"Not in your face!"

[momileigh]

I really hate it when midwives start shouting at a woman who is pushing, "Not in your face! Push like you're constipated!" and other such nonsense.

I'm not even talking about invoking bowel movements repeatedly at a time that is supposed to be holy. I cringe every time.

I'm talking about the whole "Don't push with your face!" thing. The thing is, I've only ever seen it confuse women. They have no idea what you're talking about when you say that. They start freaking out that they are doing this wrong. I've never seen a woman who, when shouted at not to push in her face, suddenly changes the way she's pushing to be more effective.

I know a lot of you are against directed pushing at all, and I'm really looking forward to seeing birth done that way. Unfortunately, I've only had a chance to see it a few times. (Once was my own second birth.)

We recently had a very sad transfer. Sad only because the mother believed that the reason the baby didn't come out is because she didn't know how to push. Why did she think this? The midwife told her so. "You just don't know how to push." "There's just no power here." "I guess you've never been constipated."

Nothing to do with the fact that she stopped dilating at 9cm and then her cervix started swelling... (I don't know why that happened either.)

This is obviously part rant, but does anyone think that the whole "Don't push in your face" thing ever has any merit?

[SublimeBirthGirl]

When a woman is unmedicated, what she needs most is freedom to move around, and encouragement that she's doing everything right. Any kind of coached pushing annoys me. There are many things I don't like about my hospital birth, but all I remember during pushing was quiet, respectful encouragement (and not a whole lot of that), which was perfect. A birthing woman should never be yelled at

[sevenkids]

Nope, it doesn't have any merit.

If a woman is pushing, and it's not moving baby down, it means she's not quite ready to push yet. Rest, breathe, lie on her side, let baby move down and rotate or do whatever baby needs to do to fit, and push when it's crazy-uncontrollable.

Yelling does not help.

[DoomaYula]

Originally Posted by sevenkids

push when it's crazy-uncontrollable.

I *haaaaaaaaaaaaaated* that feeling during my last birth. My mw said I only pushed for 10 minutes but when you have that crazy-uncontrollable feeling, it feels like 10 hours!

I hate attending births when the doc/cnm does a ve (every hour usually) and determines that the mom is "ready to push" and yet mom isn't feeling the urge. it usually ends up with the mom being yelled at to purple push for 2 hours and she gets exhausted.

[BabyBugsMom]

Originally Posted by sevenkids

If a woman is pushing, and it's not moving baby down, it means she's not quite ready to push yet. Rest, breathe, lie on her side, let baby move down and rotate or do whatever baby needs to do to fit, and push when it's crazy-uncontrollable.

Yelling does not help.

Heh.

My most recent birth ended with a >4 minute second stage, with some yelling to STOP pushing from the labor/delivery nurse. When she realized that my pushing really was crazy-uncontrollable, she stopped yelling at me and started yelling down the hall for help!

[Romana]

Being yelled at while pushing was totally unnecessary and extremely annoying (yes, I know I was making noise and working hard - that doesn't make me deaf). I wouldn't mind being reminded to do little pushes when the baby's crowning - I never had a pushing urge so there was never anything uncontrollable going on, and it was helpful to know when to slow down to prevent tearing.

Thank goodness my doula was whispering in my ear, reminding me I actually *didn't* have to push as hard as possible for 10 full seconds.

[JSerene]

People with epidurals often need coaching to push. It doesn't seem necessary with someone unmedicated.

[sevenkids]

I don't even think people with epidurals need coaching, I've seen more than a few babies practically fall out of a woman with an epidural who couldn't feel her contractions or pushing urge. If she is being checked for dilation, and ordered to push as soon as she reaches 10 cm, she probably will need coaching. But if she's left alone (like when her OB and nurses are busy delivering another baby in another room) the uterus works amazingly well to get the baby out without directed pushing.

[maxmama]

Originally Posted by sevenkids

I don't even think people with epidurals need coaching, I've seen more than a few babies practically fall out of a woman with an epidural who couldn't feel her contractions or pushing urge. If she is being checked for dilation, and ordered to push as soon as she reaches 10 cm, she probably will need coaching. But if she's left alone (like when her OB and nurses are busy delivering another baby in another room) the uterus works amazingly well to get the baby out without directed pushing.

I love "passive descent"! We usually passively descend blocked moms until there's some urge to push through the epidural (our blocks are pretty light).

Though I have to say I had a mom once who never had any pressure, nothing -- I was changing the pad under her and the baby was starting to crown. Huh.

[momileigh]

Thanks for all the replies... but perhaps I could redirect a little bit...

Specifically: do you think there's any such thing as pushing in your face? Are popped blood vessels in the eyes because you "pushed wrong," or simply because you were pushing too hard under coaching? Can you look at a woman's face and tell that she's pushing in her face, and can telling her not to do so make any difference?

I'm inclined to think that "pushing in your face" is a lot of hooey, but if anyone has info to the contrary I need to know. All the midwives I work with insist upon it, so before I toss it out the window I'd really like some opinions specifically on pushing in your face.

[onelilguysmommy]

well i dont get why women are told to push like theyre having a bowel movement, anyway. if youre pushing with your utrerus, youre going to have a better result than pushing your entire abdomen and fousing on your bowels!

[momileigh]

For me personally, I always felt the pressure in my vagina. Never ever would have mistaken it for a bowel movement. Never felt like I was pushing "like you're pooping." It was a totally different sensation for me.

