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10 hours of pushing. Yes, I said pushing. Anyone else have very prolonged 2nd stage??

post #1 of 26
Thread Starter 

So - to preface, I posted my birth story on another site... and have not yet found a similar story. Pretty much I have gotten a lot of incredulity, and several people told me I am very lucky to have gotten a positive outcome. I am posting here because I thought I may find more opinions from natural minded mamas/midwives/care providers. Any similar stories? Should we have transferred, and at what point?? headscratch.gif

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This is going to be long, but I really want to get this off my chest and see if anyone else has faced something similar, and find out what things were like the next go round for others...

I had my first baby at home with my wonderful midwife in September.

I spent 12 hours in active labor from midnight on (birth pool = awesome) before I got to the pushing stage. Everything was going great and we all thought I'd have my peanut within an hour or two. Lo's vitals were great, positioning was perfect, and I was feeling pretty good. I'm a very athletic person and I was blessed with an easy pregnancy, so all signs pointed to a textbook delivery. After all, everyone knows the pushing stage means the end is in sight!

And then... I started pushing (following my urges). And kept pushing. And kept PUSHING! It was so immensely frustrating, you have no idea.

After about two hours I think my pushing contractions began to get a little erratic, so we started trying things to speed them up. I had been pushing in a standing position by our bed, so my DH and midwife coaxed me into moving around. (BTW, much easier even during transition than during pushing!) Pacing, up and down stairs, DH helping me rotate my hips, on hands and knees, directed pushing on bed, in shower, on toilet. Nipple stimulation to encourage contractions... just craziness. After about 6 hours of pushing (and no sleep the night before) - I was exhausted. And I mean bone weary, and discouraged - because baby was still so high I couldn't even feel the head by reaching in as far as I could with my fingers. At this point I was starting to feel afraid that I would have to go to the hospital, and I was no longer thinking very clearly. I told my midwife I did not want to go, but DH and midwife basically told me if things didn't change within an hour I was going. They called up the hospital and gave them a heads up... things looked bleak from my POV.

But I am a stubborn, determined person and I was not finished yet. My midwife told me I had no chance of delivering the baby at home unless I could regain some energy. So, I ate the most nauseating meal I have ever had in my life. A huge bowl of chicken soup with a slice of buttered bread, and as many tablespoons of honey as they could get in me. Gag (I had already thrown up twice, and was praying I could keep it down). I forced myself to eat every bite, while I held onto the table through pushes. Then back into the shower for more nipple stimulation, and out again for stair pacing. Within an hour the change was amazing, the food hit my system, pushing picked up - and suddenly baby dropped. I could feel her head!!

By this point I had been pushing for over 8.5 hours, and it was taking a toll. Pushes were coming hard and fast again, and I couldn't seem to keep up. So I laid on the bed to slow things down with DH supporting me from behind, which helped tons (love, love that man!). The last place I thought I'd have my baby was on the bed, on my back, with DH helping me pull my knees back - but that is where she was born because once she began crowning (took an hour of crowning) I could no longer move. Her shoulders got stuck at the end a bit, and had a second degree tear, but she was born! At home! Naturally!! After 12 hours of active labor, and 10.5 hours of pushing at 10:30 PM, a beautiful 8lb 4oz baby girl! Amazingly, with almost no moulding, and no bruising at all.
joy.gif


It was all a bit of a traumatic experience for me to be perfectly honest, even though I feel blessed that I was able to have her at home. I never expected things to go the way they did. My midwife said that in 400 births, she had only once seen another similar to mine. No clear indications as to why it took so long to push (no apparent malpositioning, fit mother, etc.), but it did. She told me I should be proud of myself for persevering through it all, but really... I'm just praying that if I have another it will be faster. And easier. Apparently my vaginal muscles were spasming when I pushed, so my body was kind of fighting the baby coming down for at least the last part of labor. My midwife suggested I may want to see a physical therapist before I have another to see if they have any suggestions...

So long story short, has anyone else had anything similar happen?? Had an extended pushing phase? Had another baby after with more normal pushing phase?

