" only hinders the process of the baby coming out easily and quickly. In other words, don't interfere with nature; the body will do its thing if you just let it. Which is right? Can both be correct, in different instances? Unfortunately for those hoping for definitive answers, this article does not attempt to even begin addressing this particular question; it's far afield from the intent of this piece. However, this is a question worth considering, and possibly we'll publish an article in future with "Push/No Push" as its sole focus. Different Kinds of Pushing And Breathing During Labor There's also the difference of "spontaneous pushing" versus "directed pushing," however, that aspect of pushing in labor is well-studied, and this article shall not really explore this aspect of pushing, either. Why? It's just a diversion from the truest purpose of this article, that is, to find out what pushing means, not to add to the confusion by introducing other variables that are distinctly NOT about the pushing aspect of labor, but rather aspects peripheral to the topic. A good meta-study entitled, "Pushing/bearing down methods for the second stage of labour," by Brazilian researchers Andrea Lemos, Melania MR Amorim, Armele Dornelas de Andrade, Ariani I de Souza, José Eulálio Cabral Filho, and Jailson B Correia, analyzed the results of over twenty studies involving pushing and breathing variations during labor. The study is comprehensive and yields a great deal of information, a treasure trove of data for the curious. The research team found little difference in outcomes as far as directed or spontaneous pushing, among other conclusions. The meta-study also covers such important topics as perineal laceration during birthing, however, these conclusions are not illuminating to the topic at hand, though the reader may find these aspects of the meta-study interesting for other reasons. (Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev. 2017 Mar 26;3(3):CD009124. doi: 10.1002/14651858.CD009124.pub3. PMID: 28349526; PMCID: PMC6464699.) https://pmc.ncbi.nlm.nih.gov/articles/PMC6464699/ Laboring Down: Yet Another Variant We Shall Ignore Laboring Down is the practice of waiting to push after entering the second stage of labor for one to two hours. This particular variation is also going to be ignored in this paper. Again, another peripheral variable that will only take us off topic. It's generally accepted that the second stage of labor begins when the cervix is dilated to 10 centimeters. This stage of labor can last anywhere from a few minutes to many hours. Is there any benefit to this practice? Some birthing professionals believe so. Some birthing professionals may practice Laboring Down if they feel a patient in labor is too numb down there. Waiting lessens the effects of the anesthetic. https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://my.clevelandclinic.org/health/articles/22959-laboring-down&ved=2ahUKEwjLpc2JjMSMAxUHF1kFHSwZDvMQFnoECB8QAw&usg=AOvVaw0QnY0IeQfepjHhZ9Ka38ml What Is Pushing During Labor? In order to even know what we're talking about, and which position regarding the definition of pushing during labor holds the most merit, we have to begin with considering what "pushing" even means, in this experiential context. It turns out, once we start investigating the ideas that are out there in the real world, we find a confusing mess of non-agreement on even the most basic of definitions for the word "push" relating to labor amongst medical authorities. This does not make our task any easier; it turns out that the twin questions of "push or no push?" and "what is a push?" have many different answers, from even medical specialists dealing with birth. Pushing Or Bearing Down? Most of the time, the phrase "bearing down" is used interchangeably with "pushing," in the context of labor and birthing. Bearing down generally means pushing downward with steady pressure. Bearing down is defined simply as "1. the expulsive uterine contractions of a woman in the second stage of labour." in the Online Oxford Reference. For this article, we shall stick with using the term "pushing" to mean the phenomena that may be described using either term in this context in the real world. The verb "bear" first appears in Early German, from the word beranan, which meant to "give birth to," among other related meanings. Does the word etymology help us, in this case? Or, are we just as confused as before? It seems like we're just going in circles so far. A Useful Definition From A Different Medical Specialization "Bearing down means that you try to breathe out with your stomach muscles but you don't let air out of your nose or mouth." Think of it this way: It's like what your abdomen does automatiaclly when trying to exhale through the small opening of a straw. Apparently, the act of "bearing down" with a focus of compressing the abdomen and diaphragm, via voluntary muscular control, affects the Vagus Nerve. The above definition is stated in this context, and not perinatal women in labor, to be clear. However, the explanation