Pushing

1. I suppose coaching has to happen if the woman is medicated to the point that she cannot feel her contractions. Was your midwife a nurse with medical training, or a direct-entry midwife with traditional training? Sometimes (not always) the CNMs just do what is standard medical practice, just like an OB managed birth.

2. Yes, MDs coach pushing when it is their practice to, or when medication is involved. My homebirth midwife did no coaching whatsoever. From what I know, midwives who take a traditional approach do not coach pushing.

3. Pushing with an urge should be fine. Pushing without is not so good nor is excessive time spent pushing. Aza, what is a "good" range? 3.5 hours sounds long to me, but I don't know . . . I only pushed 45 minutes.

4. Your body will get that baby out of you without any help from you. Women who are unconscious or even paralyzed below the waist have vaginal births. In fact, there is such a thing as a "no push" birth-- you allow the power of your contractions to bring the baby. Looking into this for myself next time.

3.

There is a saying in ballet that a dancer can only be as good as her teacher. Same with birth professionals, I think. Medical or traditional, it is a passing down of information and the professional will do exactly what he or she was taught. A lay midwife will coach if that is how she was taught, and a CNM might allow spontaneous pushing if that was her training. So I ask about training. My midwife trained at The Farm, and that gave me great insight into what kind of practioner she would be. Best wishes Carrie & thinking good thoughts for your future new addition :-)

I have had two natural, medication free birth, so I can only comment on my experience.

My prolapse occured after my first birth, and I had a straight forward birth so to speak, but I remember I was getting quite stressed and the nurse said that it was too late for pain relief flipped me over and told me to start pushing, so I did with each contraction, I think for around an hour.

After my prolapse and before my second birth I got onto this site and realised that I was most likely pushing far too earlier, so my second birth did not do any pushing until OMG!!!! I NEED TO PUSH!!!!!!!!! Feeling happened, my body just had to push, and amazing and total different feeling to the first, my body sort of took over. So I pushed in 3 goes baby born!!!

But I guess also my first was harder, being the first, it was a dry birth (my waters broke days before LOL I didn't know)

Oh, such very interesting questions for sure. I agree with bad_mirror on the differences between midwives. There really is a far-reaching continuum of types of midwifery, especially in the US. I would say that it is pretty simple - the more normal, non-drugged, non-augmented births a midwife has seen, the more they know about normal physiological pushing. Thus, the more out of hospital experience, the more experience with normal birth physiology. It is rare that obstetricians see this because they are, by definition, professionals who treat a variety of pathological conditions rather then supporting an inherent physiological process (which midwifery does, ideally). Sometimes, unfortunately, medically-oriented midwives fall into the same paradigm as the obstetrical / medical model.

I think true midwifery comes from learning from the women, not fellow midwives. It has taken me a decade to realise this and my life/work is better for it beyond measure.

I also agree with bad_mirror that the amount of drugs a woman is on will have direct repercussions on how much 'coaching' she may need to work with the now-silenced primal urges in her body to expel her baby (i.e. fetal ejection reflex).

There is a huge difference between forced pushing to fit into some preconceived idea of how and when a baby should be born and under very distressing conditions (can you possibly imagine pooing in a room full of total strangers who are all telling you how to do it correctly?!) and the incredibly profound stirrings of a uterus that is beginning to 'throw down' as I call it...and this stirring building over an hour or so....no urge to push, just a subtle shift of labouring to open the cervix to the motions of nudging your baby down and out...then to the unmistakeable fire in the eyes, hyper-alert awareness of a woman who is doing the most primal thing on the planet...pushing out her baby.