(BTW, keep in mind we were constantly checking baby's vitals the whole time and she never showed any signs of distress. If she had, I would have gone to the hospital in a heartbeat.)

post #2 of 26

Wow, my 2 1/2 hours seemed frustrating enough, I can't imagine 10!  I do have a friend who had an 8 hour pushing stage during her homebirth.  Hers was due to a really stubborn cervical lip, that wasn't discovered for the first while.  Like you, babe's vitals checked out just fine the whole time.  She just had her second, a 9 lb-er, with a much more normal pushing stage.  I can't remember exactly how long, but I think it was maybe 45 min?

post #3 of 26

Wow!  That is some determination you have!  I have a friend who pushed for at least that long for her second, an hbac.  Her first was a hb transfer.

 

I pushed for 3 hours with both labors and ended in c/s because babies vitals were NOT good.
 

Our midwife said that sometimes it's just the shape of the pelvis that causes the baby to have a hard time coming down.

post #4 of 26

wow, thats impressive! i hated pushing in my births so 10 hours sounds so difficult and exhausting. Congrats to you for sticking to it. I'm sure I would have begged for the hospital before 10 hours. My last baby took 4 hours of pushing (and only 2 hours of labor before that!) and that was sure tough. I had a stubborn lip and my midwife had to hold it back while I pushed his head past it. It took a LONG time for that to be successful. We think the lip was caused by his nuchal arm. He also had no molding on his ginormous 15 inch head. He was 11lbs. I don't think it was his size and big head that took forever, I think it was his elbow sticking out like a chicken wing! lol. His shoulders got sort of stuck, since his arm was in a weird position, but not shoulder dystocia. His shoulders rotated the way they're supposed to after the head was out, it just took my midwife extracting his arm and then he came out easily. So not quite like yours, since I know why it took so long..and it didn't take even half as long as yours! 

post #5 of 26

not 10 hours, but it was four.. and horrendous. no drugs, just a bit of gas.

 

good grief, how did you do it for TEN hours?!

 

with my first labor, start to transition was 1 hour and pushing was 4. dc had to be suctioned out because the vitals were not good and the doctors/nurses kept saying between themselves i looked awful/completely exhausted (dh later tells me). it was 'suction now' or emergency ceaser if the first attempt failed. from when they chose to suction to when dc came out was only 2-3 minutes long, but it felt like an eternity.

 

Quote:
Apparently my vaginal muscles were spasming when I pushed, so my body was kind of fighting the baby coming down for at least the last part of labor.

 

maybe, maybe not.. you could have anatomical defects that also make pushing almost impossible. following my first birth, the doctor found the reason for my long second stage - i had some sort of extra skin internally (sorry, can't remember all the details) that was acting as a rubber band. i'd push dc out and dc would get pushed back in by the extra skin. he cut it off during stitching (i also had a 2nd degree tear) and well, all i can say that is that for my next labor (dc#2), we didn't even make it to the hospital - the labor was under an 1 hour! my 3rd labor was 2 hours, the 4th labor (my dc who is 8 weeks old) was 1.25 hours. pushing for all 3 was between 5-15 minutes. so the doctor at my first birth obviously solved the issue at hand.

 

don't fret for future labors - the fact that stage 1 labor was very quick is a great sign. prolonged pushing is usually caused by a problem (that can hopefully be resolved).

 

Congrats on your baby!

post #6 of 26

re; transferring... i also think you're lucky to have had a good outcome and i'm as 'natural minded' as they come.

 

i know if i had chosen a homebirth, my dc would not have made it. it takes 15 minutes alone to make it to the hospital (5-7 mins by emergency ambulance) and that coupled with actually making it in there and prepping for an emergency ceaser, is long enough to permanently disable or kill a babe who is already being deprived of oxygen due to a difficult labor. i had several doctors, nurses and 1 NICU paed in the room with me, just waiting. when i think about it, even though it's been several years, i *still* tear up at the thought of it all. i later found out that sadly, they were expecting a near-death or stillborn baby, hence the team of medical professionals in the room.