may be useful in helping us understand what is meant by "bearing down," specifically. The phrase, and surrounding text, may be found at the Kaiser Permanente page entitled, "Vagal Maneuvers for Supraventricular Tachycardia (SVT)." https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.vagal-maneuvers-for-supraventricular-tachycardia-svt.ps1283 The Variations of What "Push" Might Mean The following is a brief list summarizing the possibilities of what pushing might mean, including instances of not pushing, which is also practiced among a minority of doctors and midwives. The author created this list drawing from their own understanding of the Pelvic Floor, having been trained in, and having practiced, Pelvic Floor Massage for Perinatal Women, and likewise from their understanding as an educator, as the author is presently working on the creation of a Continuing Education course on the Pelvic Floor based on what they learned as a student, and expanding from there based on the author's own concepts derived from the commonly held ideas as a solid foundation. And so, some of the ideas on the list about what pushing is may seem uncommon, and are possibly not the most accurate, but are included for the sake of completeness, as they are potential answers, knowing what the Pelvic Floor can do, in terms of motion and movement. Checking What's Out There: What's Said About Pushing During Labor Next, this article's author checked on-line and read what postnatal women had said on forums like Quora and Reddit. Finally, the author perused ob-gyn, hospital, and midwifery websites to see what they had to say about pushing and what pushing is. This process provided the author the opportunity to see the range of ideas, what people think in the real world. No new ideas about what pushing might encompass came from this process, as the author's initial list was exhaustive. However, as the author read on, it became apparent that a few explanations predominated amongst women and medical professionals. More than any other answer, "pushing" is thought to be synonymous with the action and tensing of muscles involved in defecation. We do not have statistics of distribution of how women and medical professionals think about this matter, at this time. Actual Accounts of Women Found Posted In Online Forums
"For me it was like a STRONG period cramp (like a stretching and pulling sensation) that radiated from my lower back to my abdomen."
"TMI but my first labor pains felt like intense bowl movement cramps, the kind where you start to sweat and feel faint. Like where you feel like if you don’t get to a toilet you’ll die lol."
"My cramps have made me throw up before from intensity so yea, it was definitely comparable to period cramps."
"Think of it more like diarrhea cramps if you’re having a hard time visualizing period cramps."
"Mine came on fast and furious… I’d compare it to having a series of Charlie Horses in the same location as period cramps."
"My contractions felt like mild period cramps in my lower back."
"I feel like contractions are like period cramps in the same way that a light breeze is like a hurricane."
"For me they did feel like period cramps, but not terribly bad ones."
"With my labor my contractions started in my lower back and radiated around my front, lower abdomen area. They started off as bad period cramps and intensified over time."
"For me, contractions were never anything like period cramps. IMO they feel exactly like uncontrollable Charlie Horse muscle spasms, spread across your abdomen in increasing intensity and duration."
This is but a small sampling of women's accounts that may easily be found online concerning what Labor Pains feel like. Some Women Say Labor Contractions Are Like Monthly Cramps; Others Claim Sensation Like Need To Defecate What's behind this? As many women cited that they felt they had to poop, and they did, clearly it was an urge to defecate. But, was it anything more? It's not easy bearing down or doing certain Pelvic Floor exercises without first having evacuated the bowels, in truth. Could it be that many women just have to go to the bathroom, and that must be dealt with prior to any real pushing happening? Or, could both be correct, or neither? Is There One Right Answer? Not every answer can be the most correct. Some ideas about pushing during labor may be completely wrong, though widely believed, even by doctors and other trained medical professionals. More than one answer can be correct, however. There may be options as to how to proceed as far as pushing goes, in the second stage of labor. Likewise, some women, in some pregnancies, may fare better with one form of pushing than another. There is insufficient data on this topic to really draw any conclusions at this time. Various Definitions of "Pushing" During Labor The following list includes all possible explanations as to what pushing during the birthing process refers to that the author could think of. (The definition from Kaiser-Permanente was added later, as this was not one of the ideas the author had considered.)
