MYTH: You shouldn’t push if you’re not fully dilated

When you’re in labour, you will get the urge to push. Sometimes this happens before your cervix is fully dilated. This can only be ascertained if you consent to a vaginal exam. If this is the case, you’re likely to be told to stop pushing in case you cause damage to your cervix. But that’s easier said than done! Anyone who’s given birth will tell you the uncontrollable urge to push is just that… uncontrollable!

But 10cm dilated is the goal isn’t it?

Well, no it’s not. We are told “fully dilated”

is 10cm, but the real goal is to dilate to the size of your baby’s head… our cervixes don’t understand the metric system and don’t magically stop dilating once they hit the 10cm mark! What our bodies do do, is dilate and efface our cervix to the point that they can birth our babies, That diameter will be different for everyone, just as every size of baby is different!

So is pushing before your cervix is fully dilated dangerous?

Although many midwives advise people to stop pushing if they are not fully dilated, in the belief they may cause trauma to the cervix, this is not backed by evidence. The urge to push is uncontrollable, and stopping this may lead to complications, disempowering the birthing person and seeding distrust in their body and the process. The urge to push before full dilation may actually serve a purpose, to rotate and position baby in to an optimal position, and the pressure may also encourage the cervix to dilate.

“Evidence supports the notion that women instinctively push in the most effective and safe way for themselves and their babies during birth. A birthing woman is the expert regarding when and how she pushes. Providing directions implies she needs our guidance and that we are the experts. Facilitating women’s instinctive birthing behaviours rather than directing them is evidence based and reinforces women’s innate ability to birth.”
Supporting women’s instinctive pushing behaviour during birth: The Practising Midwife journal - June 2015

So what happens if you’re told NOT to push?

This explanation from Rachel Reed describes the likely outcome:

“Here is a scenario I keep hearing over and over: A woman is labouring away and all is good. She begins to push with contractions, and her midwife encourages her to follow her body. After a little while the midwife checks to ‘see what is happening’ and finds an anterior cervical lip. The woman is told to stop pushing because she is ‘not fully dilated’ and will damage herself. Her body is lying to her – she is not ready to push. The woman becomes confused and frightened. She is unable to stop pushing and fights her body creating more pain. Because she is unable to stop pushing she may be advised to have an epidural. An epidural is inserted along with all the accompanying machines and monitoring. Later, another vaginal examination finds that the cervix has fully dilated and now she is coached to push. The end of the story is usually an instrumental birth (ventouse or forceps) for an epidural related problem – fetal distress caused by directed pushing; ‘failure to progress’; baby mal-positioned due to supine position and reduced pelvic tone. The message the woman takes from her birth is that her body failed her, when in fact it was the midwife/system that failed her.

“Although some experts such as Roberts and Frye suggested pushing with the early urge may cause harms, such as cervical trauma, prolonged second stage and maternal fatigue, evidence from the research studies did not show any association between the early pushing urge and an increase in adverse maternal or neonatal outcomes.
The literature reviews by McKeon et al., Chalk, and Davis, and the textbook by Chapman and Charles agreed there was no evidence that showed pushing before full dilation might cause cervical edema or trauma. In addition, no adverse neonatal outcomes were reported with the early pushing urge in any of the research studies and case reports.”
Downe S, Trent Midwives Research Group, Young C et al (2008). ‘The early pushing urge: practice and discourse’. In: Downe S (ed.). Normal childbirth: evidence and debate, 2nd edition. London: Churchill Livingstone: Elsevier.

So the key takeaway? Trust your body! Like so much else in birth, the instincts you have in labour most likely serve a purpose, and interfering may cause more harm than good. Your body is built to give birth, and knows what it’s doing!

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