Pushing: Is it Safe to Wait to Birth Body After Head Emerges?

Midwives and some obstetricians, following delivery of the baby's head, will wait for another contraction to deliver the body. However, some obstetricians believe this is dangerous and immediately deliver the body without waiting for a contraction. I would appreciate your comments on this issue. (I am not referring to shoulder dystocia but normal delivery.) Is it safe to wait for a contraction before delivering the body?

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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

I'm not sure if this has ever been studied under controlled conditions. My opinion is taken from animal models. I have seen many animals give birth unassisted and unattended; no one puts the lambs or foals through a complex series of hand maneuvers to deliver them and the mothers push when they have to.

If a human baby is under no stress, the heart tones are good and the mother is willing, I feel that the midwife or attendant can wait until the next contraction to deliver the shoulders. If there is meconium present, or the baby is under some kind of stress or the mother is not listening well and following your guidance at this point, waiting for the next contraction may be counter-productive.

A contraction may cause a great expulsive effort in the mother and this may lead to lacerations or a very rapid delivery. Sometimes, it is a good idea to deliver the shoulder between contractions to avoid this. If the mother is too exhausted or the pushing is very ineffective, a midwife could wait for the contraction or the end of the next contraction.

Generally, after the birth of the head, the midwife is busy suctioning and reassuring the couple and the next contraction comes without any serious waiting.

There is a circumstance too when during second stage, the uterus is tiring and the contractions only come every five minutes or greater. This is really too long for the baby's neck to be compressed and I feel in that circumstance it is necessary to assist delivery of the shoulder. After the birth of the shoulders, it is nice to have the mother or father reach down and deliver the baby. They can tell you if it's a boy or girl!

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