PUSHING (TYPES 1 THROUGH 7) 1. Push like you're pushing out poop. Just $&*! Out The Baby?! Is defecating really the same as pushing out a baby? Many believe so, from ob-gyns to midwives, as well as many postnatal women who've gone through the experience. This is probably the most commonly held belief in our society among people who are directly involved in birthing, either firsthand or as a medical professional. However, this is only the first, of many, explanations of what "pushing" during labor may mean. In support of this idea is the fact that as the baby descends, their head tends to compress the colon. Perhaps this helps to initiate the sensation to push, as is the case when a person has to go to the bathroom. Is Constipation The Same As Pregnancy, Then? While this interpretation of "pushing" being the same as when you're trying to push when constipated may sound reasonable, perhaps other answers are even more reasonable. (And, remember, if you're pushing when trying to go #2, chances are you aren't eating sufficient amounts of fiber in your diet!) Really, what's meant by those adhering to this belief is that labor pushing is identical to the sort of pushing that goes on when one is trying to defecate when constipated, to be clear. Does this sound correct? Many believe so. An Intense Need To Poop? Ummm...No? Intestinal cramps, like when you get food poisoning, the flu, COVID-19, or ate too much acidic food (chugging the entire container of orange juice on your hike for example!), feel altogether different. These types of cramps make you want to poop. ITENSELY AND IMMEDIATELY! It's a deep, sharp pain in the lower abdomen like a knife slicing through you. You start to sweat. You get chills. You end up going to the bathroom and a stream of near-water flows out, as the cramps feel no less a nightmare. The cramps make you want to push, and more watery stool comes out. Your intestines still feel like knives are cutting them. Thankfully, birth is not the same as defecating. The truth is, intestinal cramps in the colon do not feel like women's pelvic cramps. Ever. While both structures are in the pelvis, the sensations each produces is distinct. Period cramps, as well as birthing contractions, are focused within the uterus, vagina, vestibule, uterus, uterine ligaments, round ligaments, posterior pelvic ligaments, and even the lower back, and sometimes upper thighs. 2. Push your abdomen in, "bear down" and compress your abdomen and diaphragm by tightening, as if exhaling, but do not exhale. This is the literal definition of "bearing down" from Kaiser Permanente. Is this also applicable in labor? Squeezing the baby out by compressing the abdominals, as well as the diaphragm, with or without breath work? Might the focus of "pushing" be the tightening of the abdominal wall, a sort-of abdominal-breathing-type motion? Perhaps some of these enumerated possibilities be able to be performed together? Is this movement mutually exclusive with the action described in Variant #1? 3. Pull your pelvic floor upward and inward and hold. Pelvic Floor Tightening And Pushing During Labor This is one of the basics pelvic floor training exercises that women perform as part of a Pelvic Floor Awareness session, either directed or on their own. This concept of "pushing" involves holding the pelvic floor in voluntary contraction, which has the result of moving the vagina upward and inward. It's like what women do when stopping the flow of urine; it's essentially this same action. But is it the real answer as to what "pushing" is? The author did not actually find any support, anecdotally, for this explanation of pushing during the second stage of labor. And so, either it's a hidden truth of sorts, in that no one in our current medical-birthing milieu is aware of this, which is a distinct possibility, or we can interpret this to mean that there's no talk of this explanation because the explanation is completely lacking merit. This is the author's own hypothesis, and the author didn't really expect that a holding posture would necessarily help a baby to go outward; it seemed counter-intuitive. Even so, this possible explanation is included for the sake of completeness. And, further along in this piece, we will explore yet another possible Definition of Pushing, which may well include this aspect. Again, please note that only antagonistic movements seem to be mutually exclusive, for instance, loosening and holding, the Pelvic Floor. Is THIS what pushing means, or should mean? Does this, perhaps, constitute a component of what pushing is all about?