 

i should ask the question though - were the baby's vitals good during the entire ordeal? because if they were, then theoretically, is a more of a nuisance for the mother than a danger for the baby. in my case, my dc was not doing well at all. i'm very thankful that we too had a good outcome.

post #7 of 26
Quote:
Originally Posted by LoveOurBabies View Post

re; transferring... i also think you're lucky to have had a good outcome and i'm as 'natural minded' as they come.

 

i know if i had chosen a homebirth, my dc would not have made it. it takes 15 minutes alone to make it to the hospital (5-7 mins by emergency ambulance) and that coupled with actually making it in there and prepping for an emergency ceaser, is long enough to permanently disable or kill a babe who is already being deprived of oxygen due to a difficult labor.

 

A lot of what we talk about in the HB community is the length of time it takes to prep an ER for surgery. Many women factor the amount of time it takes to prep the ER in with their transfer time to the hospital. With the mother educated or a well trained MW, I think the idea is that you would alert the hospital and the ER is prepped while the mother and child are on the way - making the wait for a surgery room similar to that of a hospital birth. Of course this is ideal and it doesn't always happen this way but I wanted to address that issue in your post. 

 

OP, I pushed for 4 hours with DC#1 with a hospital transfer after 2 hours (followed by a non-medicated, intervention free (despite the threats!) hospital birth) and then a 2 hour second stage for DD#2. I can not imagine pushing for 10 hours - you are a champion!!  

post #8 of 26
Quote:
Originally Posted by LoveOurBabies View Post

i should ask the question though - were the baby's vitals good during the entire ordeal? because if they were, then theoretically, is a more of a nuisance for the mother than a danger for the baby. in my case, my dc was not doing well at all. i'm very thankful that we too had a good outcome.

 


The last sentence of the OP says that babe's vitals were doing fine the whole time.  I don't think a long pushing phase alone is a problem worth transferring for.  Obviously, signs of baby in distress would be.

post #9 of 26

One of my best friends pushed for about that long, I think it was 8hrs, with her first baby (hospital birth).  She has since gone on to have 3 more children, 2 at home, and had "normal" pushing phases with the rest. 

post #10 of 26
Quote:
Originally Posted by LoveOurBabies View Post

not 10 hours, but it was four.. and horrendous. no drugs, just a bit of gas.

 

maybe, maybe not.. you could have anatomical defects that also make pushing almost impossible. following my first birth, the doctor found the reason for my long second stage - i had some sort of extra skin internally (sorry, can't remember all the details) that was acting as a rubber band. i'd push dc out and dc would get pushed back in by the extra skin. he cut it off during stitching (i also had a 2nd degree tear) and well, all i can say that is that for my next labor (dc#2), we didn't even make it to the hospital - the labor was under an 1 hour! my 3rd labor was 2 hours, the 4th labor (my dc who is 8 weeks old) was 1.25 hours. pushing for all 3 was between 5-15 minutes. so the doctor at my first birth obviously solved the issue at hand.

 

 

I had this same situation! Short active labor, then pushing forever and just couldn't get him out. We were at home but less than 1/4 mile from the hospital entrance. We transferred and I ended up with a 4th degree tear thanks to an episiotomy and forceps, but I'm not convinced they fixed my problem when they stitched me. I'm hoping to see a specialist before I get pregnant again to make sure that extra tissue is not likely to be a problem again, and if it is Im definitely willing to have surgery if it will allow me to have births like your subsequent ones!

post #11 of 26
Thread Starter 

Thank you, thank you for your stories and comments! hug2.gif I was starting to feel so down about my birth story. I was originally really proud of myself for persevering in the midst of an extremely challenging birth. I mean, I remember thinking at one point during labor that I knew why women asked for pain meds in hospitals, and knowing that if I was thinking that way I was probably in transition (sure enough within a half-hour I was fully dilated). That was nothing compared to several hours of pushing. I am not a martyr, but I did not want a CS or other intervention unless I really needed it - and I made it through a lot to have my baby at home. I am a confident home birthing mama, but after thread upon thread full of women telling me my midwife was irresponsible, and that I was endangering my child due to the prolonged pushing phase (despite excellent vitals)... it began to hit home! (And it was not a designated natural birth forum, so I do realize many of the posters were already disinclined to support HB... but still, it got to me.)

