Call the Midwife: Melissa Chappell on the Second Stage of Labor (Pushing)

Melissa Chappell, Utah County Midwife

This is the seventh post in a series of blog posts based on interviews I’m doing with midwives who serve Utah County.

In this post, I’ll introduce you to the wonderful Melissa Chappell, owner of Songbird Maternity and co-owner of Utah Birth Suites, alongside Seasons Warner. She attends births at their beautiful new birth center in Provo, as well as home births in Utah County.

Twenty-six years ago, when Melissa was pregnant with her first child, she took a Bradley Method birth class and had a great first birth experience, even though her labor was very long. After that birth, she wanted to teach others to help them prepare for awesome birth experiences, so she became a childbirth educator. Later, she became a doula, then a doula trainer, and then a midwife, which she has been doing since 2015! She attended The Community School of Midwifery and completed the North American Registry of Midwives (NARM) Portfolio Evaluation Process and earned her CPM and Utah State Licensure (LDEM) credentials in 2018. Now, she also enjoys teaching potential midwives! Over the 25 years she’s served the birth community, she has touched the lives of hundreds of birthing families.

During our interview, I asked Melissa if she would talk with me about pushing, or the second stage of labor. If you’ve ever watched a TV birth scene, you likely imagine many people standing around, chanting, “Push! Push!” or counting from 1 to 10 as the mother bears down, purple-faced and out of breath. But, as Melissa can attest, birthing your baby doesn’t have to be this way!

In fact, that’s not how it goes at all at the births that Melissa attends. “Most of the time, if you just let a mom follow her body, she’s going to be able to push on her own,” she says. Melissa mentions that some people say they’ve given birth to multiple babies and never really felt the urge to push. “A lot of times that comes from people not really being given the time for their bodies to get to that point where they’re ready to push,” Melissa explains. “I mean, no one’s just going to sit there with a baby inside them forever! Their bodies are eventually going to help them know how to push the babies out.”

Sometimes, you may reach full dilation (10 cm), and still not feel, instinctually, that it’s time to push. Your contractions may even slow down for a while and give you a little break. When that happens, Melissa calls it the “rest and be thankful” stage. As you take some time for a little break before birthing your baby, your baby descends further into your pelvis, until you may notice that you’re grunting a little at the top of each contraction. When Melissa hears that little grunt, she gets excited—the baby is almost here!

Once the second stage of labor (pushing phase) starts, the length of time until baby is born varies greatly. On average, Melissa’s clients push for under an hour, but some push for a couple of hours, and every now and then, up to four hours! Recent research indicates that this is safe as long as both the mother and her baby’s vital signs look good and she is making progress in moving the baby down.

In a first birth, Melissa will sometimes offer gentle coaching or direction if her clients would like more guidance about how to push. One way she may do this is by gently placing her finger inside the bottom of the vagina (in the perineal space) to offer direction about where to push. Of course, Melissa never does this without the explicit consent or request of her clients!
For many clients, though, Melissa doesn’t give any direction or coaching. She just gives them time and space to listen to their bodies.

And what about cervical exams? Melissa says she rarely does them. (Although with first time moms, she does them a little more frequently, to help them assess where they are in their labor progression when they first arrive at the birth center.) “As a midwife, after doing this for years and years, you get to a point where you can tell without doing a cervical check, if someone is almost ready to push.” She listens to the sounds her clients are making (like that little grunt at the top of each contraction), and she watches the pattern of their labor: the length, frequency, and intensity of their contractions. By closely watching and listening, Melissa says that cervical exams to ensure complete dilation before pushing begins are rarely needed. Melissa further explains, “If you’re really, really empowering a laboring person to listen to their body and not push unless she feels that overwhelming urge, you’re not going to have people pushing on cervixes that are not ready to be pushed on.”
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Melissa is not alone in the way she empowers and encourages her clients to listen to their bodies and instinctively push during labor—there are many other fabulous midwives across Utah County who offer that same sort of care! I’m grateful that Melissa took the time to discuss this important topic with me, and for the individualized and empowering care she gives to her clients. She has a vibrant personality and lots of enthusiasm for the incredible work she does. Head on over to her website to learn more!

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