4. Work with the contractions and assist by tightening the pelvis. This variety of pushing instructs the woman undergoing labor to push, explaining that she should tighten muscles and ligaments at will that are already spasming with contractions. This is what started the author on the quest to find an answer; the question of whether there was a connection between cramps, spasms, and labor contractions seemed worthwhile to pursue. After coming to their own conclusion that this may be the truest definition of pushing, the author found that many birthing professionals do agree, though it is far from the majority. The author of this article included a Pelvic Core Awareness Exercise within this document, further along, that is related to assisted tightening of the pelvis, to build strength and endurance, training muscles and ligaments to work more effectively. The author has found that some women and perinatal medical professionals also hold this to be the most accurate interpretation of what "pushing" means, this is to say, activating the muscles that are tight and in spasm in the pelvis during the monthly cycle. While not the most popular interpretation, this is not uncommon.
5. Let the pelvic floor go loose, and let the vagina relax and move downward and outward. There is no push in this instance, so this would be regarded as a form of "no-push" birthing, though still focused, as far as mind goes, on the pelvic floor. Being still in body, the body will do its thing, all on its own. Won't it? This is a mindfulness technique, and is very Zen-like in its concept. Accomplish by Not-Doing. And, every major faith talks about being still in mind and body, from the Abrahamic faiths to Hinduism, Buddhism, and others. Does this also apply to women giving birth? Or, is birthing a specific exception, like when you're interrupting your stillness mediation in the flowery field because you're running from a bear? Is this type of vaginal and pelvis floor loosening a truer spiritual approach to birth? Being aware of the contractions but doing nothing at all but merely watching it all flow by? We might wonder. Using this technique, no deliberate pushing is done, but if the pelvis contracts on its own, the pregnant woman allows it to happen and does not fight the contractions. Whatever the pelvic floor, pelvic core, and pelvis, decide to do, it's fine. You have faith in the process and have let go. Ideally, the experience of birthing could bring a birthing woman to a rare moment of pure Being, beyond conceptual thought.
6. "Push" (?) after epidural administration. This is a weird scenario that's more common than you might think, happening in hospitals across the nation every day. This one makes little sense, really, when we consider basic facts. An epidural is an injection into the spinal cavity of Fentanyl and cocaine. The idea is to numb the pelvis, preventing the woman in labor from experiencing pain. Or, much of anything! To illustrate my point that there are some practices that are worth looking at, I propose that you consider this scenario, dear reader: If you come back from the dentist and have numb lips, even if you usually whistle amazingly, chances are, you'll fare about as good whistling afterwards as you might drinking water after having had administration of dental anesthesia, dribbling most of the water down your chin. Your lips would be numb. How in the world could you ever whistle in a rudimentary fashion? Isn't asking women to "push" when they can't feel their pelvic structures, and therefore, tighten or loosen, a form of playacting? As there is no data available as to whether women pushing after receiving an epidural accomplishes anything at all, it's questionable whether "pushing" under anesthesia is really even a thing. Placebo much? I want an example of an anesthetized body part being able to be contracted or loosened at will by a person. Of course, there won't be such evidence forthcoming. How could there ever be? An anesthesiologist might explain that there are different degrees of numbness; it's not a binary numb/not-numb sort of thing. At some point, a woman may not feel too much but can still feel pressure. This is said to be the ideal amount of anesthesia during childbirth. Factors affecting this are the precision of the injection, proper dosing based on patient weight, and whether the mother was only lying on one side after injection, which may cause over-numbing on one side, and insufficient numbing on the other. Also, people do not always respond the same way to the same dose; women have different sensitivities. Some women report feeling nothing, some report feeling pressure and little else, and some women report not feeling quite so numb at all, and experiencing a great deal of pain. What Women