Some women push with intensity, and how they do this while also feeling like they are splitting in two still blows my mind. Other women can hardly keep up with the involuntary pushing their body is doing and they have to put their head to the ground and bum up in the air to lessen the bulldozing force that is happening without their help (this head down urge is not easy in a pool ;) Most often, it is somewhere in between...it slowly builds, it ebbs and flows, it might take minutes or it might take hours. Most often if it takes hours and hours, it does so because there are amazing rests in between (there is nothing like a woman snoring in between pushing contractions). This sort of a situation is very different to a drugged woman with medications affecting the baby and poor positioning and the whole spiral that leads to true fetal distress. This is why the medical world has put timelines on childbirth...they have created conditions in which timeframes are sometimes a good idea. I have seen 2nd stage take hours and hours...not because a woman is forcefully pushing with all her might, being told what to do by other people, but because it simply takes time for a baby to negotiate through the pelvis and find the path of least resistance and the bpnes to mould and maybe move back up a little to get the head into a better position....it really is not rocket science.

I have no idea if that answered your questions but I am incredibly sleep deprived yet very high from a recent birth where - you guessed it - the woman needed no instruction for me on how to birth her baby, she just needed eyes of confidence and hands to hold.

Thanks for starting this most important topic, Carrie...

go with your urges :)
I had a horrible coached pushing experience with my first birth- was told to push- was asked * do you want to do this all day* and when mentioned that women who have paralysis don't push I was told to *get over that*

anyway, long story short- I finally had an urge and pushed as I wanted to and ripped right open- darn.
for my next birth I only pushed when I couldn't stop myself- which was about 3 times
third birth- one push for the head, one for the shoulders and he was out.
but for that birth, about 2 hours before the baby was transverse- I went into the bathroom and sat on the toilet and pushed and pushed as he moved into position (about 5 min)- I thought he might be born right then- but nope I had two more very comfortable restful hours and then just the two pushes

my 4th birth the baby was not in a good position. everything felt wrong to me- the sensations were unbearable - so I tried pushing- and it felt so so good. So I just pushed, contraction or not for about 20 min.
I need to send my birth story in.
but it felt really necessary. and good. and I felt guided to do it.
and this was the birth I had done all the research for a no push birth

so ya, just go with it. tune in to your baby and your body and just go with it.

Hi Alemana,

On your third child, when the baby was transverse, did you push on your tummy with your hands to get the baby in position, or did you bear down?

I could feel him moving
not the wiggle kind of move
but this really intense, crazy intense moving and it made me grunt and bear down- I couldn't stop myself :)
so no I didn't do external version- he was moving all on his own. I just went with it.

"They told me the urge to push feels like the pressure of having to have a bowel movement"
Not really...this is only an indication that the next sensation will probably be the subtle throwing down feeling and then eventually an involuntary pushing urge (or not, sometimes women do not have to put any push behind what their body is already doing, i.e. coma woman whose body births a baby).

I think another important thing to think about is the primal physiology of pushing and the interplay of oxytocin and adrenaline and the flight or fight response. This is why who you are surrounded by in birth and the environment in which you decide to birth is so important. Ina May Gaskin's idea about the Law of Sphincters is so logical, and Sarah Buckley has done incredible work in the form of 'Gentle Birth, Gentle Mothering'.

Carrie, back in a previous life before I knew better, I have been the person to check a woman, feel no cervix, and tell her it is ok to push. It was not infrequent that if she began pushing without a strong urge (i.e. going with the pressure in bum feeling, not true pushing urges) a little bit of cervix would be caught between the baby's head and the pubic bone and begin to swell. (Or, after artificially breaking the waters, the change of pressure on the cervix can muck things up as well). This was not a fault of her body, it was the fault of her care-provider for trying to lead the course of events. Never a good idea in 2nd stage, generally speaking! I know better now and refuse to work under a regulatory system that would force me to do otherwise.

