The Rest and Be Thankful Stage

During my first labor, I experienced what Sheila Kitzinger calls the “rest and be thankful stage” after reaching full dilation and before I pushed out my baby. The “rest and be thankful stage” is the lull in labor that some women experience after full dilation and before feeling the physiological urge to push. While commonly described in Kitzinger’s writings and in some other sources, mention of this stage is absent from many birth resources and many women have not heard of it. After writing recently about the spontaneous birth reflex, I received a comment stating the following: “I was particularly interested in the idea of resting after full dilation before pushing. This makes sense if you are only following your body’s urges to push, but never something I had seen (or remember seeing?) spelled out before.

I always make sure to tell my birth class clients about the possibility of experiencing a lull like this, because it is during this resting phase that labor is sometimes described as having “stalled” or as requiring Pitocin to “kick it off again” or as requiring directed or coached pushing. Also, think of the frequency of remarks from mothers such as, “I just never felt the urge to push.” When exploring further, it is often revealed that what the mother actually experienced was no immediate pushing urge instantly following assessment of full dilation. Depending on the baby’s position, this can be extremely normal. The way I explain it to my clients is that the lull represents the conclusion of the physiological shift happening in the uterus—the transition between contractions that open the cervix and the contractions that push the baby down and out.

As I wrote in a previous post from several years ago:

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–-at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–-but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

In the book, Our Bodies, Ourselves: Pregnancy and Birth they share the following important point:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”

via Waiting before pushing… « Talk Birth.

That’s right, the length of time between full dilation and baby’s birth is the same, whether the mother waited one hour before pushing, or started pushing without the urge immediately following full dilation. I know which one sounds easier and more peaceful to me!

In my own experience with my first baby, I found that I felt like I should be pushing after full dilation and thus began to do so before feeling the full urge. I ended up pushing for about an hour and fifteen minutes. I suspect if I’d just continued hanging out for 45 minutes to an hour, he may have flown out in 15 minutes. Prior to pushing though, I did experience a rest and be thankful stage of about 30 minutes in which I sat in a rocking chair, joked about feeling “trippy,” and talked about being an A++ birthing woman. I describe it in my son’s birth story:

After finding out that I was fully dilated, I started to feel very odd and I really think I had to go through a sort of emotional/psychological transition to adjust myself to the fact that I had “missed” the physical transition point…I sat in the rocking chair for a while and kept saying things like, “am I dreaming? Is this real?” I also made a joke about feeling “trippy” like in Spiritual Midwifery. We also joked about what an A+ + + laboring woman I was (a family joke–I was a 4.0 student throughout college and grad school and so we always say that I like to get an A+ + + on everything I do). Those pressure feelings I had been having for a while, got a little more intense and I started pushing kind of experimentally. I was on my knees with my head on the bed on my pillow again and during one of the little pushes my water broke with a giant, startling POP and sprayed across the room including all over my friend. At this point, the midwife left saying, “I think I should call the doctor.” via My First Birth « Talk Birth.

The blog Birth and Baby Wise has some great thoughts to share on resting and being thankful (note the blog is from an educator in London, thus the use of the term Syntocinon, rather than the U.S. based brand Pitocin):

… it seems that there is little appreciation for this well documented pause amongst health professionals working in the consultant-led units of hospitals. Any stop in action once the magic ’10 cm dilatation’ is reached is met with almost instant medical intervention to get the contractions back up and running, ie a syntocinon drip. Women experiencing this are already on a consultant-led unit, where a higher level of medical intervention can be anticipated, but it is strange that there seems to be such a rush to use a syntocinon drip to get the contractions going again, providing mother and baby are both coping well.

