Preparing for Labor: Understanding Common Interventions During Pushing, Birth, and After.

As your due date approaches, you've probably spent time thinking about contractions, packing your hospital bag, and creating your birth plan. But have you considered what happens during the pushing stage and immediately after your baby is born?

Many routine birth interventions are performed during the second and third stages of labor. Some are medically necessary and can be lifesaving, while others may simply reflect a provider's standard practice. Understanding these labor interventions before your due date helps you make informed decisions and have meaningful conversations with your healthcare provider.

At Ada's Gift Doulas, we believe that education leads to confidence. Knowing your options allows you to advocate for the birth experience that's right for you.

You've made it through the first stage of labor—what an accomplishment! Now it's time to meet your baby.

As labor transitions into the pushing stage, many parents want to relax and let the hospital team take the lead. While your medical team is there to keep you and your baby safe, it's also helpful to understand some of the routine interventions that may be used during the second and third stages of labor. Knowing your options ahead of time allows you to have meaningful conversations with your provider and make informed decisions during your birth.

Follow Your Body's Urge to Push

If you and your baby are both doing well and there isn't a medical reason to hurry, you may want to avoid being coached into forceful, prolonged breath-holding ("purple pushing"). 

Instead, many women choose to push with their body's natural urges. Research suggests that physiologic pushing may reduce strain on the pelvic floor and may decrease the risk of excessive perineal trauma. Every labor is different, and there are certainly situations where directed pushing is appropriate, but when circumstances allow, listening to your body is often the best approach.

If you'd like to learn more about physiologic pushing, check out our previous blog on the topic.

Choose a Position That Works for You

One of the wonderful things about labor is that your body often tells you what feels right. And what feels right is often what is best to progress labor.

You may feel most comfortable:

• Standing

• Squatting

• Hands and knees

• Kneeling while leaning on the raised head of the bed

• Side-lying

• Modified hands and knees

While there are occasionally times when pushing on your back is necessary, upright and side-lying positions can often make pushing more effective and may help reduce pressure on the perineum. Don't be afraid to move and change positions if your provider says it's safe to do so.

Perineal Stretching

As your baby's head begins to crown, some providers use their hands to support or stretch the perineum. 

While gentle support of the perineum can be very helpful, current evidence suggests that routine aggressive stretching is not always necessary. When birth is progressing slowly and safely, and the mother is following her body's natural urges, the baby's gradual descent allows the tissues to stretch naturally. However, your provider may recommend hands-on support in certain situations.

This is a great topic to discuss with your provider before labor begins so you understand their usual approach.

Guiding Baby's Birth

As your baby's head is born, your provider may guide your baby's shoulders and body through the birth. This can involve pulling on your baby’s head. Though the doctor tries to be gentle, this can lead to damage to the sensitive tissues of the neck and shoulders that can make your baby uncomfortable and nursing more difficult than it needs to be.

In situations where mother and baby are doing well, many families prefer allowing the baby to rotate and emerge with minimal assistance whenever possible. In other circumstances, such as shoulder dystocia or signs that the baby needs to be delivered quickly, more active assistance is both appropriate and potentially lifesaving.

You can let your provider know that, when medically safe, you would appreciate a gentle, hands-off approach.

Immediate Care After Birth

If your baby is born healthy and breathing well, immediate skin-to-skin contact offers many benefits, including:

• Helping regulate body temperature

• Supporting breastfeeding

• Promoting bonding

• Reducing stress for both mom and baby

If your baby needs extra help transitioning, such as bulb suctioning or vigorous rubbing, ask your doctor if they can provide initial assessment or basic resuscitation while your baby remains close to you or even on your chest when appropriate. 

If more advanced care is needed, your baby's medical team will cut the cord, move the baby to the warmer, and act quickly to provide the necessary support.

Delayed Cord Clamping

Delayed cord clamping has become standard practice in many hospital, and for good reason.

Waiting before clamping the umbilical cord allows your baby’s blood (up to 1/4 or 1/3 of its total volume) to transfer from the placenta to your baby, providing extra iron stores and blood volume that can benefit your newborn.

Many hospitals delay clamping for only 30–60 seconds. Some families choose to wait until the cord has finished pulsing and turns white, which may take several minutes. You may want to discuss your preferences with your provider during pregnancy and include them in your birth plan. You may also need to remind your provider of your preference to wait to clamp the cord after your baby is born.

Delivering the Placenta

After your baby is born comes the third stage of labor, the birth of the placenta.

Some providers routinely use cord traction and uterine massage to help deliver the placenta more quickly, especially as part of active management of the third stage of labor, which can reduce the risk of postpartum hemorrhage in some situations.

However, if there is no apparent risk of hemorrhage, they may be comfortable allowing the placenta to separate and deliver on its own without the active management.

Every situation is unique, so it's worth asking your provider how they typically manage this stage of labor and when they recommend intervention.

The Bottom Line

Medical interventions during labor exist for a reason, and many can be incredibly beneficial or even lifesaving when they're truly needed. At the same time, not every intervention is necessary in every birth, and can even lead to further issues when not necessary.

Understanding your options before labor begins allows you to ask questions, communicate your preferences, and work together with your healthcare team to create the safest and most healthful birth experience possible.

How a Birth Doula Can Help

Preparing for labor isn't about memorizing every possible intervention—it's about understanding your options and feeling confident as you make decisions throughout your birth.

As experienced birth doulas serving Lafayette, Indiana and the surrounding communities, we help families prepare for labor by discussing common birth interventions, creating personalized birth plans, practicing comfort techniques, and providing continuous support throughout labor and delivery.

Our goal isn't to replace your medical team. Instead, we work alongside your healthcare providers to help you feel informed, supported, and empowered during one of life's most meaningful experiences.

If you're expecting a baby and would like to learn more about how a birth doula can support your pregnancy, labor, birth, and postpartum recovery, we'd love to connect with you.

Written by: Joy Elliott