By Kathleen Donahoe, ACE, AFAA, MBA.

Since 2010, I've been teaching pregnant people how to push out their babies. I have a different approach to the pushing phase of childbirth- I teach the PHYSIOLOGY of pushing...and it really works! Parents, doctors, midwives and doulas report to us over and over: 'People are pushing out their babies in 20 minutes with this technique---without tearing!'

As the co-owner of Oh Baby! Fitness, I've taught over 10,000 pregnant and new parents how exercise can help them have comfortable pregnancies and healthy (both physically and mentally) postpartum periods. When I tell people what I do, they picture me wearing a sweatband and cordless mic as I count out squat reps, but really, what my work looks like is a lot of education: education about the physiological changes of the perinatal period (and how exercise can help people to have an easier pregnancy and faster recovery) and increasingly education about the core box, specifically the transverse/inner abs and pelvic floor.

Oh Baby! Fitness has fitness instructors all over America teaching expectant families the specific physiology of pushing, and we've had extraordinary feedback from participants, doulas, L&D nurses, midwives and OBs. We firmly believe pregnant people can and should be taught HOW to push out their babies long BEFORE the big birthing day. They need to be taught what to do to avoid the reflex of freezing, tensing EVERYTHING (not helpful!) or panicking. Teaching people about this part of labor gives them agency and empowerment for the most exciting part of labor. Let's dive in!

1- Get excited that you can teach this part!

I'm not going to lie, I think this first step might be the hardest for some childbirth educators! There is a history of NOT educating pregnant people about pushing, instead trusting that their bodies will 'get the baby out' as it should. I 100% agree that a baby is going to come out of a birthing person, however, many people spend a not-insignificant part of labor being coached by a L&D nurse, doctor or midwife on what pushing is and how to do it. Is there any reason this needs to happen DURING labor? I'd argue no, and I've observed that teaching people the physiology of pushing while they are still pregnant results in shorter pushing stages, as well as fewer tears and cesarean sections. It also empowers people during what can be the scariest part of labor- giving them power by providing education about the coordination of muscles to most efficiently push out their babies. We trust pregnant people's bodies to get their babies out, let's also trust their brains to understand the physiology and give them a chance to practice before it's game time.

2- Understand the physiology of pushing efficiently.

Once you get excited about teaching pushing, it's time to dive into physiology. The most efficient way for a person to push out their baby is to ENGAGE their rectus and transverse abdominals and to RELAX their pelvic floor. This is easier said than done- these muscles almost always fire together, and to get the abs strong with a relaxed pelvic floor is kind of like patting your head while rubbing your tummy- which is why it's so helpful to give people a chance to practice! Often when birthing people come to push out their babies they engage ALL of their muscles, which LIFTS their pelvic floor, making it harder for the baby to come out. It's complicated stuff! But below you'll learn how to teach people to train those muscles individually and then how to put it all together in what we call 'Coordinated Pushing'

3- Teach the role of abs in pregnancy and pushing.

The first piece of education for clients is the basics of abdominal muscles. At Oh Baby! Fitness, we believe the core muscles (the pelvic floor and abs) are the key to a healthy pregnancy and easy, faster delivery.

The abdominals are made up of four kinds of muscles:

1. Rectus Abs: Most people think rectus abdominals are the only abs you have. These are at the front of the torso and are commonly referred to as the 'six-pack' and are the muscle group targeted in sit-ups. When a person is pushing and their spine is curved forward, their rectus abs are ENGAGED.
2. Internal and External Obliques: these muscles are found along the sides of the torso and aid in twisting and turning- these are not used for pushing.
3. Transverse Abs: these are the interior layer of abdominals (the inner abs) and the most important in pregnancy- both for posture during pregnancy and for pushing. These are the muscles that are engaged when you suck in your belly. It can be helpful to have your students or clients visualize their transverse abdominals as the muscular sling that carries the baby. They can be found right where the seat belt goes across your tummy.

Having your clients find their transverse abs is going to help them push out their baby- getting this muscle strong and engaged is how they will push out their baby. Have them try this to find that muscle.

Standing, so that the class can see, demonstrate a transverse ab hold/pulling your bellybutton to your spine. Tell them to think of 'hugging' the baby with their ab muscles. Let them know that hugging the baby won't hurt the baby at all. Have them stand up and try. If they have a support person with them, let that person see the difference in relaxed abs with bad posture and engaged abs with good posture. Encourage the support person to hold their abs in too- it's good for everyone to strengthen their transverse abs! Pregnant people should be encouraged to engage their transverse abs regularly throughout the day. A good cue is to ask them to pull their baby up and away from their seatbelt whenever they are driving. THIS is good posture and engaging the inner abs strengthens them and will help ease labor and pushing.

4- Teach kegel w/ relaxation or 'dropped' feeling

Now that your students and clients understand how to engage their transverse abs, we want to help them 'find' their pelvic floor. The coordination of strong, engaged transverse abdominals with a RELAXED or dropped pelvic floor is the most efficient way to push out a baby. Teaching people how to drop their pelvic floor sounds tricky but is actually pretty straightforward:

Have your students or clients get into a sitting position (cross-legged is generally good) and have them imagine their pelvic floor (sometimes it can be helpful to describe the muscle as a trampoline that supports the weight of the baby. The baby is head down on the trampoline.).

