What if we stopped telling women to push when they’re in labor? That’s what a new program at a U.K. hospital has decided to do, and the results might surprise you.
If you’ve ever seen a woman delivering a baby in a movie or a television show, you have heard the rallying cry: “Push!” If you’ve had a baby yourself, you’ve likely heard it, too. After all, after ten months of pregnancy (we all know it isn’t actually nine) and surviving the last, what feels like, 1,795 days of pregnancy, we all just want that baby out as fast as possible.
But pushing might not be the best thing for laboring moms. Studies show that pushing can increase the likelihood of tears, can put the baby at risk, and put the mother at risk
In fact, the United Kingdom is way ahead of the United States. In 2014, the Royal College of Obstetricians and Gynecologists (RCOG) and the Royal College of Midwives in the UK put out a call for action after seeing a sharp rise in severe perineal tearing affecting nearly 14,000 women in 2013 to 2014. In addition, staff at Medway Maritime Hospital in Kent initiated a project to stop telling women to push.
Over a 12-month period after the program was implemented, the incidence of women with severe tearing went down from 7 percent to 1 percent. How have they gotten such amazing results? Largely, simply by not asking women to push when they are in labor.
Midwives were also discouraged from pulling a baby out once their shoulders emerged and instead supporting the baby’s weight as it emerges, all of which reduces pressure on the perineum. Holding a hand against the perineum while the baby crowns and is born also provides important counter-pressure and support for the perineum.
Doctors say there are several reasons, besides tearing, that women should not force pushing during labor. Women are also encouraged to slow down during labor, and nurses coach them to breathe through contractions instead of pushing. Some of the reasons include:
- The cervix is actually incomplete- it isn’t until 10 centimeters that the baby is ready to descend through the cervix
- It allows the doctors to massage the perineum, decreasing the likelihood of tears
- It gives mom a break, and allows her to recuperate which can help the process of labor
- Stopping active pushing can allow the doctor to check for cord entanglement around the baby’s neck
- It helps the midwife or doctor to gently guide the baby out once they have crowned versus being forced out, which can cause shoulder dystocia
Guidelines also discourage women from staying on their backs in labor — they are encouraged to try alternate positions. Changing positions during labor can help slow down pushing, allow breathing through contractions, and allow actual pushes to become more effective. Some alternative positions for labor include:
- Kneeling upright
- On hands and knees
- Using a birth seat
- Water birth
- Supine reclined
Research shows that giving birth in an alternative position versus their back can help a mother through labor as well as give a more positive birthing experience. In upright positions, gravity helps to push the baby down, allowing mom to have more effective pushes. There is also more oxygen flowing to both the mom and the baby, and the uterus is able to contract more strongly. In fact, in 2017 research has found that for those moms who labor in upright positions, they have a 25% less chance of an episiotomy, a 25% less chance of a forceps or vacuum-assisted birth, and 54% less likely to have a tear.
The program has been so successful in the United Kingdom that the results were published in the European Journal Of Obstetrics & Gynaecology And Reproductive Biology, and they have since rolled out nationally. This project is affectionately called the STOMP project, or the Stop Traumatic Oasis Morbidity Project, seeks to minimize the occurrence of childbirth-induced vaginal tears. Their 2014 study has continued to make waves in the birthing world in Europe, even 5 years later, with the hopes that the same idea will take shape for moms all across the world. It has helped moms minimize tears and c-sections, and helped them to have a more pleasant birthing experience overall.
Research has consistently shown that birth experiences for mothers is important. A traumatic birth experience can cause post-traumatic stress disorder and increases the likelihood of postpartum depression, anxiety, and/or psychosis significantly. In fact, researchers in 2013 found that mothers who experienced a traumatic birthing experience had a significant impact on their health, their continuing roles, their decision-making abilities, bonding wit the child, relationship with the husband, and psychological inability to have another child.
Both the idea of “less is more” when it comes to pushing as well as the giving moms alternative birthing positions to help make pushes more effective and controlled in order to provide a positive birthing experience are not something new to those in the labor and delivery fields. Midwives and obstetrical care providers may not be surprised by this information, but it’s great news for women everywhere that these methods are finally getting formal recognition as the better, safer way for women to labor.