Say Online About Pushing After An Epidural "It was terrible. I couldn't feel a thing. Hard to push when you have no control over your muscles. All the doctors and midwives yelling at me to push harder, feeling like I was on the precipice of a vacuum/forceps delivery, just horrific. I've never been so afraid. After a while the epidural wore off just enough for me to find my transverse abdominus and I was actually able push her out in 2 pushes" Reddit User EmSanderz on r/beyondthebump "I feel like my epidural was pretty strong. I couldn’t feel or move my legs at all, it was really scary tbh! The doctor came and broke my water, and I actually had to ask if he had already done it right after because I couldn’t feel a thing!...When it was time to push I was on my back and they were holding my legs up and telling me when to push, but I couldn’t even feel I was pushing. It’s really hard to describe, but I just sorta took in a deep breath and started straining like I was trying to poop, which I did LOL. " Reddit User AssVictoriam on r/beyondthebump "So my epidural was apparently perfect basically because the only thing it numbed was my uterus and cervix lol I could feel everything else. The urge to push, stretching, everything" Reddit User ellegirl82091 on r/beyondthebump https://www.reddit.com/r/beyondthebump/comments/1axl6fn/what_was_pushing_like_if_you_had_an_epidural/ "[The epidural] actually made it kind of difficult cause when they told me to push I wasn't sure if I was actually pushing or just grunting and holding my breath." Reddit User MeowMixUltra on r/babybumps https://www.reddit.com/r/BabyBumps/comments/sxcux0/once_you_get_the_epidural_what_does_the_pushing/
7. Don't push. Focus on breathing, instead. Or, watch the TV. Or read a book. Quite different than number four, this way of dealing with pushing completely ignores the pelvic floor and any interference with the process, whatsoever. This is another true "No Push" practice regarding the second stage of labor. The idea is to distract the pregnant person from the contractions, or even sometimes breathing into the contractions, but doing nothing else, in terms of willfully contracting or relaxing anything associated wit the pelvic floor. This is probably one of the most commonly practiced forms of "Not Pushing" during birth that you'll find today. Does it work? Apparently; babies are born every day using this technique. Of course, it's the body's autonomic process at work during birthing, so really, a women doesn't have to do anything beyond let time pass, apparently. What does it suggest that techniques like these seem to be effective? Regardless of what the birthing woman does, eventually, the disorganized, weak spasms in the pelvis will coordinate into strong contractions that will work to bring the baby down and out. The "disorganized, weak spasms" in the pelvis can also be thought of as the chaotic and unpredictable sounds of the individual members of an orchestra tuning up, which, when finally ready to all work together, result in a rhythm. This is much like how the contractions in various muscles and ligaments in the pelvic floor, along with the uterus itself, come together to create strong, unified contractions after "warming up." These rhythmic contractions then propel the baby to the outside world. Perhaps this is a more empowering way of looking at it. So, Which Is Best? Should I Be Pushing During Labor? And, Which Kind Of Pushing, If So? Which is this the best course of action? Perhaps for some women and some births, not pushing is best? What might be some determining signs and factors suggesting a woman might fare better pushing or not pushing? Perhaps there is no single answer as to how to go about dealing with contractions and the matter of asking which method of pushing is best remains the determination of the birthing professional. To push or not to push? That is the question! What is pushing, even, that is the better question! No One Right Answer About Pushing During Labor? These are all distinctly different possible explanations, and even medical professionals and women who've given birth multiple times cannot come to agreement on what is meant by "pushing the baby out." Which is correct? Is there more than one answer that could be considered to be correct? Pelvic Floor Training and Pushing In an untrained individual, there is little awareness of the pelvic floor, and some areas mat be too tight, while others areas of the pelvic floor too lax. After learning about the Pelvic Floor, a woman can easily "check in" on how her pelvic floor is feeling. After practicing Pelvic Floor Exercises, each can potentially be controlled independently of the others, at will, and each sphincter can be both relaxed and tightened, like when you're