Question Re: Pushing and Hospitals

[MrsMoe]

Because I have no other option but to birth at a hospital...

Why is it every picture, video, documentary etc of women pushing the baby out in hospitals is done flat on her back???

Do hospitals "allow" you other pushing positions?

Does the hospital force you to push in bed?

[ABand3]

I think that's probably because most women giving birth in hosptials have had pain medication, so it's less likely they can/should be anywhere but bed. If you don't have meds, it probably depends on your OB/midwife's preferences.

I haven't given birth in a hospital, but attended a friend's birth in hospital and she was free to move around as she pleased, and ended up pushing squatting on the bed with a squat bar.

[earthmama369]

I didn't have an epidural, and I had a good doula, so I labored in just about every conceivable position at the hospital. Even during external monitoring the nurses had no problem with me sitting up as long as I could keep the monitors relatively in place. Then again, I apparently was scarily focused while in labor and no one wanted to mess with me.

[mwherbs]

Habit is the primary reason

epidurals dictate position alot of the time along with easy position for care provider to see and do epis and any sort of instrumental delivery.

over 20 years ago I was assisting a woman at a hospital birth and she was kneeling upright with elbows on the elevated bed- doctor wanted to check her since she was making pushing noises- he said turn around and I said just check her there and he tried to but could not understand what he was feeling or doing so still ended up having her turn around and then that was the way she pushed the baby out--

[crazy_eights]

Some of it is habit and some of it is training. I've had OB's that had no problem with other positions and some that are adamant that they push the baby out on their back b/c 'what if they have a shoulder dystocia?' . That is how they are trained to deal with most obstetrical emergencies and of course they are ever vigilant for the rare complication.

[PortraitPixie]

I had a hospital birth, and they let me push any way I wanted. . .but closer to delivery I wanted to bush in bed, not really on my back, but like in an almost sitting up position, holding my legs back. The only thing was. . . tho I was at a ten I don't think I was quite ready to push. . .and felt kinda pressured into pushing. . .counting to ten, push again. . .from what I have learned here, it's better to not push until you can't help but push. . .kwim? Don't push until your body just takes over and almost pushes for you. . .

SORRY!! I went off on another tangent. . .

[MrsMoe]

Thanks for the replies! I dread being forced to have another flat-on-my-back-labor.

Suppose I can go over more of it in detail with the OBGYN and my doula as well.

I was not on pain relief meds with my last (I was on pitocin and anti-biotics for my MVP,) but was forced to lay flat on my back during the entire delivery - btu this was likely due to my severe preeclampsia - and the hospital was out of the dinosaur ages.

[operamommy]

Definately go over it in detail with your OB. Despite how nasty the hospital nurses might want to get and how much "policy" they want to site, what matters is that you have your OB on board. At least that's what I've found in my situation. My OB is so touchy that when I went into the hospital with pre-term labor the nurses wouldn't even do a vaginal check without getting her permission first. It might be more inconvenient for the hospital staff when you push in a different position, but since when did we exist to make their lives easier?

[pamamidwife]

actually, being flat on your back is somewhat preferable than being on your sacrum/tailbone. At least flat on your back with your legs up, your pelvic outlet is open.

egads. hospital births. good luck! OBs are surgeons, known for their surgical skill. how can they surgically open your vagina if you're not on your back?

/sarcasm

[MrsMoe]

Originally Posted by operamommy

Definately go over it in detail with your OB. Despite how nasty the hospital nurses might want to get and how much "policy" they want to site, what matters is that you have your OB on board. At least that's what I've found in my situation. My OB is so touchy that when I went into the hospital with pre-term labor the nurses wouldn't even do a vaginal check without getting her permission first. It might be more inconvenient for the hospital staff when you push in a different position, but since when did we exist to make their lives easier?

I went over my birthing plan with my OBGYN last Friday, which included:
- I want the birth to allow a choice of birthing positions.
- Natural pushing – non-directed unless there is a medical need or concern.

And he was totally fine with it. I just got to thinking tonight of hospitals forcing you to lay flat on your back because the only pics I see of hospital births are in this position! Also, it dawned on me, that with my last the Dr. didn't show up but to catch the baby, otherwise, the hospital nursing staff was in charge of my entire L&D and I wasn't clear on hospital policies etc.

[pamamidwife]

just know that many OBs agree to one thing, but there's always a "good reason" why they don't adhere to it in birth. Just make sure you have people willing to put up a stink for you.

Or just stay home as long as humanly possible and birth your baby on the way.....then turn around and go home before they can get to your babe! (sorry PMS)

[crazy_eights]

Originally Posted by pamamidwife

egads. hospital births. good luck! OBs are surgeons, known for their surgical skill. how can they surgically open your vagina if you're not on your back?

