Input from Midwives/Doulas Wanted

[StacieM]

Warning: this is long

I've done 5 births with no epi. My most recent I did with an epi.

My biggest fear is not pushing the baby out. That's the "easy" part. I also handle from 0cm to 7cm rather well.

It's after that - transition, when I feels so much like pushing and everyone is telling me not too. When I was 19 & having my first they told me do NOT push until they say because I could hemorrhage. Scary thing to hear. Hard as heck not to push when you so much feel like it.

But I've seen cases where providers told moms it was okay to push at 9cm if they felt that urge.

With #3 they told me I was 9cm with a little lip of cervix (bulging bag). I had seen other moms push at 9cm so when I felt the push, I didn't stop it. I let my body do it.

I felt baby go from "floating" to crowning in one contraction (they had said she was still not engaged when they broke my water at 9cm). She was born on the next contraction - no tears, very smooth delivery.

My #4 - I wasn't at 10cm. Dr wasn't there yet. They were trying to get me to wait for dr (he's only 5 minutes away). That's only like 2 contrx. I figured I could handle it. Then 3 strong ones in a row hit. My water broke and again baby moved right down to crowning.

#5 - things didn't happen quite as quickly when I got to the hospital. I was at 7cm. My contrx where pretty spaces out (5-7 min apart). I was glad. I used the opp to rest.

Next time dr checked me I was 8cm - I told him to leave my water alone. He didn't he broke it and of course, contrx got more intense and closer.

They asked me to let them check me. I didn't move - told them not yet.

Then when I felt pushing contrx I could not deny - again, I didn't try to stop it, just said "Pushing" and nurse and dr jumped up saying, "Wait, wait! Let us check."

Very quick check and they said okay go ahead and push.

For whatever reason I was so out of control during that delivery. I think baby may have been face up. I could not bring my knees up like I normally did before. I kept arching my back. I couldn't take deep breaths. She didn't crown on one contrx like rest. I was seriously about to yell, "Get this baby out" when I felt her head deliver.

But after feeling so out of control on that delivery and after hearing my dr say that my uterus is getting older and probably not as efficient as before, I lost confidence.

The thought of that transition period when they tell me not to push made me so anxious. Throughout my most recent pregnancy I tried practicing my breathing, doing positive visualizations and I always just felt fear and anxiety. Thus my decision to get an epi. I just did not feel in the right frame of mind to safely birth baby that time.

Even now as I think of this baby I'm having those feelings of anxiety surrounding delivery. It's not the contrx that scare me, it's not the actual delivery I worry about. It's that part right before that when my body starts saying to push and they say I'm not ready yet that scares me.

Sorry this is so long - my question is, is it really necessary for me to wait until 10 if I feel a strong pushy contraction? Or is it okay to let that happen once I hit 9cm?

I so much want to go without epi again, but I have this fear of transition. Is it a valid fear?

Or has my dr made me scared of something I don't need to be scared of.

I do feel "pressure" around 7-8 (and more intensity/pain but the pain I can handle). I feel most strong urge to push more around 9cm. For me 8-9 doesn't seem to take very long. I can usually breathe through 3-5 tough contrx from 8-9. Just want input on if I'm afraid of something I don't need to be afraid of - letting my body push at 9cm.

Thanks for reading this far. Your input is appreciated.

[BirthFree]

Gloria Lemay has a great article about second stage (pushing/delivery) that I would suggest you Google. There are varying degrees of thought on the physiology of labor/birth, but mine is that except for the rare, if you feel that overwhelming urge AND you feel progress with your push, you don't need permission except from your body. Epidurals remove the natural ejection reflex babies have in delivery (they help push themselves out by using their feet against the top of your uterus when it clamps down, that reflex they have to push off ground as newborns if you touch their feet to it). Your muscles get older, with age, but it's not inefficient. With good nutrition you should have no trouble with pushing, and if you are worried I suggest NOT doing an epi since it makes your muscles less in tune and baby unable to help. It sounds like your provider has planted seeds of doubt (for shame!), but that your body knows just what to do. Hugs!