stopping going bathroom, or conversely when you're pushing as when constipated. This sort of fineness of pelvic floor "motor skills" must be developed, and is usually not possible when an untrained woman contracts, as all structures are tightened with one action for many without learning training. The exercise presented within this article is for Pelvic Core Awareness and Strengthening, and may be added to your Pelvic Floor Exercise program, but it's distinctly different, something else entirely that definitely complements the Pelvic Floor exercises we provide for patients to check out and learn about in our Pelvic Floor Massage Therapy sessions. The Unequaled Value Of Firsthand Accounts By Postnatal Women and Birthing Professionals To be clear, not every idea about pushing that a woman or ob-gyn has presented to the world is factually, or medically, accurate. Still, we value firsthand accounts and personal interpretations of experience parsed by one's own meta-views of life and reality, and appreciate that these individuals chose to share their knowledge and experience. There is no correct answer here; we're merely taking an inventory of ideas, and even asserting our own. So, do we make any determinations as to which ideas hold the most merit? We've determined that there is no single "best" answer, and in fact, there are multiple "best" answers, depending on medical history and circumstances related to the individual giving birth, though some views on what pushing is might be far afield from either what's happening, or what should be happening, during birthing. In The End, Trust The Process, Trust Your Body Regardless of what you, or your birthing professional may conceive of pushing to mean, correctly or otherwise, when you're experiencing involuntary pushing and bearing down in labor, your body will know what to do. It's important to stress this. You may, in fact, hold a mental conception of the process that's way off. It matters little; your body will contract the correct sets of muscles and ligaments at the right intensity to make the baby come out. You don't have to know what's happening, or properly identify the pushing process, in order to assist pushing during labor. Of course, knowing what's happening can only help, and having prior to labor worked on strengthening and toning the tissues of the pelvis, developing awareness of these pelvic structures, and even gaining voluntary control of same, likewise are probably advantageous in nearly all cases. Conclusion: Pushing Means A Lot Of Different Things To Different Postnatal Women, Doctors & Midwives, and Medical Centers To start with, a women who hasn't developed Pelvic Floor Awareness can't possibly push in the same manner as someone who has, so instructions to each group cannot be universal. Further, the various interpretations of what pushing means remains a source of confusion in our medical culture, and a woman working with a birthing professional should understand what they mean by pushing or not pushing, and have a clear discussion about what their birthing professional interprets the word "push" to mean in this context, and further discuss the implications of the doctor or midwife's ideas. There are many different variations of how to breathe and push, including not pushing. Most seem equally effective, surprisingly. The author presented a definition of "pushing" that seems to have at least as much, if not more, support in medical fact and female anatomy, than many more popular explanations related to pushing during labor. The unique Pelvic Core Menstrual Cramps Awareness exercise presented in this article can be performed by oneself at the time each month that a woman is experiencing menstrual cramps, or during a Pelvic Floor Massage Therapy session, and may have various benefits. Seeking to help women gain awareness of, strengthen and tone, and ultimately be able to tighten or loosen at will, the various structures comprising the Pelvic Floor and Pelvic Core, is a goal of this particular Pelvic Core Menstrual Cramps Awareness exercise and Pelvic Floor Massage Therapy. This can only help during the birthing process, inarguably. In final conclusion, the author can say, with certainty, that while many of these meta-systems and ideas are in contrast with one another, somehow birth happens, regardless. This lends support to the notion that it's largely irrelevant how one thinks pushing works or how a woman in labor chooses to breathe, and that a woman's body innately knows precisely what to do...even when we don't. That does not preclude the possibility that some methods of pushing might help more than others In what ways? We just don't know. That has not been studied, yet. The Author's Own Ideas Supported By Past Research The ideas and