/sarcasm

HOW could I forget that one?!?!?! "We're going to need a little more room here....."

[scrappingmom]

it irks the heck out of me every time i see one of those L&D shows with the lady flat on her back trying to kinda do a crunch with each push .. dh laughs at me sometimes cause ,especially when they are saying its been long pushing and ushes dont seem effective etc, i'm all but screaming at the tv... ya know.. kinda like the dh's at a football game .. AANNNYYYWAAYYYY... my first i was more kinda reclined i guess... leaning back but not layng back either, second, had a diff doc, had me laying totally flat, my legs kept cramping on me while trying to push and it felt like i was getting nowhere and fast! he was my longest delivery(dont shoot me for the complaint) was 17 minutes, my third i told the doc i was sitting up or in any position i wanted.. she just asked me not to pick the toilet...lol .. i was 9 minutes delivering a baby that was "too big" for me to deliver.

Personally i felt the sitting up was WAY more effective in the pushing.. i hate seeing woman suffering thru labor.

[guestmama9915]

Along w/ all the suggestions already I'd suggest taking a tour of the hospital you're planning to birth at. At mine, they mentioned the option of a squat bar rather than stirrups, which I'm definitely doing whether I squat or not, and also allow freedom of movement, even walking out into their courtyard w/ a fountain - very nice! I think it will depend on your hospital, but my OB and hospital I seem to have lucked out on a lot of counts. Good luck with your birth!

[cottonwood]

"he was my longest delivery(dont shoot me for the complaint) was 17 minutes, my third i told the doc i was sitting up or in any position i wanted.. she just asked me not to pick the toilet...lol .. i was 9 minutes delivering a baby that was "too big" for me to deliver."

How the heck did you make it to the hospital in time?

[Artisan]

I would just stay out of bed and not ask for permission to do anything. They can not physically strap you down to the bed. If you are not in bed when the urge to push strikes, they can't make you push that way. You also have the right to say no to anything. If the doctor says to lie down and push, just pretend you don't hear or say that you're going to push in the position that feels right. No one is going to physically pick you up and throw you on your back -- you have to comply.

So don't comply and don't ask permission! But do it with a smile...

[mwherbs]

if you had preclampsia, your bp was high this might be why they had you lying down in labor-- laying down can keep your bp down some-- in the same turn gentle pushing will also keep the bp lower-- if you had very high bp it would be hard to be able to move around- they would be afraid you would have a seizure and get hurt- the nurse's diligence in keeping you in bed would be there

[Undercover Hippie]

The nurses at our hospital are fans of the semi-sitting position... which as Pamamidwife said is not any better than lying flat, and maybe worse since your tailbone can't open. All the hospital beds here have squat bars but I've never seen/heard of anyone actually using one. I know I wanted to use the squat bar with DS but I never thought of it and no one suggested it--it's such an intense time for you and DH, and a nurse may not suggest it if that's not their inclination... yet another reason to have a doula with you! But I do know people who have birthed standing up at our hospital... one doctor saw a midwife catch a baby that way and now she will do it too. I think the nurses/doctors are just scared of the unknown. They are not trained or experienced with anything except flat on back or semi-sitting positions, so they don't feel comfortable with anything else until their eyes are opened!

[MamaTaraX]

The hospital I'm at likes semi-sitting position and is really into using tug-of-war. It really comes down to the particular care provider though. If an OB likes you flat on your back, that's probably where you'll end up. Here's an interesting thing I heard the other day at abirth: This OB, who's really natural birth friendly, says to this mom, "Midwives talk alot about squatting and how it opens up the pelvis and brings the baby down. This position (on herback in stirrups) mimics that. Your legs and pelvis are open. I don't think gravity is as important as anopen pelvis" I'd never heard it put like that,thought it was really interesting. 1st time mom, pushed baby out in 20 minutes. Interesting. While I don't think flat on your back is the bestway to go, I do think it'sbetter than sitting on your tailbone too much. And to be honest, I laboredon myback natural) with my second fora little while because I was tired and because my body realized that being flat helped himfind the way he needed to go.

Talk to your OB, get it in writing if you need to. Make your wishes known and makesure they are on board with those wishes or be prepared to battleforyour wishes to be respected.

Namaste, Tara
mama to Doodle (7), Butterfly (2), and Rythm (due at home 1/06)

[USAmma]

Most hospitals will allow pushing any way you want as long as you are not compromised with an epidural or something. My birth center/hospital provided stools, balls, bars, and anything else that a woman would want.