If you are inclined, it would not harm you to go through positive visualization/reinforcement about what you fear... and tell your support system, they can help you to see baby sliding down and out with power.

[Brisen]

I agree -- if you're feeling super pushy and your pushing is making progress, go for it.  I've heard that pushing against a cervix that isn't fully dilated can cause swelling, but I think that generally happens when the woman is being directed to push when she doesn't feel like it (either just not feeling an urge or she has an epi).  Since I've had fast births before & tearing, I was advised to do as little pushing as possible, to slow down the birth, but I was never told not to push at all when I was feeling like it.

My births have all gone pretty smoothly, but transition is still scary.  That's one of the hallmarks of transition, how you know you're in it -- things are overwhelming and you think you can't do it any more.  I'm not trying to minimize your fears or worries; as for it being a valid fear, well, I think that women genuinely feel fear/worry/out of control during transition.  It's not that it's not real, but it is normal, and very often part of the birth process.  I know for me, when I start feeling that way, it's kind of a relief, because I know that pushing and the baby are coming pretty soon.  But it still feels overwhelming.

I don't know exactly where in my dilation I feel these things, but the contractions close to transition are similar to what you're describing -- a LOT of pressure, more pain, but I can handle it.  Then when things are at their peak, I start feeling like I need to push.  Sometimes it starts out with less of a pushy feeling and more of a bearing down feeling; it seems to me like it might be my body using the baby's head pushing on the cervix to open it up the last bit.  I don't know.  But then I start feeling the urge for "real" pushes, ones that move the baby out.

Long story short -- I really think that in most cases if a woman is left alone and allowed to move in whatever way feels right, including pushing, when she wants, her body will do what it needs to do to help that baby out.

[lilkat]

I recently read an article in Midwifery Today about how if mom is feeling a strong urge to push, pushing before complete dilation is fine. Of course, now I can't find the article. But it basically says what Birthfree and Brisen said above. And I agree: trust your body and allow yourself to do what feels right. After 6 births, you know what to do!

Also, have you considered looking for a new care provider? I know not all women have a lot of options, depending on what is available locally, state regulations, insurance coverage issues, etc. But if your OB is not following your wishes (breaking your water when you explicitly said no) and undermining your confidence (by saying your uterus is not efficient), and the nursing staff makes you anxious (by yelling at you not to push when you feel the urge), you might want to look for someone who is more supportive of your needs.

[mamaprek]

Follow your body!  =)

[StacieM]

Thanks ladies.  I had also heard about the possibility of swelling your cervix shut, which just sounds terribly painful and was another thing I was worried about. 

I don't know why I didn't think of this before, but I did some googling after posting this and just cried reading some of the things I found.  I know now that my body has always done an amazing job of birthing my babies.  I really need to work on getting back into that frame of mind.

With the epi this last time, I could feel baby moving down with each contraction after a certain point.  Even with the epi, baby was not difficult to "push" out. 

I know transition is the most intense part.  Typically, if my water is in tact (which it has been for deliveries that weren't "interfered" with much) contractions are intense and I can tell it won't be much longer, but there really isn't that super crazy urge to push until my water breaks at which point, I seem to move to fully open very fast anyway. 

Yes, I have thought about changing providers.  I was actually all set to after that deliver where my provider broke my water after I specifically asked him not too.

But then I started bleeding with my next pg and he was the one who could get me back in the fastest after my ER visit, so I just stuck with him.

Again, I briefly thought about it for this time, but then also felt like just staying with what's "familiar."

After reading the stories I googled last night though, I'm definitely going to call the one midwife group that would allow me to deliver at the same facility.  I want to at least call them and ask a few questions as see if they'd be a better fit and if they'd be a provider that can help support my own belief in my body. 

Thanks again everyone!

[lilkat]

I'm glad you're finding some answers and some relief  with what you've found online. And I'm so happy you are starting to trust your body again. The midwife sounds like a good potential option; I hope it works out!