Pushing Myths Debunked (and More Context Added)
In addition to the workout, we released a longer video where we talk through pushing mechanics and debunk some really common misconceptions.
A lot of people have heard that opening the bottom of the pelvis during pushing means knees and ankles out, or internal hip rotation. And yes, that can absolutely be helpful. But there are a few important things we need to understand more deeply first.
Most of the time when someone starts pushing, the baby is not actually in the pelvic outlet yet. They are usually still in the mid pelvis. Because of that, asymmetrical pushing positions may actually feel better for you and be more productive. This can be as simple as pulling one leg toward your body instead of both legs, or pushing in a lunge position.
When it comes to opening the pelvic outlet specifically, it is important to understand that the outlet is mostly soft tissue. This is different from the pelvic inlet and mid pelvis, which have much more bony architecture that the baby has to move through. In those areas, pelvic mechanics really matter to help create space. At the outlet, the focus is more on releasing and allowing those tissues to yield.
Because of that, it can be more helpful to think about finding pushing positions where you feel like you can relax the most, rather than trying to torque or force your hips into a certain direction.
Another thing to remember is that pushing mechanics are different than normal pelvic outlet mechanics because we have a different internal pressure happening. You have the baby’s head pressing through the pelvis, which changes how the bottom of the pelvis opens and responds.
The last piece that is so important, and often overlooked, is the rib cage!
We actually had a doula comment on one of our reels recently saying she had "never heard of the rib cage positioning making a difference on the pelvic outlet," so let me explain why the rib cage does in fact matter. Pushing is a pressure management activity. We increase pressure within the abdominal cavity to help push the baby out, and the main driver of that pressure is your diaphragm, which sits at the bottom of the rib cage.
Your rib cage position absolutely influences how strong your pushes are going to be. Pushing in a more neutral or slightly rounded position can help your diaphragm better align with the pelvic outlet and make pushes more effective.
Your rib cage also influences your pelvic position. When your rib cage flares or you arch your back, your pelvis tends to tip more forward. When you bring your rib cage down and find a more rounded position, your pelvis tends to tuck slightly underneath. A more neutral or rounded position can make internal rotation easier based on how the femur moves in the socket.
So yes, your rib cage position absolutely influences pushing.
You can learn a lot more about this in our newly released YouTube video, and we go significantly deeper into the nuances of pelvic mechanics inside our Pelvic Mechanics workshops, offered both online and in person.
My biggest piece of advice when it comes to pushing is to find a position that feels best for you and to be willing to change positions with very little expectation. You can absolutely go into birth wanting to try a few different pushing positions, but it is just as important to be okay if a different position ends up feeling better in the moment.
Sometimes a position sounds great ahead of time, and then when you are actually pushing, it just does not feel right. That does not mean anything is wrong. It simply means your body is giving you information.
Find the position that feels best for you, and choose a birth team that is going to support you in that. You want people around you who are willing to help you move, adjust, and change positions as needed, instead of forcing you into one specific pushing position.