BUT I've been at tons of births where the moms are convinced that their baby is a big poop. (I've seen them cry and say things like, "You don't understand, I REALLY have to poop!" when I can see the head.) And I've heard lots of moms say, "It feels EXACTLY like you have to have a bowel movement!" So must be different for different people. I guess for some, it is a reasonable comparison... but that doesn't mean I'm comfortable commanding someone to "push like you're taking a huge dump!" (I am SO serious. This is what I have to listen to... and worse.)

ANYWAY back to the face thing, if we could...

[MamaRabbit]

When I teach CBE, we talk about the sensations of pushing and how it can feel like a bowel movement. But I never mention it to the mom when she's actually pushing. I feel that that can spoil the moment for her Not what I'd want to hear on a birth video! Though with my first, I was thinking "just like poop, just like poop" as I was pushing And she came flying out!

With my second at home, my midwife just said, "focusing your pushing down instead of out of your throat" She told me later that normally she says nothing about pushing but could see that I was getting tired and making lots of noise from my throat. In her experience, she saw that that kind of pushing was less effective. (Australian CNM of 30 years with mostly homebirths)

[sevenkids]

I think the only way a woman can truly push "in her face" hard enough to get broken blood vessels is if she's holding her breath for counts of 10, 3X per contraction. It builds up a lot of internal pressure, which is the theory behind purple pushing; to build up enough internal pressure to force the baby out.

"Push like you're pooping" works for some women, most feel a lot of rectal pressure as the baby's head moves down (and no one pushes for pooping by holding their breath and counting to 10). What almost always works, if mom is willing, is to ask her to put her hands down and "push the baby into your hands". That way she can direct herself and feel her progress (and I see very few tears when mom directs her self this way, she knows just where to apply pressure/counter-pressure and just where to rub gently and just when to let go).

With my second at home, my midwife just said, "focusing your pushing down instead of out of your throat" She told me later that normally she says nothing about pushing but could see that I was getting tired and making lots of noise from my throat. In her experience, she saw that that kind of pushing was less effective.

I know what she's talking about, some noises, like high-pitched, throaty noises, are counter-productive to getting the baby out. Tight throats make tight bottoms, low-pitched, loose throats make loose bottoms. I see more tears with high-pitched "EEEEEEEEEEEEEEEEEEEE!" noises than with low pitched "OOOOOOOOOOOOOOOOOOOOO!" or "AAAAAAAAAAAAAAAAAAAAAAAH!"

Anyway, I hate directing pushing unless the baby needs to come out SOON.

[A&L+1]

In general, women respond more to suggestions of what to do rather than what not to do. Being told repeatedly that you need to stop doing something like pushing with your face makes no sense - if she didn't change to effective pushing at the first comment what makes anyone think that yelling and repeated comments will work? (I suspect what makes one think this is EGO - i.e. I know what to do, she doesn't and I can control her with my voice if only she was smart enough to listen to me).

On a personal note, I had an OB tell me to "just stop pushing if I am not going to do it right" and many MANY requests to stop pushing with my face during my unmedicated hospital birth. It was completely degrading and frustrating for me to be told I was doing it wrong repeatedly especially since I had arrived at the hospital 10 cm dialated and up to that point felt like quite the birth goddess. To be honest, the "don't push with your face" thing made no sense at all at the time because I knew that the reason I couldn't "push right" was because the OB insisted I be on my back. I pushed my daughter out as soon as I could switch position and be back on my side.

[maxmama]

Face thing:

Some women, especially those with a block, push with their faces: they squinch them up, they put a lot of effort into the upper part of their bodies, but the baby doesn't move. Then they get the idea, their faces stop being the focus of their pushing efforts and the baby moves. I don't think anyone should yell at a laboring mom, but some really don't seem to get where they need to push to get the baby out. It's usually moms with epidurals.

[prothyraia]

This is entirely off topic, but I'm pretty sure you're not SUPPOSED to push hard when you're constipated. I mean, hello hemmorhoids?

[momileigh]

Maxmama... that makes sense to me. When I had coached pushing for my first, I think I was advised as if I had an epidural in, and had a tear as a result. But why would midwives who don't deal w/ epidurals adopt the kind of advice that is only appropriate for epidurals?

Prothyraia - I'm with you on that. If I'm constipated, I'm eating or drinking something to help myself out, NOT sitting on the can pushing as hard as I can.

[maxmama]

Originally Posted by momileigh

Maxmama... that makes sense to me. When I had coached pushing for my first, I think I was advised as if I had an epidural in, and had a tear as a result. But why would midwives who don't deal w/ epidurals adopt the kind of advice that is only appropriate for epidurals?

Oh, because sometimes we muck around in order to feel like we're doing something. Let's face it: most of normal birth is standing there and not doing things. That's hard, just like it's harder to listen than to talk.

[doctorjen]

Originally Posted by maxmama

Oh, because sometimes we muck around in order to feel like we're doing something. Let's face it: most of normal birth is standing there and not doing things. That's hard, just like it's harder to listen than to talk.

That's why I bring my knitting. I find it much easier to keep my hands and mouth to myself when I'm knitting, and babies seem to come out faster when I'm trying to finish an important row than when I'm standing there anxiously waiting! (sort of like how fast the baby comes seems to be inversely proportional to the number of people in the room with gloves on - the more ready you are the longer it takes sometimes.)