I remember a mom-to-be in our clinic, her eyes wide with a mix of excitement and, let’s be honest, a little bit of fear. She’d read so much, talked to so many friends, and then she asked, “Doctor, what about just… waiting a bit before I have to push? Is that a thing?” And it is. It’s something we call laboring down, and it’s a topic that comes up quite a bit when we’re chatting about birth plans. It’s this idea of giving your body a little more time to do its thing, even after you’re fully ready to start pushing.
So, What Exactly is “Laboring Down”?
Alright, let’s break it down. When we talk about laboring down, we’re referring to a period where you might not actively push, even when your cervix—that’s the opening of your uterus—has dilated (widened) to about 10 centimeters. That 10-centimeter mark usually signals the start of the second stage of labor, the part where your baby begins their journey down the birth canal.
Instead of starting to push immediately, with laboring down (sometimes called “delayed pushing” or “passive descent”), you essentially wait. You might wait until your baby moves further down on their own, or until you feel this really strong, can’t-ignore-it urge to push. The idea is that your body’s natural uterine contractions, along with a little help from gravity, are doing a lot of the work to bring your baby down, even before you start actively pushing. Sometimes, you might wait until your baby’s head starts to emerge, which we call crowning.
What if I Have an Epidural?
This is a common question! Yes, it’s possible to choose laboring down even if you have an epidural for pain relief. The thing is, a really effective epidural can sometimes make you quite numb, so you might not feel that natural urge to push as strongly, or at all. In that case, your nurse, midwife, or doctor will be your guide, helping you know when it’s the right moment to begin.
If you don’t have an epidural, you’ll likely feel that urge to push quite clearly. If you opt for laboring down, you’d wait until that feeling becomes pretty overwhelming.
It’s worth mentioning that current thinking from groups like the American College of Obstetricians and Gynecologists (ACOG), as of around 2019, leans towards encouraging women with epidurals to begin pushing once they reach that second stage, even if the urge isn’t strong. But, like everything in childbirth, it’s a conversation to have with your care team.
Is This a Common Choice?
You know, laboring down is something we see fairly often, particularly for moms who are giving birth for the first time. Labor can be a marathon, especially that first time around, and for some, the thought is that laboring down might help conserve a bit of energy for when the pushing really needs to happen.
Laboring Down vs. Immediate Pushing: What’s the Difference, Really?
So, delayed pushing means you hold off on that big pushing effort, or maybe just push very gently, for the first part of that second stage. Immediate pushing, on the other hand, is when you start pushing as soon as your cervix hits that 10-centimeter mark. This often takes the form of directed pushing, where your healthcare provider coaches you on how and when to push with each contraction.
Understanding the Effects and Making a Choice
Now, what does the research tell us? This is where it gets a bit nuanced.
Some studies suggest that laboring down for an hour or two might make the second stage of labor a bit longer overall, but it could also reduce the actual time you spend actively pushing by about 20 minutes. That sounds pretty good, right?
Historically, and some providers still feel this way, there was a belief that laboring down could:
- Help you save energy.
- Increase the chances of a vaginal delivery.
- Lower the risk of needing a cesarean birth (C-section) or having other complications.
However, more recent studies haven’t found strong, consistent evidence that delayed pushing offers significant benefits over immediate pushing. In fact, some research has pointed to a slight increase in a few specific complications with delayed pushing. These can include:
- Chorioamnionitis: This is a bacterial infection that can happen in the sac and fluid around your baby.
- Postpartum hemorrhage: This means heavier bleeding than usual after you’ve given birth.
- Neonatal acidemia: This is when a newborn baby’s blood is a bit too acidic right after birth.
It’s important to remember these are slight increases, not huge red flags for everyone, but they are part of the picture we consider.
How Do We Decide if Laboring Down is for You?
This is the most important part: it’s your birth, and it’s about making an informed choice that feels right for you. The best way to figure this out is to have an open chat with your doctor, your midwife, and your birth partner. We can talk through your specific situation, your health, your baby’s health, and what your preferences are.
Putting together a birth plan is a great way to think through these options beforehand. We can discuss the potential upsides and downsides of laboring down as they apply to you. There’s no one-size-fits-all answer here.
Key Things to Remember About Laboring Down
- What it is: Laboring down means waiting to actively push after you’re fully dilated, letting your body do more work initially.
- Epidurals: It’s possible with an epidural, but you might need more guidance on when to start pushing. Current guidelines often suggest starting to push sooner with an epidural.
- Time Factor: It might make the second stage longer overall but could shorten your active pushing time.
- Potential Risks/Benefits: The evidence for big benefits is mixed, and some studies show a slight increase in certain complications. It’s all about weighing these for your individual situation.
- Talk to Us: The most crucial step is discussing laboring down with your healthcare team to see if it aligns with your birth preferences and medical situation.
You’re doing great just by asking these questions and wanting to understand your options. We’re here to walk through it all with you. You’ve got this.