Something else that I have grown to believe very strongly is that 2nd stage is also directly related to not only what is needed on a physical level (pelvis opening, tissues stretching, baby's head moulding) but also very closely tied to how the baby needs to experience the final part of labour in relation to oxygenation. It is simple fact - statistics and anecdotes show time and time again that a woman who is directed to push will often end up with a baby in distress. It makes total sense to me, and I have seen this in actuality, that there is an interplay between the baby and mother that helps to keep the baby's oxygenation at an optimal level. This results in the type of labour a woman will have, in particular pushing. The number of times a baby has come out totally tangled in the cord after a really bizarre labour / pushing pattern and the light bulb goes off that this was the coping mechanism of maternal / fetal physiology...it is very telling. No doubt in my mind that coached pushing, arbitrary time lines, and protocols based on black and white rules rather than individual situations are very dangerous to women and babies.

I think aza is onto something
the 'when to push/how to push' probably works best when the mother can follow her urges, which are likely related to what the baby needs.
this just feels 'true' to me
my first, was your typical medical delivery. I was given an epidural during transition (told I couldn't birth a baby if I was screaming like that), legs up in those godawful stirrups, numb, and told to push like I was having a bowel movement (how on earth did we find ourselves comparing babies to poo??)
second, was a faster delivery, in a hospital with mw. told to push as soon as I was fully dilated but wound up with that bit of cervix that got caught and swelled up. nice. then told NOT to push for over an hr. not so nice. finally, mw got her hand up there and held the cervical lip open and was told to push while the godawful ob pushed down on my stomach.
third time I got smart and had a hb. pushed when I wanted too but on a birthing stool in full squat (do not recommend, by the way)
fourth time, already knew about the prolapse and had looked into the 'no push' birth. that was an awesome delivery. mw didn't make it in time, my doula was encouraging me to push because she was nervous and just wanted the baby out and breathing asap but I was in total control and really, my baby orchestrated the whole thing. I could tell that my uterus was pushing in response to him moving and not the other way around. it was INCREDIBLE. huge contraction and out came his head, then what seemed like a few minutes before another huge contraction and his shoulders and then he wriggled out. SO COOL
I wanted a repeat performance for number five, but she bulldozed her way outta me like aza said, I had my head on the floor and bum in the air and could not help but push with her and OMG did that one hurt, but out she flew in under 10 min.

so I think, just be ready to go with whatever. you will know how if you trust your baby and your body, and of course the people around you trust too.

haha, great stories gmom!

Carrie, it is SO common for a baby to be born with a cord around the neck (1 in 5 comes to mind but don't quote me on that). It is so often trotted out as a big scary thing, but it rarely poses a problem. Severe cord entanglement can of course be troublesome (or perhaps not, ask alemama, she has a fantastic story to share ;) ) but generally speaking cord around the neck is not a huge deal. Remember, a baby is not breathing yet, so it is NOT like they are going to strangle. The vessels in the cord are protected by an amazingly thick substance called wharton's jelly that protects the blood flow.
It is very rare for a nuchal cord to be so tight that it needs to be cut when the head is born to allow for the rest of the body to be born (which sounds like what happened with you?), and actually, this is very dangerous practice as the lifeline to the baby has now been cut off. Most times the baby will just birth with the cord wrapped or it can be somersaulted through the cord.
Anyway, back to pushing and our regularly scheduled programming....

hey, im a bit of a newbie here. really interesting disscussion going on here, i had nver heard of 'no push' birthing, but didnt actively push my second baby into the world, i was just so blissed out(all natural,no drug home water birth)and relaxed,i didnt want to push as such, just breathed while my body expelled my baby,who was wriggling out like a slippy fish(something i missed during my first birth,while furiously pushing)
seems to me that there are two types of pushing, the active pushing that midwives like to liken to having a big poo, and the involuntary pushing of the body. i know i couldnt stop the way my baby was coming down and out second time round, i wasnt 'doing' anything,just relaxing...maybee if i was push push pushing it would hav been harder?
makes sense to me that allowing the body to birth is more gentle on the pelvic floor than pushing,which in my experience is stressfull and hurts(because of tension i think)
i told my midwife outright when she arrived at my home, the last thing i need is you shouting PUSH at me!!!!