Things to consider during the pushing phase can include:
Pushing before you are ready
Cervix not completely open
Lying on your back
Instinctively pushing
Caregiver's preferences
Pushing before you are ready. Most women will move from the 1
st to the 2nd stage of their labour without a hitch. Following their body's signals when they feel the urge to push. This is normal and does not necessarily require your caregiver to perform an internal vaginal examination to 'allow' you to push.
Occasionally, you can start to push, but it sounds a little 'half-hearted' (or inconsistent). This may also be accompanied with some heavier bleeding and more pain than before. These can be signs that the cervix is not completely open yet. Experiencing the desire to push (before the cervix is completely open and out of the way) can happen if you have an anterior lip or the baby is in a posterior position.
An anterior lip can occur when a small part of the woman's cervix remains undilated and is pinched between the baby's head and the bony pelvis (starting to swell when the woman pushes). If this happens, your caregiver will usually encourage you to resist the urge to push, by panting during the contraction, and if possible encouraging you to assume a 'head down, bottom up' position, to take the pressure off. You may wish to read more about this in Anterior lip.
With a posterior position, the back of the baby's head can press on the woman's bowel early, before the baby's head rotates around to the front and her cervix is completely dilated. Again, you may need to assume a 'head down bottom up' position to take the pressure off. Leaning forward may also help the baby to move around. You may wish to read more on this in Posterior position.
Cervix not completely open. Sometimes if the cervix is almost completely open (but not quite), the woman can experience small, spontaneous grunting pushes (at the peak of their contractions).