To push not to push


So you’re having a baby. Perhaps you’re very happy to go along with what the medics say – you don’t read much, you go with the flow, and then you go into labour and give birth. Easy peasy huh? When you get to the pushing bit, it could be that you go with your body, and it all makes sense. Or it could be that the script goes something like this:

‘OK, so when you feel the urge to push, I’d like you to take a big deep breath, and hold it, and push down into your bottom. That’s right. See if you can get three big pushes out of that pain. Really push. Come on, a bit harder. Good girl. Can you just push a tiny bit harder? That’s right, get angry with it. Get really angry with your baby. There. Well done…’

There’s a beautiful example to illustrate what I mean just here:

This is called directed pushing, or Valsalva pushing. Some call it purple pushing because the idea is you hold your breath for six seconds, and push with all your might. Your eyeballs pop and you go purple. Perhaps your head swims a bit.

But hey, you’re having a baby, and this is what you have to do to have a baby, right? You’ve never done this before, and the midwives and doctors have seen it plenty of times. They’re the experts, right?

The only thing is, in a straightforward birth, where there’s no epidural, and there’s no reason to hurry the baby out (eg the baby is not distressed), there might be another way.

Because all that coaching, all that cheerleading, is a bit contraversial, actually. Some studies suggest that it shortens the second stage of labour, but not by all that much – I have seen research quoting times from seven to 20 minutes.

Bring it on then. We all want a shorter pushing stage, don’t we?

Think again. Perhaps not, when you realise what you pay for that seven to 20 minutes, which is:

  • Increased risk of your baby becoming distressed (therefore, increased risk of forceps, ventouse, episiotomy)
  • Increased risk of damage to your bladder
  • Increased risk of damage to you pelvic floor
  • Increased risk of damage to your vagina
  • Increased risk of you become distressed

Then why is it happening? Or rather, given there might be a time and a place for it (back to that epidural or other sound medical reasons why it’s actually very sensible to hurry this baby out), why is it happening when it’s not necessary?

I have several theories on this, but I’m not a midwife, so I speak from the sidelines. It could be to do with habit, the need to do something rather than do nothing, a feeling of control. It could be to do with institutionalisation, or fear, or a lack of confidence in a woman’s body… but, to be honest, should that really be your problem when you’re in labour, and if you’re being asked to do something that you didn’t want to do?

So instead of why is it happening, perhaps the question from my standpoint as a doula and childbirth educator, and from the standpoint of the labouring woman and her partner, is to consider how best to avoid getting into a ‘valsalva’ situation in the first place, and if you do, how to make the best of the situation.

And this leads us back to the same old same old. You’re avoiding an epidural, and you’re finding ways to minimise stress to the baby during labour, through plenty of antenatal practice on breathing and relaxation, and upright, forward-leaning positions in labour. You’re also – crucially – going to have your baby in a place that celebrates, rather than fears natural birth, with supporters and professionals who feel the same.

And if despite all this, the cheerleading starts, it’s over to your birth partner. This is the point where your supporter becomes your advocate. She wants to listen to her body, they say – she doesn’t want to be coached. Perhaps they should then ask, gently and politely, without confrontation, whether there’s a sound medical reason for the coached pushing. They should perhaps suggest that they’ve heard it has a lot of side effects. Maybe they should even ask for a second opinion. Or perhaps they should just say, in the words of Mary Cronk, ‘thank you for your advice. I will let you know what I decide to do.’

To end, here’s another little story I found on a parenting forum yesterday:

‘My midwife told me about a woman giving birth. She didn’t speak English and communicating with her was hard. She was fully dilated but was terrified of pushing. So she didn’t. For the longest time the midwives just tried talking to her encouraging her to push. She didn’t. This went on for quite some time (not exactly sure how long) until the woman needed to cough. And with that cough the baby’s head came out.’

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~ by Kedi Simpson on June 14, 2011.

One Response to “To push not to push”

  1. I have shouted until I am purple at OBEM and especially where they are telling a woman to push! Ah well we’ll just keep on gently promoting natural physioLOGICAL birth…

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