 

I even had one person who happened to be a student CNM tell me "not [to] take this "success" to be proof that you can birth at home without complication. 10 hours of pushing is ALWAYS a complication. ...Pushing for 10 hours is not a happy, positive thing. It's a frightening thing. With all due respect, this is something that you should really meditate on and if you decide to homebirth again, I would do it coming to terms with the fact that if you end up pushing for longer than 3 hours with this next baby, that you are okay with an adverse outcome for that pregnancy."

 

Excuse me, but who is "ok" with an adverse outcome for a pregnancy?! Who even says that! angry.gif

 

In any case, I will try for a home birth again next time. As many of you pointed out (thank you LoveOurBabies & clovergirl!), every birth is different and whatever happened the first time around may have been a fluke that will not reoccur. Plus, my first HB was successful! I have a lovely baby girl sleeping in the next room to show for it. love.gif

 

If anyone has anymore stories or opinions to share please do! I just want to make sure that if by some chance, it happens to me again, I am more prepared to make a decision on staying home (if baby's vitals remain good) to continue pushing, or transferring at some predetermined drop dead point. I am 15 minutes from our hospital (10 by ambulance), so I feel pretty confident that we could get to the hospital quickly if need be. (@IdentityCrisisMama - exactly!!)


Edited by kawaii - 5/23/12 at 9:52pm
post #12 of 26

First off - congrats!!!!! love.gif I have homebirths with all my children and they were all wonderful - however that doesn't mean that they were pain free and perfect. winky.gif

 

Secondly, the first thing that came to mind about your experience is something I have read many times over the years: some women are so deeply worried something terrible will happen to their body during pushing that they actually hold the baby back without trying to. The fear does not even have to be conscious. It happens to very fit moms (who ironically tend to have longer labors and more painful labors due to muscles being tight and built, instead of soft and relaxed), unfit moms, first timers, multi-paras, in short, it can happen to anyone.

 

As an anecdote I offer my experience with my youngest baby, he is 22 months old. I apologize if my short story seems garbled - I claim pregnancy brain here! Anyway, the whole pregnancy I kept telling my husband that I felt something weird was going to happen during labor/birth. Nothing bad, just something unusual. Also, I had a lot of fear and worry during this pregnancy due to some other outside factors. Even though I had experienced two homebirths with no fear during pregnancy, labor or birth, I was actually AFRAID to give birth again when I went into labor! Like I didn't believe it would work, the old "watermelon out of a lemon" thing. blush.gif

 

During mid-labor, baby shifted spontaneously from a perfect position to a posterior forehead presentation. My usual 6 hour labor became a 12 hour labor, with 6 of it spent with excruciating back pain from a malpositioned baby. Pushing felt weird and it was harder to get him out than my other babies, for obvious reasons.

 

All said and done, I think it's a possibility my fear when labor started contributed to my baby changing positions during mid-labor. Maybe I needed a lesson in trusting birth again. I don't know. Haven't gone there yet. orngbiggrin.gif

 

Well, I hope you are able to find more information and talk to more mamas who have had a similar experience. And I think was that student CNM said to you was lousy and callous. angry.gif She obviously was totally unaware what you were really asking and she honestly seems a little too high up on her horse. She definitely belongs in a hospital environment with their arbitrary time limits on laboring women! irked.gif

post #13 of 26

My longest pushing time was 3 hours- and it was because my son was posterior, asynclictic, with a brow presentation.  I had a lip that WOULD not go away.  We tried pushing on the toilet, the birthing chair, etc. Nipple stim did nothing.  What FINALLY worked was getting on my hands and knees.  I felt this HUGE shift, and he was born 2 pushes later.  My second longest pushing was probably my most recent birth, and it was because of a nuchal hand.

post #14 of 26
Quote:
Originally Posted by IdentityCrisisMama View Post

 

A lot of what we talk about in the HB community is the length of time it takes to prep an ER for surgery. Many women factor the amount of time it takes to prep the ER in with their transfer time to the hospital. With the mother educated or a well trained MW, I think the idea is that you would alert the hospital and the ER is prepped while the mother and child are on the way - making the wait for a surgery room similar to that of a hospital birth. Of course this is ideal and it doesn't always happen this way but I wanted to address that issue in your post. 

