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"Premature" urge to push? Update post 46 - Page 3

post #41 of 49
Jen, I have a post saved from MidwifeStephPDX with some evidence on this issue. There are a wide range of dates with the most current being 2007 - http://www.mothering.com/discussions...2&postcount=24

Quote:
Here is the list of resources supporting the position that women pushing with an uncontrollable urge do not have increased rates of cervical injury, slow descent, maternal exhaustion, or fetal distress:

McKay S, Roberts J. Second stage labor: what is normal? Journal of Obstetric Gynecologic and Neonatal Nursing. 1985;14(2):101-6.

Roberts JE, Goldstein SA, Gruener JS, Maggio M, Mendez-Bauer C. A descriptive analysis of involuntary bearing down efforts during the expulsive phase of labor. Journal of Obstetric Gynecologic and Neonatal Nursing. 1987; 16(1): 48-55.

Aderhold KJ, Roberts JE. Phases of second stage labor: Four descriptive case studies. Journal of Nurse-Midwifery. 1991; 36(5): 267-275.

Cosner KR, deJong E. Physiologic second stage labor. American Journal of Maternal and Child Nursing. 1993; 18: 38-43.

Thomson AM. Maternal behaviour during spontaneous and directed pushing in the second stage of labour. Journal of Advanced Nursing. 1995; 22(6):1027-34.

Roberts J, Woolley D. A second look at the second stage of labor. Journal of Obstetric Gynecologic and Neonatal Nursing. 1996; 25(5): 415-23.

Roberts J, Hanson L. Best practices in second stage labor care: maternal bearing down and positioning. Journal of Midwifery & Womens Health. 2007; 52(3):238-45.

Roberts, JE. The “push” for evidence: management of the second stage. Journal of Midwifery and Women’s Heath. 2002; 47(1): 2-15.

Petersen L, Besuner P. Pushing techniques during labor: Issues and controversies. Journal of Obstetric Gynecologic and Neonatal Nursing. 1997; 26(6): 719:726.
HTH!
post #42 of 49
Quote:
Originally Posted by savithny View Post
I'm not saying that *everyone* *must* wait, by far. Women are not machines and labor is not a checklist, obviously. Every body is different.

But the assumption that if our body is telling us to do something it *must* be correct and beneficial is a dangerous one and is frankly wrong. Our bodies have a lot of reflexes and responses that are at best value-neutral and at worst *can* be damaging, and to say that ignoring the demands of our bodies is somehow always a bad idea is potentially dangerous.

I might have an overwhelming urge to scratch at a chigger bite. Does this mean it is beneficial to scratch? Does this mean if I scratch that bite until becomes a big open wound, that is what my body needs or wants? No. The urge to scratch comes from a reaction of my nervous system, but has no higher-order meaning or message about my body's destiny or the best way to accomplish a goal. It just *is,
I agree that it's not good to use terms like "must" but I do believe that the overwhelming majority of women in natural labor will not have their body telling them to do something wrong. I believe this because I believe that birth works most of the time for low risk women. Not 100% of the time, but the vast majority of the time. I think we do more harm by trying to prevent all women from pushing when they feel the urge "prematurely", before 10cm.

Chigger bites are not normal bodily functions. Chigger bites are a problem, an invader. Birth itself is normal, not a problem.

There are no absolutes but I believe it does more harm than good to check dilation in all women and use that as a criterion for when not to push. I think that's better reserved for when there are signs that there might be some kind of problem.
post #43 of 49
Thread Starter 
Quote:
Originally Posted by savithny View Post
I'm not saying that *everyone* *must* wait, by far. Women are not machines and labor is not a checklist, obviously. Every body is different.

But the assumption that if our body is telling us to do something it *must* be correct and beneficial is a dangerous one and is frankly wrong. Our bodies have a lot of reflexes and responses that are at best value-neutral and at worst *can* be damaging, and to say that ignoring the demands of our bodies is somehow always a bad idea is potentially dangerous.

I might have an overwhelming urge to scratch at a chigger bite. Does this mean it is beneficial to scratch? Does this mean if I scratch that bite until becomes a big open wound, that is what my body needs or wants? No. The urge to scratch comes from a reaction of my nervous system, but has no higher-order meaning or message about my body's destiny or the best way to accomplish a goal. It just *is,
For sure, I hear you that our bodily functions and urges are not some cosmic message, and that they may be value neutral. But many urges are not value neutral -- hunger means we need to eat, thirst means we need to drink, lust means we need to perpetuate the species, fear means we needed to escape the cave lion, and so on. They're not urges, they're biological imperatives -- commands rather than requests -- and if we ignore them, we get bad outcomes.
I hear you saying that the urge to push is just triggered by certain nerves being pushed by the baby's position, and that it's value-neutral. I'm saying that I think it's entirely possible that it's not value neutral -- that maybe the pushing urge is more like hunger or thirst than it is like scratching a chigger bite. Childbirth is a natural process, a chigger bite is an injury, an anomaly. While birth can break down and problems can arise, it seems like in general, during labor, a woman's body does do a fairly good job of guiding her through the childbirth process. That's just evolution. Look at the amazingly complex interplay of hormones and chemicals and physical urges that make up childbirth, which evolved over millions of years and millions of species.
If a woman feels an overwhelming imperative to push, it's a lot more reasonable to assume that pushing is the correct thing to do rather than assuming that she shouldn't push.
The main thing, though, is this: if a medical provider wants to use an intervention, I believe the medical provider has the burden of proof to show that the intervention is needed. And I am still waiting to hear anyone indicate that you get better outcomes resisting the urge to push.

