Can I breathe my baby out?

Yes, I believe you can. But it’s not always that simple.

Someone asked about this on a Facebook group recently. Women are being taught all over the UK about birth breathing in their pregnancy yoga classes. Hypnobirthing teachers advocate this as a way of giving birth. The word is out.

Breathing out a baby is possible.

Trouble is, someone forgot to tell the midwives.

‘There’s no such thing as breathing a baby out.’

‘My midwife was horrified at my suggestion to breathe the baby out.’

‘First time mums need to be taught how to push.’

The way we are expected to birth our babies, generally, in the Western world is that textbook way. You’re not in labour till you’re 4cms dilated. You should dilate at 0.5cms per hour. You can only push when you’re fully dilated at 10cms. You’ve got 2hrs in the 2nd stage and then that baby should be out. National guidelines can be found here on page 29.

Over the years we’ve developed and honed our guidelines to give optimum care and safety according to research and evidence. Those in charge of delivering care want to make sure women and babies are safe, that we continue to improve the care that we give and increase the rates of healthy mums and babies. Somewhere along the way though we forgot to ask the body what it wanted to do.

Once you’ve had a baby come out of your hoo-haa (courtesy of Lily, HIMYM) then the following baby will most likely slide out. Your uterus does the hard work of contracting, and it eases your baby down and out, while you can ‘breathe it through’. Not everyone has an easier birth next time time round, but generally it works like that.

One of my midwife mentors showed me how to get mums to breathe on the gas & air while their baby was born. She said it helped reduce tearing. And it did. Other midwives want to whip that mouthpiece out of your mouth before they’ve had a chance to shout ‘PUSH!’.

That bit of slowly birthing your baby, right at the end makes sense to everyone though. Pant, blow, breathe; whatever word you use, we encourage you to do that bit s-l-o-w-l-y.

So why not during the whole of the ‘pushing bit’, and why not first timers?

1.We’ve been conditioned to believe that the 2nd stage is really hard work. That first time mums need to work especially hard at this bit. It’s never been stretched. You’re working against nature it seems. We can’t imagine that a vagina would stretch that big to easily accommodate a full grown baby.

Ina May Gaskin tells us this story. Click here : ‘You’re gonna get HUGE!’

you're gonna get huge

2. A lot of midwives or doctors won’t have seen it. Our culture of birth doesn’t really trust the physiology or women’s bodies sadly. So we have learned to monitor and guide the process in order to protect mothers and babies. We examine and time check. We ‘allow’ two hours. We expect women to behave in a certain way. Our beliefs have evolved over a long period of time, so it will be a long time to undo that thinking.

Breathing a baby out requires everyone to trust that the body knows what it’s doing. That’s a big ask in the medical model of healthcare today. Some may have never witnessed a physiological birth. People want to provide effective, safe care, so allowing yourself to be open to new ways of doing things is a big step. You have to really trust.

3. Sometimes there seems to be no choice. Have you heard of the cascade of intervention? Basically one thing leads to another until you’re on a rollercoaster of medicalised birth.

When it’s your first will probably be more successful when the physiology of birth is respected. The majority of births happen in hospital and hospital  isn’t always conducive to enhancing your natural instincts. But it can happen and many physiological births occur in hospital.

Historically we had been led to believe or, just presumed really, that a baby gets really squashed coming down the birth canal and therefore it must be bad for them. It has always been considered dangerous to be in the 2nd stage for too long.

But how long is too long?

Even in 1977 they realised that a long second stage was not associated with adverse outcomes for mum or baby.

“It appears that it is unwarranted to terminate labor simply because an arbitrary period of time has elapsed in the second stage.”

Influence of the Duration of Second Stage Labor on Perinatal Outcome and Puerperal Morbidity, Wayne Cohen. MD

You can be fully dilated without an urge to push for hours. If your body is choosing to do this perhaps it’s not dangerous? There will be no potential cord compression until baby starts moving through the pelvis. Nothing is happening, the baby and mum are just having a rest. The body will naturally do its thing (usually) and I believe it is pretty efficient at birthing a baby with spontaneous pushing.

Sadly I believe that until more midwives start to believe in women’s’ bodies, then no matter whether home or hospital the same thing seems to happen – directed pushing. It appears to still be ingrained in the culture of midwifery. Many midwives still can’t believe that women can birth their babies without instruction.

As soon as a woman utters a grunt someone will ask “Do you feel pushy?”

So an examination is offered to check whether it’s OK to push.

As soon as full dilatation is confirmed the time limit has been set..which leads to encouragement to push harder…all in order to avoid further intervention of assistance from a doctor.  Another reason to avoid examinations unless absolutely necessary.

Purple pushing leads to fetal distress and maternal exhaustion, which leads us to believe the 2nd stage is dangerous.

We’ve been given a self fulfilling prophecy and it will take many more years, even with all the evidence at out fingertips, to disprove it. Many midwives will have never seen a genuinely physiological birth, or may believe that if they have seen one it was a fluke! So without trust and experience it’s hard to sit on your hands and believe its all OK.

If a woman and baby are healthy, why would it change in the 2nd stage? As long as the heart rate is good, and mum is well then it just works, and it doesn’t seem to take long.

Want to know more about why it works? Check out this ‘Pushing a baby out…or not.’

PS. My footnote has to say that in practice I’ve seen a few mums breathe their baby out without a grunt or noise. But most seem to have some form of involuntary gut wrenching pushing sensation that rises from their belly. This is different to being instructed to hold your breath and push on demand hard and long through the contractions. Sometimes this form of directed pushing will become necessary if the baby is close and is becoming distressed, But when a baby is well and a mum is well, then spontaneous grunty pushes are the recommended way to support you to birth your baby. Royal College of Midwives have produced a guide for midwives.

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Pushing for first time moms by Gloria Lemay

Pushing- leave it to the experts by Rachel Reed

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