exercises presented in this article are the author's own. Upon researching the merits of these ideas, the author found that a few researchers seemed to have come to similar conclusion in the past, researching specific aspects of these various theories. None arrived at these particular hypotheses, however, and so these arguments and details in support of the ideas, are the author's own, and the Pelvic Floor Awareness Exercises described in this article are, as well. This article was published April 7, 2025 on The Pregnant and Postnatal Women's Learning Center Online Portal at https://NJMassage.info/Pregnancy-Learning-Center/what-is-meant-by-pushing-during-labor/ Monthly Menstrual Cramp Pelvic Core Awareness Exercises The Connection Between Menstrual Cramps and Labor Contractions This is the author's own hypothesis that they arrived at after considering the matter at length, realizing that contractions in the pelvis during labor feel a certain way, and that fact may be significant. Next, the author considered the association between monthly "cramps" and how that birthing contractions feel, and it's widely held that these are one and the same bodily sensation, essentially. Asking themselves, "Which bodily structures in women's bodies are experiencing contractions and cramping during labor?", the author realized that contractions are probably most akin to "PMS/period cramps." In fact, many Medical professionals state that early contractions may feel like PMS/Period Cramps, which lends serious credence to my idea. Experiencing menstrual cramps, it seemed that all the same areas seemed to be in spasm that are agreed by medical sources to be in contraction during birthing. There seemed to be a connection here that was, perhaps, the strongest evidence yet. Of course, this sensation of "cramps" grows in amplitude and frequency during labor, and the birthing contractions, at some point, necessarily eclipse what that same woman may sometime experience monthly. This means that the contractions of birthing are not a different sensation than monthly cramps, just different in intensity and rate. In other words, it's a way stronger sensation to experience, but it's a difference of quantity and not quality. Pushing During Labor As An Assist To The Body So, how does "pushing" during the second stage of labor fit in with this particular set of exercises, that foster strengthening and gaining awareness of the pelvic core and beyond? In this concept of what constitutes Pushing, the birthing patient tightens, by sheer action of will, the structures that are already spasming and contracting in her pelvis, from the round ligaments to the posterior pelvic ligaments and everything from the vagina to the uterus. The involves a motion not unlike one of the definitions of pushing already mentioned in this piece, that is, holding the vagina upward and inward. These are the same cramps women usually only feel once a month, when many are experiencing PMS/PMDD or menstrual pain, only the birthing contractions will likely surpass most episodes of even severe PMDD, in terms of intensity. Monthly Cramps As A Way To Strengthen And Train The Pelvis Your monthly cramps are a great opportunity to both strengthen, and train, the structures of the female pelvis and gain awareness, and even control, over the pelvic floor and even various other internal pelvic muscles, like the round ligaments. Without any Pelvic Floor Awareness Training focusing on this particular aspect of the Pelvis, a woman may not really be able to assist the body by pushing at birth, as she wouldn't exactly know what this sort of pushing involves. This is a different exercise that the enumerated Pelvic Floor actions commonly agreed upon to be the core of most quality Pelvic Floor programs, like tightening and loosening the pelvic floor. We can wonder whether the cramping during menstruation might serve to help to expel uterine tissue that has been shed, among other functions. Again, the research isn't there to make any sort of determination. A non-pregnant woman can do these exercises monthly at the time they experience PMS/PMDD/menstruation cramps. Eventually, they may gain sufficient awareness of their pelvic structures to perform the exercise even on days they are not experiencing pelvic cramps. And, a woman can perform this Pelvic Core Awareness Exercise and then go on to get pregnant, carry a baby, and finally go into labor and choose to push, not push, using any variant they choose, or none. In no way does performing this exercise bind a woman to any sort of definitive breathing/pushing strategy when in labor. Labor Pushing Pelvic Awareness Exercises Any Woman Can Do How are these exercise performed? It's a bit like Pelvic Floor Exercises, but not exactly. The differences