Pushing vs BIRTH BREATHING
An Explanation of the HypnoBirthing® Approach
Prepared by Jennifer Elliott, B.Ed, HypnoBirthing Practitioner, www.lifesjourney.ca
The HypnoBirthing goal: a calm, gentle birth for both mother and baby using spontaneous bearing down in second stage.
Why not ‘push’?
HypnoBirthing, the book, advises against ‘forced pushing,’ ‘purple pushing’ and the valsalva maneuver. It uses the term ‘pushing’ to refer to all of these that are generally caregiver coached and directed, requiring a woman to hold her breath. This style of pushing may be against a woman’s natural instincts and desires and research has found it leads to reduced satisfaction with the birth experience. Valsalva pushing which requires a closed glottis, is associated with reduced oxygen to the baby and a tense jaw. Tension in the jaw causes women to tighten their vaginas, like a pelvic floor exercise (kegel), causing the baby’s head to meet more resistance as it is pushed down. In an article contrasting Active Management of Labour with physiologic birth, Marie Mongan, author of HypnoBirthing and creator of the program, says, “When using forced pushing, she is closing the sphincters of the vaginal outlet ahead of the baby. This kind of pushing reduces the flow of oxygen to the baby, and his heart rate may decline.”
Renowned American Midwife Ina May Gaskin believes a relaxed mouth and jaw are directly correlated with the ability of the cervix and vagina to open fully (The Sphincter Law). Research suggests spontaneous bearing down is gentler on the mother’s tissues, reducing the incidence of stress incontinence.
What is Birth Breathing?
HypnoBirthing refers to the concept of ‘spontaneous’ or ‘mother-directed’ pushing as ‘birth breathing.’ We encourage women to ‘breathe down’, ‘bear down’, ‘nudge the baby down’ and ‘breathe down and in a J’ (the direction the baby must move to curve under the pubic bone). It may be only the language that is different from how a midwife might guide her client.
Does the research support Birth Breathing?
Yes. Spontaneous pushing has proven to be less tiring for the mother and to result in higher APGAR scores for the baby. Women report greater satisfaction and they experience fewer negative effects on several urodynamic indices.
How does a woman prepare?
The HypnoBirthing woman has learned to relax her body completely and is working to maintain that relaxation even in second stage. She does perineal massage at the end of her pregnancy, training herself to relax to the sensation of the pressure of the baby’s head. She visualizes the tissues of her vagina gently unfolding in front of the baby.
Practice for breathing down is done on the toilet during a bowel movement. She is encouraged to notice how her vagina and anus open as she breathes down on the exhale, sending the energy down her body.
What does a woman need from her care providers?
Be patient as she tunes into her body. HypnoBirthing encourages women to begin breathing their baby down when they feel the urge, which may be some time after they are fully dilated. Many women experience a resting phase before the active phase of second stage. Mongan notes that we wait for women with epidurals to allow their bodies to bring their babies down and we should be prepared to do the same for all women.
Support the mother’s ongoing relaxation and inward focus. Women may appreciate only quiet, gentle encouragement, using the language highlighted above. They take several breaths with each surge (contraction), in and out through their nose.
Mongan describes what she calls ‘the birthing phase’ this way, “Once she has mentally moved into her birthing body, she will follow the lead of her body and her baby and use the Natural Expulsive Reflex (NER) to bring her baby down to crowning. Her baby will be breathed down. She knows that Birth Breathing assists the normal expulsive pulsations of the mom’s body and that a recent study shows it to be as effective as valsalva pushing.”
Be positive. Some mothers find their bodies so relaxed, often because they have practiced relaxing while doing perineal massage, that they experience no discomfort during crowning. For this reason we do not discuss the negative possibility of a “ring of fire.” One mother said that she found the feeling of her baby coming out of her body, “exhilarating.”
Be prepared. Some mothers experience a very efficient Natural Expulsive Reflex, similar to Dr. Michel Odent’s description of the Fetus Ejection Reflex, which brings the baby’s head quickly and easily to the perineum. If a mother says the baby is coming now, believe her. She is very tuned into her body.
HypnoBirthing parents are aware that there may be concerns (known as special circumstances) that arise at any time during birth that require a more directed approach.
They are prepared to hear the recommendations of their care providers if a concern arises and to accept whatever path their birthing takes.
Thank you for your support of HypnoBirthing and birthing women.
Believing in the miraculous design of our bodies makes the miraculous more possible.
Please feel free to contact HypnoBirthing Childbirth Educator Jennifer Elliott, B Ed, for further information on Birth Breathing– firstname.lastname@example.org