Pushing in the 2nd Stage of labour

Women are still expected to push during labour using the closed glottis
or "Valsalva" technique which is done by holding your breath and
pushing down very hard for as long as possible.  However there is much
research to suggest that "coached" pushing from the midwife is more
detrimental than it is helpful.  The Royal College of Midwives published
a document in 2007 with a literature review of the evidence to support
spontaneous, woman directed pushing in the second stage and NOT
coaching by midwives.  The key messages to come out of this document
are:

The RCM following the literature review has established a set of
guidelines which are echoed by both the World Health organisation
(WHO) and the National Institute of Health & Clinical Excellence (NICE). 
These guidelines are:

·         Care within the second stage should be non-prescriptive,
thereby facilitating spontaneous, instinctive maternal behaviour.

·         There should be no arbitrary time limit for the second stage of
labour in the presence of maternal and fetal well-being.

·         Routine Valsalva or 'breath-holding' style pushing can have
harmful effects on the mother and fetus.

·         Women should be supported and encouraged to push
spontaneously, which will often include vocalisation.

·         Midwives should adopt a flexible approach to the early pushing
urge depending on the extent of dilation of the cervix and other signs
of maternal well-being. 

·         During the initial 'latent' phase of second stage there may be
no urge to push. This is normal and women should not be directed to
push during this phase.

·         Delayed pushing until there is an urge to push should be used
for women who have had epidural anaesthesia.

·         Women should be encouraged to adopt upright positions during
the second stage to encourage fetal descent and avoid instrumental delivery.

In short you should be supported and encouraged to do whatever your body tells
you to do during the second stage where labour is progressing normally without
complication or epidural insitu.  Coached pushing is detrimental to both maternal
and fetal wellbeing and should be discouraged as recommended by NICE.  Have
the strength to trust your body and conviction to continue with what feels right.

Kieren