Quote:
Originally Posted by me&3 View Post
I didn't have the urge to push for my first two, because of the epidurals I received. With my third, a homebirth, I wasn't sure what to expect, and at some point I was just really tired and wanted to get the show on the road and asked the midwife if I could start pushing. She said, sure, why not? I believe I was probably 9 cm, but I don't exactly recall. Long story short, my cervix *DID* swell, and it prolonged the labor. In the end, the midwife had to manually hold back my cervix - - can we say painful??? I'm sorry I didn't wait until feeling an urge, and will definitely not try to do that this time!
I think this is an interesting counterpoint -- pushing when you're not feeling the urge to push can be as damaging as not pushing when you do feel the urge to push. The women on this thread who resisted the urge to push have mentioned that that actually caused their cervix to swell, and pushing without the urge can also cause swelling, while the women who pushed through it are saying they didn't swell.
post #44 of 49
Thread Starter 
Quote:
Originally Posted by erin_brycesmom View Post
I agree that it's not good to use terms like "must" but I do believe that the overwhelming majority of women in natural labor will not have their body telling them to do something wrong. I believe this because I believe that birth works most of the time for low risk women. Not 100% of the time, but the vast majority of the time. I think we do more harm by trying to prevent all women from pushing when they feel the urge "prematurely", before 10cm.

Chigger bites are not normal bodily functions. Chigger bites are a problem, an invader. Birth itself is normal, not a problem.

There are no absolutes but I believe it does more harm than good to check dilation in all women and use that as a criterion for when not to push. I think that's better reserved for when there are signs that there might be some kind of problem.
Cross posted, but yeah, I totally agree, and thanks for the links. I'm excited to check them out.
post #45 of 49
Quote:
Originally Posted by *MamaJen* View Post
I wonder, in that situation, what would have happened if she had not resisted the pushing urge and continued to bear down? Would she have swollen to the point of not being able to push the baby out, or would it have been fine?
Well, she went from 4 to 7 (controllable urge), then 7 to a REALLY swollen 4 (uncontrollable urge), to a swollen 7 (lots of positions and 'blowing away the feather'), a less swollen 8 (same stuff), a less swollen 9 (more of the same).. then pushed baby down and cervix away.

OTOH, I always started the urge to push at between 8 and 9cm. It wasn't any big deal as I just followed my body's urge and pushed the cervix away and baby was out within a matter of contractions.

Back on the original topic - I would like to see better studies too... I have seen women w premature urges and nothing went amiss... other times, I have seen less-than-ideal occurrences manifest...
post #46 of 49
Thread Starter 
I posted a version of this question on Henci Goer's forum, and she wrote back with a really great and thoughtful reply.

http://www.lamaze.org/OnlineCommunit...c/Default.aspx
post #47 of 49
That's great! Thanks Jen.
post #48 of 49
Quote:
Originally Posted by *MamaJen* View Post
While birth can break down and problems can arise, it seems like in general, during labor, a woman's body does do a fairly good job of guiding her through the childbirth process. That's just evolution. Look at the amazingly complex interplay of hormones and chemicals and physical urges that make up childbirth, which evolved over millions of years and millions of species.
as a biologist i want to address the issue of evolution.

because evolution is a PROCESS that is occurring every day it means that your instincts could very well be telling you to do something that is harmful. when evolution is held up as if where we are today is _the_ final product then assumptions are made that are not correct.

it is quite possible that pushing before full dilation is detrimental to our species BUT if it's not detrimental enough to stop us from reproducing then the trait/instinct is likely to be passed to the next generation. if pushing before dilation doesn't equal maternal death each and every time it happens then it the trait isn't selected against strongly. out here, lots of jack rabbits die from running in front of cars on the highway- that has been STRONGLY selected against for the last, maybe 50, generations of rabbits and the trait is still present to run toward the lights.

to really compare you would need to compare the outcomes of women with malpositioned babies that did and did not feel the urge to push early. how many women lost (or would have lost) their lives or their babies lives without intervention? perhaps it's neither beneficial nor deleterious but just looking at women that felt the urge and had positive outcomes doesn't really benefit the argument.

i'm not for or against your hypothesis but i do like scientific clarity and it bugs me when folks think that because we do something it must necessarily be a survival adaptation that benefits the species.
post #49 of 49
Thanks, PlayaMama!
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