One reason the contractions may ease temporarily is in order to allow the baby’s head to get into a better position. If this is the case, then artificially speeding contractions up is hardly likely to have the benefit of a faster birth for the woman – if anything, a slower and more complicated birth as she tries to push out a baby that is not quite in the right position. In addition, she has to cope with stronger contractions that she might find difficult to deal with, necessitating further medical help in the shape of an epidural – which in turn makes pushing the baby out even harder…

…At this stage, the woman and her partner are incredibly vulnerable to this well meant ‘help’ from midwives and obstetricians and are unlikely to question the requirement for additional medical help. It is also unlikely that the calm and relaxed environment so important for a peaceful birth can survive the worries of the health professionals, which will affect most women and their partners. via Rest and be thankful – or panic and have a drip shoved in? | Birth and Baby Wise.

I agree. In my own personal experience with my first birth, I was very vulnerable to just the perceived expectation of it being “time to push.” With later babies, it was intensely important to me that I have very few people present at the birth, knowing how sensitive I am to the expectations of those around me. It is truly only my husband and my mother than I trust to not disrupt my “birth brain” and the freedom of my birth space.

I’d love to hear more from readers about their experiences with the rest and be thankful stage.

Did you experience this lull between full dilation and pushing out your baby?

Was the lull recognized and respected by your birth attendants?

If you pushed without feeling the urge, was the pushing stage fairly long?

With subsequent babies, I had no internal checks during labor, so I never really knew if I experienced the rest and be thankful stage with them. I just pushed when my body started pushing—I have no idea how long after full dilation that was. So, I also am curious to know if women find they experience this stage with all babies, with only the first one, or with only some of their babies?

I suspect I did experience it with Alaina, because I remembering feeling concerned that contractions were suddenly “far apart.” I started talking more and analyzing myself and the labor and this was probably part of a lull in the intensity of the contraction action while my body prepared for a powerful spontaneous birth reflex.

35 thoughts on “The Rest and Be Thankful Stage

  1. My first birth was nearly unassisted and quite fast. I don’t remember a “rest and be thankful” type stage, since everything seemed to happen so quickly. I also didn’t have any cervical checks due to the fact that I was alone in my bathroom when I started feeling the urge to push. I remember contractions 4 or 5 minutes apart, then something changed and every time I got up I started feeling the urge to push. I don’t remember a rest at all. I think that my pushing stage was around 45 minutes, but that was with some periods of trying not to push so that we could get to the hospital. I think that it would have been faster without that. Total time was 5 hours start-to-finish, so maybe there just wasn’t time for that stage in my case?

    I’m due in two weeks, so I’m interested to see what happens with this one. Thankfully we are planning a homebirth so that we don’t have to worry about getting to the hospital this time :)

    • Just wanted to let you know….I was SO looking for a link for this idea. My first birth was a typical cascade of interventions, and I only really understood that my second birth might be different, and I should prepare for that when why bestie insisted I reread the hippie birth stuff 10 days before my second birth. Just as well. I was doing so well that I didn’t realise how far in I was until I’d trown up in transition and then my contractions stopped. My partner (understandably) thought this meant I was still not in full labour, lucky I knew otherwise and called an ambulance: I was sure that when they starter again, I’d be pushing. I was right. in my third labour, when I was obviously past transition and fully dilated, I had the same thing. My labour “stalled”. I did field several “do you think you could push?” “sweetie, you need to push now” questions/ comments. I was still having some contractions, without the need to push. There were mutterings about stalled labour. Luckily, I had the sense to say “no, it’s ok. this happened in my last labour. i know what the urge to push feels like, and I’m not going to push til I need to…” At half hour, I said “trust, me, I know what I’m doing. I know how much it’ll hurt to push now, and I know how good it will feel if I wait til I need to, so just wait and don’t comment again until it gets to 60 minutes”. Praise be, the senior midwife said to the assisting “just leave her be, she sounds like she’s doing fine”. And 5 minutes later…2 pushes.

