Although it may temporarily redirect the force of the pushing downwards, upon release and over time, it causes energy to rise upwards – away from the desired direction and into the head. It is indeed ironic that these are the same techniques we use in yogic pranayama to raise energy from the bottom of the spinal column to redirect it upwards prior to contemplative meditation. Childbirth clearly requires the total opposite. Using the power of inhalation to wilfully push energy (a baby) through a confined space or tense area (the cervix and birth canal) is also the complete opposite of yogic methodology. Such a tactic is absolutely contraindicated in the performance of all yoga postures and, since we are dealing with the same mind / body complex as before labour, all such ways can be described as contrary to the flow of a yogic labour. The better practice is to use constant Ujjayi Pranayama to lower blood pressure and increase the relaxation response, and to use patience along with the nature of exhalation to open the space, rather than to force something through it! This is where all of one’s efforts should go during transition and the second stage rather than into pushing.
(iii) Pushing from above can conflict with the pushing from below. Rather than the baby descending the birth canal at a pace which allows the muscles of the vagina and perineum to gradually expand over many contractions, wilful pushing can make the descent too swift, such that the head begins to crown before the perineum is fully stretched. At this point a woman may then be instructed to stop pushing, just when she gets the real instinctive pushing urges! Unless she is suddenly able to flip out of the pushing mode she has been in for some time, it is likely that the head will be born within a contraction or two, possibly resulting in a torn perineum or the performance of an episiotomy.
(iv) Pushing increases tiredness by wasting energy. Rather than just keeping on with some deep breathing and all your best efforts at relaxation, a woman will get more tired more quickly during this forced pushing stage than at any other time in her labour.
 

	~ Forceps and Vacuum Extraction  ~

   Forceps are like a pair of big shiny salad servers, which are inserted into the vagina and held around the baby’s head to turn and / or pull the baby downwards. Forceps delivery is intended to be used only when a spontaneous delivery is not
 

possible.They are considered by many to be inhumane things and, if badly used, can be responsible for a range of problems with the development of the baby’s head, neck and spine. The vacuum extraction system, a somewhat kinder device for mother and baby, suctions onto the top of the baby’s head to affect the same outcome of pulling and / or turning the baby as it is born.
   Both these devices are used during the second stage of labour once the baby is coming down the birth canal. They are used to expedite the delivery if there are indications of foetal distress, maternal exhaustion or high blood pressure in the mother or premature detachment of the placenta, or for turning a posterior presentation. It is also common for a woman under the influence of an epidural to need such assistance to deliver the baby since she is not fully able to sense nor assist the spontaneous pushing urge of her body.
   In rare cases a baby may become distressed before he fully enters the birth canal, so if the cervix is considered to be at full dilation, in a last ditch attempt to deliver the baby vaginally, a “high forceps delivery” is attempted, whereby the baby is pulled all the way down from the uterus. This practice is now being abandoned in place of the caesarean section due to doctors’ fears about dangers for the child and potential liabilities.
 

	~ Episiotomy ~

   An episiotomy is when a surgical cut is made in the perineum (the fleshy muscle at the rear of the vagina). Episiotomies used to be a standard procedure on the grounds that natural tearing was more likely to cause a fistula. A fistula is a hole through the vaginal wall into the rectum or bladder which requires surgical repair. However, contrary to popular belief, a fistula may equally occur from an episiotomy or from uncontrolled tearing.
   Nowadays, midwives try to minimise tears and episiotomies by using massage with oil and by not encouraging pushing as the head crowns, but if there is a perceived medical need to deliver the baby very quickly, an episiotomy may be needed. It is often made when forceps are to be used to allow room for the baby plus the forceps to be delivered through the vagina.
   Most women have strong feelings about not wanting an episiotomy, some equating it with genital mutilation and others worrying the scar will affect their sex life and future birth tears. This fear