1. To help them locate their pelvic floor, educate them that the muscle connects their pubic bone to tailbone and hipbone to hipbone - it's a big muscle...the size of a piece of 8 x 11 paper! Have them imagine lifting all four corners of the muscle like a wonton wrapper. It can be helpful to have them place their pointer and middle finger right inside their hip bones, some people can feel the lift of the muscle.
2. See if they can find different degrees of tightening the pelvic floor. If they imagine an elevator, ask them to lift the pelvic floor to the first floor, second floor, third floor, and then reverse back down.. Second floor, first floor and then the basement. A full release. It's that basement feeling people who will give birth need to get acquainted with. This is where their pelvic floor needs to be to easily push out their baby. Sometimes a straw image is helpful; they want to 'suck up' the pelvic floor, and then slowly release.
3. Note: the release of the pelvic floor is just as important as engaging the pelvic floor. If your students and clients have a vaginal birth, they will need to relax their pelvic floor during the pushing stage, so it is vital to teach this release section of the Kegel.
4. While doing Kegel exercises, remind them to try not to move the leg, buttock, or abdominal muscles.Have them try doing Kegels in a side-lying position or on hands and knees. People in their third trimester may find these positions more comfortable as the weight of the baby is not on the pelvic floor.
5. Helpful cues for finding a dropped or relaxed pelvic floor are that it feels like 'peeing very quickly- like when you are in a movie and have to go to the bathroom and don't want to miss a minute'--- or the image of weight in the crotch.

5- Teach coordinated pushing

Now that your students and clients have found their engaged inner abs and dropped pelvic floor, you can help them put it all together into Coordinated Pushing! We begin with belly breathing to get people to breathe DOWN to their baby and to help them find their transverse abdominals. Educate people that they do NOT need to breathe this way to push as many will find their own breath pattern'the MUSCLE coordination is the technique.

How to Teach Belly Breathing for Labor:

1. Before you begin, remind students and clients that belly breathing is important even if they are having a planned cesarean section. Let people know that the Belly Breathing is also the first abdominal exercise they will do after they have their baby, so this is important for everyone to learn. Drawing the bellybutton to spine while exhaling is the first safe abdominal work for postpartum women.
2. Have clients place their hands on their bellies, with their middle fingers touching right above their bellybuttons.
3. Have them inhale and imagine the breath going all the way down to the baby. Their middle fingers should separate as their belly expands with the breath.
4. As they exhale, have them 'hug the baby' with their abdominals, bringing their middle fingers back together. Other cues are: 'A tiny crunch on the exhale,' 'pull the baby up and in on the exhale,' and 'exhale and engage your abdominals'.

How to Teach Coordinated Pushing:

1. Begin by teaching belly breathing. They will continue to breathe this way for coordinated pushing.
2. Remind the pregnant people that coordinated pushing can be quite difficult. It's like patting their head and rubbing their belly at the same time. They should feel free to PRACTICE and bring any questions to later classes.
3. On the exhale stage of belly breathing, have students and clients engage their abdominals, and actively drop or relax their pelvic floor. They should have relaxed glutes and lower abdominals and tight, contracted transverse abdominals. This combination of relaxed pelvic floor and tight abs is the most effective way to push a baby out.
4. Have the clients practice a few times in class. Use the phrase 'drop,' 'lower,' or 'relax' the pelvic floor, rather than 'push'. Another helpful phrase is 'push with your gut, not with your butt'. Remind clients to relax their jaw. A relaxed jaw will translate to relaxed glutes.
5. Students and clients should practice on their own. It is a difficult sequence to master. Have them start with belly breathing and advance to coordinated pushing.

Interested in learning more? Download the How to Push Out Your Baby app on iTunes for a specific step by step video explanation of coordinated pushing. Oh Baby! Fitness also offers an online pre/postnatal fitness certification that will train you to teach the Oh Baby! Fitness 'How To Push Out Your Baby' workshop and also offers a live version of the Pre/postnatal fitness training in cities around America. Visit ohbabyfitness.com or email training@ohbabyftiness.com to learn more.

References

American College of Obstetricians and Gynecologists. (2015). Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. Obstet Gynecol, 126(6), e135-142.

About Kathleen Donahoe, ACE, AFAA, MBA

Kathleen has personally trained over 10,000 pregnant and postpartum families. As a co-author of the Oh Baby! Fitness Prenatal and Postpartum Instructor Training, as well as a presenter of live perinatal fitness trainings, Kathleen teaches fitness instructors and personal trainers the art and science of perinatal fitness. Kathleen began her career as a personal trainer in Syracuse, NY. While there, she found she loved working with women who had gained significant weight (80 lbs or more) during pregnancy, and that helping them lose weight, recover from pregnancy and take control of their bodies was an exciting and satisfying job. After moving to Atlanta in 2005 for a job in non-profit management, Kathleen missed fitness and interviewed with Oh Baby! Fitness in its first months as a company. From there, she began teaching a Pregnancy Water Aerobics class for Oh Baby!. She quickly realized she had found her passion, and within a year was teaching 15 classes a week for the company. She pursued further certifications in perinatal Pilates and pelvic floor recovery and was named the Senior Instructor for Oh Baby in 2010. She graduated with her MBA in May of 2012 and was brought on full time as COO and co-owner. After nearly 10 years of training perinatal women, Kathleen joined their ranks when she gave birth to her son Peter in December of 2013 and her daughter Beatrice in 2015. She continues to teach for the company, while focusing on training and national expansion, from her home in Seattle.

Photo credits:

Kathleen Picture- Stacey Bode Photography

Kathleen teaching picture- Clare Schexnyder

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