  2. I experienced this with my first birth. I actually asked “what’s happening”, as I was in the birth pool in my kitchen, and it seemed that right after transition everything came to a grinding halt. My midwife joked, “you’re going to have a baby of course!”. And then in all seriousness said, “this is called the rest and be thankful stage. Your body is gearing up for harder work.”
    My next question was “what do we do?”. And she promptly replied, “we wait. You relax”. It was a full 90 minutes before the contractions picked back up slowly. And my midwife said, “you can start pushing whenever you feel like it.”. I panicked briefly and told her I didn’t know how. She smiled at me and said “but your body does. It was designed for this. Shut off your brain and let your body do what it is meant to do.”.
    A few minutes later I understood what she meant, as of almost it’s own volition, my body started to push my baby out. I enjoyed the ride for about 45 minutes, marveling at the great work my body was doing without me actively engaged. But then my daughters heart tones were not recovering well and my midwife said playtime was over and I should try pushing in earnest now. 15 minutes later, I was holding my infant daughter!

  3. Thanks so much for expanding on this topic! I had a fairly short labour with my son, but then completely wore myself out pushing for two hours–and he came out sunny-side up. Makes me wonder what could have happened had I waited. But, now I know for next time. Off to do some more reading on the topic!

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  5. I NEVER felt an urge to push for my first baby, but because I was fully open I was then yelled at to push, which I did for over 2 hours. It was horrendous. I still ended with an episiotomy and 2nd degree tearing and emotional scarring.
    I was convinced my body had failed to do its job.
    I have a home HypnoBirth for my 2nd baby, I didn’t push AT ALL, my 2nd phase was less than 2 minutes. There was pressure, then he was out.
    I am a HypnoBirthing practitioner now and always talk about a rest phase – awesome to see someone writing about it.
    Thank you.

  6. I was all set for a wonderful homebirth with my first, and was very happy labouring at home in the water – until they didn’t believe me that I was in established labour b’cos I was so relaxed and then when they finally clued that I was full dilated, they kept saying you MUST push altho I didn’t feel any need at all…. which resulted in a trip to the hospital, an drip to “get things going” and a team of midwives jabbing me in my perineum and shouting at me to “push to hear” even though my daughter was super happy and there was no rush at all! I had several small tears that needed stitching and all sorts of hideous burst blood vessels in my face as a result! Not how I hoped it would be at all!!! Really wish they had heard of and supported a natural rest in labour!
    My second birthing experience was a perfect home, hypno-birth with no resting stage at all!

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  8. During my first birth in a birthing center, I was never checked for full dilation – there was a lot of vernix in the water and my midwife took that as a sign that I was fully dilated and ready to push. But I was never instructed to push, she just told me that I could push whenever I felt like it. I waited for a few minutes but I didn’t feel any urge to push so I decided to push anyway. I was tired and ready to meet my baby. I pushed for 11 minutes and he was born.

    During my second birth at home, I did feel the urge to push. I was worried about pushing against undilated tissue, so I asked my midwife to check me. I wasn’t fully dilated so I resisted the urge to push. Later when we were confident that I was fully dilated (we didn’t bother to check again), the urge to push never came back. Again, I was tired and ready to meet my baby, so I went ahead and pushed. She was born after 15 minutes of pushing.

    In retrospect, given that I was very tired, maybe I should have taken the opportunity to rest. However, I know I would not have been patient enough to wait 45 minutes or an hour for contractions to start back up again. After the intensity of transition, I was ready to barrel through pushing and be finished.

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  10. This is amazing. I felt after a chaotic transition phase in the car on the way to out birthing center that I wasn’t meant to be pushing. I was immediately checked and found to be fully dilated yet had no urge to push. I received some guidance in positioning & was encouraged to try pushing but became tired and discouraged. I ended up giving birth by suction with an episiotomy and felt very deflated by the whole experience. Not only did I not have an urge to push, pushing felt downright WRONG. I think I would decline internal checks next time until I felt the urge. The rest of my labour went beautifully up to that point and I have no doubt that my body knows how to do it.