are obvious if you're familiar with exercising your pelvic floor. Pelvic Core Awareness Exercise I A woman might lie supine and relax and focus on all the areas cramping in the pelvis during a monthly episode of cramps. Next, she would just relax and allow herself to feel the cramping areas of her pelvis, lower back, and thighs. That is the entirety of the first exercise. Take at least five minutes just being observant of the pelvis. Pelvic Core Awareness Exercise II Focusing on the cramping areas helps direct the attention to those areas, and a woman can then easily feel where to assist by further tightening by will. The patient can assist by tightening everything that feels cramped up even further, which may also have the added benefit of lessening the sensation of pain associated with the cramps by reducing disorganized spasm, and actually causing the cessation of the cramping, to some degree. This also strengthens and tones the cramped tissues, by repeated practice over time. This isn't the same as simply pulling the pelvic floor upward and inward, though that may well be a component of this exercise, as a shortening of the vagina, via upward movement accomplished by the pelvic floor, seems to be involved. This exercise involves that, and more. It's about ultimately feeling the muscles and ligaments surrounding the uterus, and developing awareness of these structures, and finally voluntary muscle control, to tighten, or loosen the muscles the body is tightening when having menstrual cramps. The idea is that this will strengthen a woman's pelvis over time, and potentially even aid in birthing via gained awareness and a stronger pelvic core. It's easier to gain conscious control of (usually) involuntary muscles when those muscles are already contracting. And so, a woman may the opportunity to learn how to further tighten the pelvis aided by the discomfort provided by monthly menstrual or pre-menstrual cramps, in this exercise. That constitutes the second exercise. Take at least three minutes performing this tightening at first. You may increase time, adding one minute every week. Pelvic Core Awareness Exercise III A woman might lie supine and relax and focus on all the areas cramping in the pelvis during a monthly episode of cramps. Like Exercise II, we begin with focusing on the cramping areas to help direct the attention to those areas. Next, unlike Exercise II where we assist by further tightening by will, the goal is to feel the areas cramping and totally let them be free and relax. Telling a woman to "relax" a tight pelvic floor at will without explaining how is not very helpful. Feel the areas of tightness while you lie flatly upon your back. Sort-of imagine these cramped spots going from hard, tight bands to loose, lax, soft tissue. If you're unsure how to proceed, start by relaxing a familiar body part, like your hands. If that still doesn't work, tighten your hand in a fist, and then relax, repeating a few times. Likewise, do the same with your pelvis, effectively doing Exercise II in very short bursts, if necessary, just to help you be able to relax those same muscles and ligaments. The muscles and ligaments of the pelvic floor will tighten back up due to hormones, so this requires a continual process of self-observation while this exercise is performed. And, that's the third, and final, exercise. Take at least ten minutes performing this tightening at first. You may increase time, adding one minute every day, or you may proceed more slowly. Potential For Spasm and Movement of The Pelvis Performing the Pelvic Core Awareness Exercises that involve a woman relaxing and letting the cramps spontaneously happen, she may feel like her pelvis itself is expanding and contracting, at times. It is not outside the realm of physical reality that the pelvis also spasms to some small degree with spontaneous internal or external rotation of the hip, as sometimes may happen when doing these exercises. As the pubic symphasis has ligamentous tissue, and allows movement, whether infinitesimal, as during monthly cramps, or significant, in the case in labor contractions, it is possible that even those ligaments of the pelvis spasm. Potential For Multiple Simultaneous Spasms Likewise, a woman may experience what's been described as simultaneous cramps, in different areas in the pelvis, sometimes oscillating in concert, at other times oscillating at different rates and intensities, while performing these exercises. While there is surely a recognizable frequency and amplitude for the "major cramps," there are likely other, faster oscillations that are less pronounced affected the same tissues. This would also be true during birthing, concerning contractions. 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