 

OP, I pushed for 4 hours with DC#1 with a hospital transfer after 2 hours (followed by a non-medicated, intervention free (despite the threats!) hospital birth) and then a 2 hour second stage for DD#2. I can not imagine pushing for 10 hours - you are a champion!!  

 

Thank you for clarifying. When I originally posted, I had no idea this was in the home birthing section. I was just caught by the title. I'm not overly familiar with the ins and outs of home birth, although we *did* plan to have a home birth with the 3rd babe.. It was case load midwifery with home birth and funded by a public hospital (with very limited places). I booked in when I was only 5 weeks along. When I came up to 37 weeks, I tested positive for Group B strep and one of their policies with home birth was that you weren't allowed to be positive, so I had to come into hospital for birth. Because of the change of plans we never did get to go through the nitty gritty of transfers and such, hence my limited knowledge on the topic. I thought a transfer took into account the travel time as well decision making and prep time by medical officials and if that were the case, it wouldn't be the safest option for a very small amount of births (like my first birth).

 

I second the champion comment!

post #15 of 26

I pushed for 5.5 hours with my son (in hospital, with monitoring, baby's vitals were fine, and we eventually had a vacuum-assisted delivery).  I find your story alarming because extended second-stage labor has a lot of risks - maternal exhaustion can inhibit delivery and eventually lead to heart failure, labor is tough on babies, and the risk for post-partum hemorrhage in this situation is very high.  Sometimes babies don't descend because they're tangled up in the umbilical cord, so that would worry me as well.  In retrospect, I really wish I had not been as afraid of c/s as I was - I had a c/s with my next baby (for placenta previa), and it was far less traumatic for me than my first delivery.

 

You are absolutely a champ, but I am not a fan of the course of action your midwife chose to pursue.   It makes sense to me that a lot of people find the story alarming.

post #16 of 26

Congratulations on your baby!  I am wondering if you were truly fully dilated the whole time you were pushing.  It sounds like maybe your body need some energy to get ctxs strong enough to finish dilating or remove a lip of cervix.  Just by the way you describe feeling the baby drop, that is the way many mothers feel when they are finally fully and ready to push.  In any case, congrats.  I had a 5.5 hr second stage and know how difficult extended pushing can be.  I actually separated my pubic bone in the end- not pleasant.  Glad to hear you are all healthy and well!
 

post #17 of 26

I pushed for a really long time, through the night at least, with my attempted HBAC baby. They weren't hard pushes though, just body sorta pushing pushes. If that makes sense? He was moving down during each push and once he got really low his heartrate would drop with pushing, when I stopped pushing his heartrate went back up and his body moved back up. That was only the last hour or so, up until that point his heartrate was totally fine, at which point it became apparent he physically couldn't descend past a certain point so we transferred to the hospital. It ended up in a csection during which they discovered a significant band of scar tissue from the first incision right at the point where he was getting stuck so I'm guessing that had something to do with it.  In retrospect, I'm not sure how I feel about the whole thing although my midwife is fairly conservative and not hesitant to transfer when necessary.
 

post #18 of 26

Not anywhere near that long, but with my scond I pushed for awhile and swelled and midwfe decided she was malpositioned with her head presenting 'military'. We tried to get her lined up for awhile but I couldn't not push and was tired, had been in labor for 20ish hours. She mentioned transporting to my husband and said she would give me another hour or two but I decided to go right then. Got fentynol when we arrived and that was enough to help me relax while I got to 10 and she had finally got to a good position and I had her about an hour later. 

 

I have not had any problems with the rest of the babies, so I think positioning was really the issue with her.

post #19 of 26

I think that sometimes prolonged pushing phases can be attributed to a misunderstanding of when one starts 2nd stage.  Many women feel the urge to push, and do so in a gentle manner, for hours before 2nd stage (with expulsive pushes) truly begins.  Now, this doesn't matter at all--women don't care when second stage begins, usually; they only care about when it ends.  It's very important for midwives (and other attendants) to not focus too much on what the woman's body is telling her to do, to not bring too much attention away from what the mom needs to be focusing on, even if it sounds like pushing and looks like pushing. I've also seen women who rush to push because they know it's the way out! 