  11. I’m pregnant with my first and I just had to tell you how glad I am to have found this post! I’m doing a lot of research on childbirth and coming up with a birth plan I think will work for me, but I had never heard of the rest and be thankful stage until I landed here. I guess I just always assumed when you were 10cm that was it. You started to push and you didn’t quit until the baby was out or they decided it was futile and sent you for a c-section. And I would have still believed that in a few months when it’s time to push my little one out if I hadn’t read this. Thanks for opening my eyes!

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  14. I had a prolonged second stage at our home birth. I pushed for seven and a half hours! That was a record in my midwife’s 15 years of practice, the longest pushing phase to still successfully birth at home. It was HARD. 36 hours of labor, total. I received three bags of IV fluids to combat dehydration because I was plagued by nausea and vomiting.

    The midwife told me I could start pushing. She said she heard a change in my voice. I grunted a little deeply just once and she reacted to that, and said, “You could start pushing.” I would have preferred to start pushing spontaneously, and that will be clear to my next practitioner (or the same midwife), should we have another birth opportunity.

    • Wow! That is a LONG time. I’ve had one client with a seven hour pushing stage and that was the longest I’ve ever witnessed. Thanks for sharing–interesting experience/perspective!

  15. I am still grieving the birth experience of my son and it will be a year Christmas day. We are both doing well but I am still searching for peace and understanding of our situation. I found this post helpful and hit home with me and what I think I missed out on. I had planned a home water birth with Midwives. I was their second birth last xmas day, which Im sure must have been a blue moon event for them, and I was quite far along in my labor when they finally arrived to attend me. When I fully dilated 3 hours after they arrived, they suggested I bear down to see if that urge would ignite…it didn’t for me, but I trusted the professionals I had hired and so I continued to push with direction. In the back of my head, I’m thinking, I remember Ina May talking about the “rest and be thankful stage”, but again flew back to trusting my birth team over my body:( My contractions were slowing down and this seemed to concern them?? so they decided to try the breast pump for 30 minutes while on the birthing stool. I pushed in every position possible for 5 hours before transferring to the hospital. I was so sure I was going to pop a vein in my head and at that point wished it just would. Once there, they didn’t know what to do for me but c-section as I was so swollen. When they ripped my son out of me they concluded he was OP and Asynclitic, like a truck that got stuck in the mud, his head was extremely molded off to one side. For weeks after the birth I would sit and nurse him going over it again and again and then I felt a light bulb go off and it led me back to the pushing too soon idea and the fact that I had a tired birth team that probably just wanted to go home…I guess I am looking on here to hear any opinions on this matter. I have since become a Doula and have seen many natural births progress beautifully with this stage not being rushed. There was no emergency for us, so why would a midwife encourage pushing at this stage? anything please:)))

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  17. I had this with my third baby!
    I had been pushing already, and made a big and sudden push (which, in retrospect, was a very unwise thing to do, as I suffered a terrible third degree tear- though, of course, I didn’t know this at the time). Then everything stopped. The midwife asked me what was happening, and I just said “I’m having a rest”. I don’t remember any more contractions after that- I just pushed when I felt ready. It’s a shame about the tear, because apart from that it was a beautiful birth- the only one I managed to have at home.

  18. I rested for a whole hour before pushing. So glad to have had a home-birth and an experienced midwife. Pushing itself lasted just a few minutes and the whole birth was a bit over 5 hours, so that lull took a considerable portion.

  19. Gosh I wish I’d known more at my first birth and had a different birth experience. My midwife, whilst highly qualified was highly interventionist. On reaching 10cm I was instructed to push which required a lot of coaching because I instinctively had no idea what to do. I firmly believe now that my body was not ready to birth and that what happened for the next two hours was painfully unnecessary, including a massive episiotomy. Needless to say that with my second birth I changed midwives and didn’t arrive at hospital til 20 mins before I gave birth, 5 mins of pushing was all it took.

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