After about an hour or two for first time mothers or about 15 to 30 minutes for women having their second or subsequent baby (of course you are welcome to do it faster than this and some women do!), the baby's head usually reaches the level of the woman's anus. At this point the woman's
perineum will start to bulge and stretch and the pressure of her baby's head can be seen to push her anus open (distending it out) or dilating it up to the size of about a 50 cent piece (Australian coin) or 3 to 4cm diameter.
This stage of the pushing is usually felt as a combination of painful pressure mixed with some 'burning' sensations at the peak of the stronger contractions as the nerves in the stretching perineum start to become stimulated. It can be a challenge at this point to stop 'pulling back' or 'withholding the push', in a sense. This is a common physical reaction. Your caregiver may notice your anus 'pull in', even though you appear to be pushing. Being able to let go of this resistance can help your baby to come down. You may find you need your caregiver to talk you through this.
Sometimes getting into a warm bath (or using warm compresses on the perineum) can help at this stage. (Be aware that a water birth may be inevitable if you get into the bath at this point in the labour this is only a problem if you wish to avoid one!) Try to remember that the incredible pressure you are feeling is normal and will pass as your baby moves past your bowel and further onto the perineum.
If there are faeces (or motions) in the rectum, the small amount present in the very end of the bowel will usually be passed at this time, with little more coming away after this because of the pressure as the baby's head closes off the bowel. Caregivers see the woman opening her bowels as a positive sign as it tells them that the baby is moving down closer to being born.