The process of giving birth involves a complex series of events, and the pushing stage is one of the most physically demanding periods for a laboring mother. Historically, various methods have been employed to guide this final stage, with some techniques becoming common practice in hospital settings. One such method, often referred to as “purple pushing,” has drawn increasing scrutiny from medical professionals. This term describes a specific, vigorous pushing technique that causes a visible, temporary change in the mother’s color due to the intense effort required.
What is Purple Pushing?
Purple pushing is a common term for closed-glottis pushing, or the Valsalva maneuver, used during labor. This method involves the mother taking a deep breath, closing the glottis (the opening between the vocal cords), and bearing down forcefully for ten seconds or more. This intense effort is typically directed by a healthcare provider, who instructs the mother to push with each contraction, regardless of her natural urge.
The “purple” designation comes from the mother’s physical appearance during this strenuous effort. Prolonged breath-holding and forceful straining cause a rapid increase in intra-abdominal and intrathoracic pressure. This pressure temporarily restricts venous return to the heart, leading to a backup of blood that manifests as noticeable reddening or purpling of the face, neck, and sometimes burst capillaries in the eyes.
This directed pushing method gained popularity in hospital environments because it was believed to expedite the second stage of labor, offering convenience in a monitored setting. The goal is to maximize the downward force on the baby with each push, utilizing the mother’s muscular effort. This forceful, coached approach contrasts sharply with the body’s natural, spontaneous pushing reflex.
Maternal and Fetal Risks
The intense strain of purple pushing poses risks for both the mother and the baby. For the mother, the high intra-abdominal pressure significantly increases trauma to the pelvic floor. This includes a higher risk of severe perineal tears, which can affect the muscles supporting the rectum, and an increased likelihood of developing hemorrhoids.
The excessive effort causes increased maternal exhaustion, as the technique demands significant energy. The Valsalva maneuver can also cause temporary spikes in blood pressure, which may concern mothers with pre-existing hypertension. In the long term, the sustained pressure can contribute to pelvic floor dysfunction postpartum, including urinary or fecal incontinence.
The most significant concern for the baby is the effect on oxygen transfer. When the mother holds her breath and strains, the resulting drop in blood pressure and cardiac output reduces blood flow to the uterus and placenta. This compromised circulation decreases the amount of oxygen reaching the fetus, which can lead to temporary fetal distress and changes in heart rate patterns. This hypoxia can negatively affect the baby’s acid-base balance, a measure of fetal well-being.
Physiologic Pushing: The Recommended Alternative
The evidence-based alternative to directed pushing is physiologic or spontaneous pushing, often incorporating open-glottis pushing. This method centers on the mother following her body’s natural, reflexive urge, rather than being coached on a specific count. Spontaneous pushing encourages the mother to push only when she feels the undeniable urge, similar to the body’s natural reflex during a bowel movement.
The core mechanic of this approach is open-glottis pushing, where the mother pushes while exhaling, vocalizing, or making a grunting sound, keeping her airway open. This prevents the prolonged breath-holding and subsequent pressure spikes associated with the Valsalva maneuver. By maintaining an open glottis, the mother sustains better oxygen saturation, which ensures continuous blood flow and oxygenation for both herself and the baby.
The advantages of this method include reduced maternal fatigue because the mother pushes in sync with her body’s natural contractions and reflexes. Open-glottis pushing also allows for a more gradual and controlled descent of the baby, which lessens the force on the pelvic floor and reduces severe perineal injury rates. This approach is widely recommended by major health organizations as it aligns with the body’s innate birthing mechanism, promoting better outcomes for both mother and child.