Hey there! Last week on the MamasteFit Instagram, we shared a ton of tips on pushing from our experience as a doula and midwife team. There is so much nuance to pushing, and there is no one “right” way to approach it.

Let’s break down some of the most common recommendations for pushing, and why they may or may not be the best approach for you or your clients.

1) Is KICO (Knees In, Ankles Out with Internal Rotation) the BEST pushing position?

The best pushing position is the one you choose. That might include internal rotation, but it could also be asymmetrical, side lying, or even flat on your back. What matters most is having the space and support to explore a variety of positions and find what feels best for you in the moment.

​

A few things we have been considering as we continue to expand our understanding of pelvic mechanics at the outlet:

First, the outlet is mostly soft tissue. Because of this, your ability to relax and yield into a position may matter more than trying to force a specific hip position. There is less bony architecture here compared to other levels of the pelvis.

Second, baby is usually not at the outlet when you begin pushing. They are often still navigating the midpelvis and working under the pubic bone. Because of this, asymmetrical positions may actually create more usable space than a perfectly symmetrical KICO position.

Third, while baby’s head is moving through the outlet, their body is still navigating the inlet and midpelvis. This brings up an important question we have been exploring: if we focus only on the head at the outlet, are we impacting how the rest of the body moves through the pelvis?

This is something we recently discussed in one of our Pelvic Mechanics workshops with a homebirth midwife. She noticed an increase in shoulder dystocia in clients pushing in side lying with a lot of internal rotation, and wondered if it could be related to reduced space at the inlet for the shoulders. This is not a conclusion, but an evolving conversation that highlights how much we still have to learn.

So no, there is no perfect pushing position. Even KICO is not necessarily “best.” It is about what feels best for you in the moment.

​

Here is a YouTube video we did last year that breaks down a bunch of these concepts!

2) Should you never push on your back?

Pushing on your back might actually feel best for you. I have had many clients push effectively in this position, and I personally pushed on my back for two of my three home births. It simply felt the most natural.

The common concern is that being on your back works against gravity and may limit sacral movement. But again, we have to consider what actually helps you relax and push effectively.

The outlet is largely soft tissue, so your ability to relax matters more than perfectly optimizing bone positioning. In most cases, your hips are slightly elevated and the surface beneath you has some give, allowing for sacral movement. Additionally, the internal pressure from baby’s head helps move the sacrum out of the way.

Pushing is not just about gravity. It is about pressure gradients. You are creating internal pressure to move baby down, which does not rely on gravity alone.

If upright positions feel best, go for it. If a more restful position feels better, that is just as valid.

3) Should you avoid holding your breath to push? Will it cause prolapse?

I have seen messaging suggesting that breath holding during pushing leads to prolapse, and I find this to be a harmful oversimplification.

Many people will experience some degree of prolapse after birth, but most will not have symptoms or functional limitations. It can simply be a variation in how the body heals, similar to how skin changes after pregnancy.

The pelvic floor and perineal tissues have an incredible capacity to heal. That is the lens we should approach this with. Healing is expected.

Also, the pelvic floor experiences injury during birth regardless of breathing strategy. It is designed to stretch, and that stretch can create temporary changes that your body is capable of recovering from.

​

There is so much nuance to pushing, and it is a topic that gets a lot of attention. It is easy to create strong opinions about what should or should not happen. But when you are not consistently supporting births in real time, it is also easy to oversimplify.

Roxanne and I support births in person and work with prenatal and postpartum clients every day. What we see over and over again is that there are many ways to approach birth that can still be incredibly empowering. There is no one way to do it.

And since it is Doula Week, we also wanted to share a new video breaking down what a doula actually does, how they support you in labor, and why having one can make such a big difference in your birth experience.

Watch it here:

​

The biggest takeaway here is that there is no one right way to push, but there is a way to feel prepared, confident, and supported going into your birth. Talk with you next week! We have a few videos coming out about preventing leaking with running this upcoming week, so stay tuned for our newsletter with all of my tips!

Gina

Stay Strong in Pregnancy and Motherhood!

MamasteFit is one of the only fitness training facilities in the country that exclusively works with in-person prenatal and postnatal fitness clients—and also provides hands-on birth support. Our prenatal and postpartum fitness programs aren’t random “safe” modifications pulled from the internet; they’re designed specifically for this stage of life, tested and refined with our in-person clients, and approved by our in-house pelvic floor physical therapists.

Our prenatal programs were created to keep you strong and pain-free throughout pregnancy with specialty exercises to help you prepare for birth with pelvic opening, pelvic floor, and birth prep movements.

Our postpartum programs were carefully designed with our in-person fitness clients and pelvic floor PTs to ensure there is a smooth transition from rehab and recovery to fitness. Many PTs recommend our programs for both pregnancy and postpartum because of how seamless they integrate with someone's 1-1 PT!

And if you are beyond the first 6–9 months postpartum and ready to continue strength training with us, check out our Beyond Postpartum Strength Program!​

This is the strength programming I personally use to feel strong in motherhood while continuing to support my pelvic floor and core.

The program moves through 6–8 week cycles with new workouts each phase. Every cycle focuses on a different training goal, including strength endurance, maximal strength, power, and stability so you can continue progressing long after the postpartum phase.