Pushing: Is it Okay to Follow Your Body's Rhythm?
For my first baby I took Lamaze-style classes and I was instructed to push while my partner counted. Even though I was fully dilated, I never felt the urge to push. All this did was turn me purple, but my baby just didn't move down. Since then I've read that it's fine to listen to my body and push only when I feel the urge, as long as all is well with my baby. Is this true? What's the real story on pushing?
Question:Peg Plumbo CNM
Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more
Traditionally, when second stage begins (at ten centimeters dilation), women have been instructed to begin pushing. Is this right or effective for every woman or every birth? The answer is "No.”
The urge to push is stimulated when the baby's head has descended sufficiently to stimulate a reflex (Ferguson's Reflex). Epidural anesthesia, fear and more commonly, a high station of the fetal head, reduces the urge to push.
In the event that a woman chooses to have epidural anesthesia, this Should be one of the risks that is discussed with her. Typically, the epidural is allowed to wear off before the mother is encouraged to push.
Midwives have always followed maternal cues to assess whether or not a woman is ready to push. The mother's eyes open widely, contractions may space a bit, she perspires, or may even vomit, gets restless, expereriences rectal pressure and may feel the urge to push.
If the baby is full term, appears to be healthy and has tolerated the labor well to this time, it is best to allow the mother to push when she feels the urge. If encouraged to push before the sensation is obvious, she may exhaust herself and swelling (edema) of the perineum may occur. This could impede the second stage of labor, rather than facilitate it.
In the past, we've coached mothers as if they were on the wrestling mat. We've shouted at them, counted to ten, breathed with them and pushed Their legs back while chanting "push, push, push". Contrast this with a mother who reaches the second stage of labor and is allowed to attend to the rhythm of her own body. She pushes rather tentatively at first, at the same time giving in, yet holding back. With quiet support and encouragement, she begins to arch her back, then curls up to push (sometimes quietly, sometimes with great force and noise). A side lying position is especially effective in spacing the contractions a bit and provides a small rest between contractions. The baby's heart rate does best in this position as well.
If speed is of importance, as it can be sometimes, especially with a baby who is not tolerating labor as well as we would like, the mother can be assisted into a squatting position, on the toilet, birthing chair or grasping a bar on the birthing bed. She may find pushing in an "all fours" position to be effective also. Helping the mother into a variety of pushing positions, even in a tub of warm water, can be a very effective method of faciliating the second stage of labor.
Support has recently been given in the medical literature for the use of exhalation pushing. Breath holding impedes oxygen flow to the baby, so pushing while the mother exhales is recommended.
I would agree that waiting until the mother feels a strong urge to push and letting her find her own pushing style is the best way to accommodate the second stage of labor.
Answer:
