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Physiological Pushing vs Coached Student Spotlight – Sarah Ziegenhagen

February 16, 2023

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Birth seen on TV is most people’s first glimpse of what it could be like.  I remember the TV show Friends. Rachel, a first time Mom is on a hospital bed, blue gowns, covers, masks, her knees are pushed up to her armpits.  The Dr and nurses commanded her to PUSH!  Rachel’s face is red and she closes her eyes and bears down, her chin to her chest.  After a few of these pushes the baby is out.  All is well, right?  Coached pushing, getting instruction from someone else has many known dangers, stress on baby’s oxygen levels and perineal trauma to the mother are only a few.  In Contrast, “Spontaneous labor in a normal woman is so complicated and so perfectly attuned to each other that any interference will detract from optima character.  The only thing required from the bystanders is that they show respect….and do no harm.”(The universal aspects of childbirth, Kloosterman)  Getting back to the way our ancestors birthed, trusting our inborn wisdom allows us to learn the benefits of physiological pushing, rather than giving our power away through coached pushing which takes on greater risks for you and your baby.

In Jena La Flammes book, Pleasurable Weight Loss, Jena reminds us of the wisdom of our animal body.  Our body is part of Mother earth, tapped into the intelligence of mother nature.  In today’s culture we have learned to see our body as a possession to be controlled, tricked, tamed, and coached.  What if we looked at our body as our minds partner, a living, breathing, feeling, and wise female animal that belongs to life itself.  Phylicia Rashad, the famous Mother on the Cosby show shared in an interview how her Mother’s advice was timeless,  “Look within yourself to discover your own truth.”   “Live with constant awareness within”.  This is how a healthy pregnancy and physiological birth starts, by acknowledging our body as wise and tuning in and trusting our partnership with her.

Michel Odent talks about the fetus ejection reflex, a natural “let down” like a milk ejection reflex, of a laboring woman when she feels safe, secure, and undisturbed during her labor.  The fetus ejection reflex happens most often when the woman has no interference at all during her labor.  After watching births, there is a point where a woman will call out for help, exclaim that she cannot do it, grasp onto someone or something to help save her from this pain.  Michel Odent argues that if the woman is left alone, left to continue her labor with no interruption, the baby will soon be born, fetus ejection reflex.  In contrast most obstetricians and labor nurses have been trained to eliminate pain and keep the woman comfortable.  This could be as simple as asking the woman what her pain is on a scale to 1 to 10 and/or administering pain relief.  This pulls the mom out of her body and back into her thinking brain, stalls labor and can then lead to the need to be coached to push the baby out.  Odent relates the final stages of labor to a male orgasm.  The first phase of erection does not need adrenaline, but the ejaculation of sperm is under the control of the sympathetic nervous system that uses adrenaline to eject the sperm out of penis.  The passive stage, the erection is followed by an active, violent and even aggressive action.  Odent argues that in birth the same physiology takes place, hardening of the uterus for the opening of the cervix, passive stage, until the active, aggressive ejection of the birth of the baby.  As a midwife or birth attendant our goal is to create a safe, dark, quiet and warm birthing environment; similar to an environment a couple would feel safe to orgasm.  This demonstrates how our body has the physiological processes to birth naturally and easily as long as our mind is not distracted or feels threatened to “keep us safe”.  Odent says, “Any interference tends to bring the laboring woman back down to earth and tends to transform the fetus ejection reflex into a second stage of labor which involves voluntary movements.”  When women feel private, safe, and unobserved-birth hormones are optimized for both Mother and baby. “This coupled with our access to great nutrition and hygiene, we have a better chance of an easy and safe birth than that of our foremothers from whom we inherited the female anatomy and physiology that gives birth most easily and efficiently.”(O’Mara, Peggy, Having a Baby, Naturally)  Women able to move during labor into instinctive delivery positions facilitate the natural descent of their baby.  Being fully aware and in tune creates positive psychological, emotional, and physical well being of the mother and her connection to her baby.

Being instructed or coached during the pushing phase of labor, regardless of how you are feeling can have consequences for baby and woman.  Coached pushing brings us back to my example of Rachel bearing down, lying on her back, pushing her baby out. This intensity of pushing creates increased perineal trauma and long-term effects on bladder function and pelvic floor health for the mother (Bosomworth and Bettany- Saltikov 2006; Kopas 2014).  Forced, sustained bearing down has been linked to fetal bradycardia, increased episiotomy rates and need for neonatal resuscitation. (Roberto Calderyo.Barcia)  In 1977, Calderyo studied the effects of forced pushing during labor, his research demonstrated that forced pushing during labor results in an insufficient oxygen supply to the fetus.  Baby could also get “pushed” into a compromised position, rather than instinctively trusting your body and baby as you enter the pushing phase….sliding the baby out.  

Preparing oneself during pregnancy gives women confidence, patience, and trust needed to birth in the physiological way as its proven design.  The easiest way to start becoming more embodied is by taking a breath.  Follow the movement of air through a deep inhale, down to your diaphragm and gently exhale the breath out.  By focusing on your breath, we are tuning into our body, listening to the body’s wise system which is our partner in this life.  Reflect on the ways your female body has served you, its instinctive processes.  Your body’s intricate and elaborate design to create and nourish a baby.  Give gratitude for the phenomenon of this intelligent life force.  Continue your relationship with your body by dancing, spending time in nature, massage, stretching and reflective journaling.  Surround yourself with people who you can have honest conversations with, where you can share your joys and fears.  Get a second opinion, so often we take one person’s word for a whole truth.  Do some research, ask around, be diligent to collect a wide variety of information to base your decisions off.  Look at nature as a guide to how natural systems work.  

Research has reminded us that our body knows what is good and right.  More importantly women have chosen to take charge of their birth story, the power of this experience has made an undeniable spark in women.  We can see the true gifts of birth, the joy of connecting with a baby in an undisturbed environment.  The love expressed between the birth support team when birth is allowed to flow.  When a woman believes in her intuition and is the vessel to the processes that make up birth, her body will do what needs to be done in the safest and most efficient way, naturally.  


Kloosterman G. The universal aspects of childbirth: Human birth as a socio-phsychosomatic paradigm.  J Psychosom Obstet Gynaecol 1982;1(1):35-41. Pg 40

La Flamme, Jena. Pleasurable Weight Loss. Sounds True 2005; Ch 1, pg 1-20

Phylicia Rashad – Lessons from her mother.

O’Mara, Peggy.  Mothering Magazine’s Having a Baby Naturally. Atria Books 2003; pg 161

Bosomworth and Bettany- Saltikov 2006; Kopas 2014

Calderyo, Barcia

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