 

I'd be very interested in what the midwife documented about your 2nd stage.  I've seen it many, many times--a woman perceives that she has begun 2nd stage hours before it begins in the chart.  Regardless, your baby is here, is safe and was not compromised.  10 hours of pushing is alarming.  Seriously alarming. 

 

You did mention in your post that you are a very athletic person.  If you had a very toned pelvic floor (as I've seen in some women who are athletes), it can sometimes lead to a prolonged pushing phase.  Next time, the road is paved--the muscles will remember how to move out of the way and hopefully your baby will come faster. 

post #20 of 26
Thread Starter 

Thanks for the comments ladies!

 

@ Thyme Mama – As for a mental block... I have no doubt that fear is a player in many labors (as the mind/perception is incredibly powerful), but from my POV I felt everything was going perfectly for about 16 hours. I was at home with my midwife & DH, as planned. The birth pool got me through 1st stage easy peasy (or as easy as that can bebiglaugh.gif), and I was confident I was going to see my baby within a very little while. (In fact, I remember happily chattering during the first part of pushing about what the date was, and what my baby’s birthday would be, and being excited to finally find out the gender.) It wasn't until I'd been pushing 4+ hours that I started to flag (guessing 10 years of martial arts training have probably increased my endurance and pain threshold quite a bit). I wasn't anxious at all (that I can remember) before that point. I had no reservations going into the birth at all, I was 10 days overdue and ready to be done with it! Now my next labor on the other hand… that may be another story. I have a lot to process before I get that far so I can hopefully not let fear get in the way of my next baby. I’m so glad you were able to get through your labor, despite the difficult positioning! I will try to keep your story in mind as an extra reminder and work hard to be positive, thank you for sharing.

 

@olive&pimiento and @onlyboys – If there was a cervical lip my midwife did not catch it, because I asked to be checked and was toldI was fully dilated to 10cm right around 12:00. My contractions had become infrequent, and I was beginning to feel the urge to bear down so I asked my midwife to check my dilation. (She wanted me to leave the birth pool because she thought my contractions had simply slowed down, and I was thinking, “No way, I know I just transitioned and I’m pretty sure this is my break before pushing!”. Guess I handled transition pretty well since she had no idea I was at 10cm, lol.) She told me I was fully dilated and I could push if I was feeling the urge, but not to worry about pushing if I didn't feel ready yet. I’m sure things started out slowly for the first half-hour or so, but my urges became strong pretty quickly if I remember rightly. My body wanted to push - so I followed my instincts. There was actually one point where my midwife suggested I rest through a few pushing contractions, but it was like someone telling me not to throw up. It was excruciating, and I couldn't do it. My body convulsed into bearing down no matter how hard I tried to control the urge. The bearing down instinct was there and it was strong. After discussing with my midwife later we both agreed the pushing phase was over 10 hours.

 

The whole thing is really puzzling, especially since first stage went off without a hitch. I discussed the labor with my midwife after the fact and neither of us could come up with an answer as to what caused the delay. I mean, no obvious detectable malpresentation, my midwife did not identify a cervical lip at the time I asked to be checked, I was in good spirits, baby was an average 8lb 6 oz, I’m 5’5 and 127lbs normally – so not tiny, and I pushed with my urges. Suggested issues that could have contributed: toned pelvic floor, undiagnosed cervical lip (although I was checked and told I could push whenever), subtle malpresentation that resolved itself, some effect from vaginismus (midwife’s suggestion, as she thought my vaginal muscles may have been hindering baby’s progress down), misalignment of mom’s pelvis, etc. I guess maybe it could have been more than one thing? I mean, you would think it would have to be something noticeable to cause a such a delay – but there is no easy place to cast the blame. 10 hours delay is a big consequence to pin on any one thing... (sigh)

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