Can we talk about pushing?

[redhotmama]

My first baby I pushed because I was told to, never felt the urge. After two hours, the hospital's limit before enacting a c-section, I requested forceps.
3rd degree tear.
She was 9lbs. 3 oz.

My second baby, born in a birthing center, I felt the urge and pushed heartliy because I was afraid of the overwhelming sensation of baby on the perineum. Ten minutes and a 1st degree tear.
She was 9lbs. 10 oz.

My third baby was born at home. What a difference. The pain was at least half. There was an urge to push which I thought was gas. I did not
push.at.all She gently came out on her own into my waiting hands when I dropped to my knees in front of the toilet. My midwife never laid a finger on me. She told me I was lovely and strong and capable. And I was.
There was zero trauma to my perineum.
She was 9lbs. 12 oz.

So...my question is, is pushing even necessary? Because of my personal experience of having seen at least 200 births (only in a hospital setting) there has only been one or two births like mine, so I am unsure. Tell me your thoughts please.

[AlpineMama]

I was directed to push when I was complete. I had been giving mini-pushes before, so they checked me and said I was 10 cm. I had an urge to get out of the tub and get into bed; I wanted to rest, I guess they figured I wanted to push. DS was in a bad position with hands by his face. He was stuck for quite some time (an hour and a half) while I pushed and pushed to please the midwife. They held my legs back and I couldn't muster up the words to tell them to let me go. Then at the very end I don't know if I necessarily felt an urge to push, but I felt a rush of adrenaline and all of the sudden the baby was out. I didn't increase my pushing throughout. But I didn't really feel like pushing until the very end. I think if I had been left alone I would just not have pushed until then, thus saving myself a lot of energy.

[AdinaL]

I don't know. I started having a VERY STRONG urge to push shortly after my water broke. And I pushed for 3.5 hours. I didn't have any tearing, per se, but a couple of labial skid marks, one of which crossed and opened an artery, so there were stitches involved. I had to push, it was seriously not an option to not push. I tried several times to not push, wasn't gonna happen. She was fully posterior with a nuchal hand when she was born though, so that may have been part of why I *had* to push. And part of my skid marks too. My perineum was completely intact. She came partway out and retreated many times (I though three or four, my husband says more like 15 ), so things did stretch around her very well.

She was born at home, in the water, and I wasn't ever directed to push.

[danotoyou2]

I've heard of coma patients birthing babies naturally... so pushing isn't necessary, I think.

Also, a coma patient is sort of the ultimate relaxed patient, ya know? Totally effective contractions, because they're not tensing up anywhere else (and diverting blood).

However, the body tells us to push for a reason. I think that babies would eventually be born, but if we didn't listen to our instinct to push, we would end up with more oxygen deprived babies (in birth canal too long, compressed cord).

That's my thinking on it. I didn't push at all for my first (c/s at 5cm), but pushed for about 45 minutes with my HBAC. It was something I NEEDED to do.

[newmama8824]

When I hit 8 cm (I think) my body pushed on its own. It was a little push but I did nothing... my body just pushed... It didn't push again until I was complete and at the peak of a contraction my body would just push... I dont think I did much pushing at all.

[redhotmama]

Originally Posted by danotoyou2

I've heard of coma patients birthing babies naturally... so pushing isn't necessary, I think.

Also, a coma patient is sort of the ultimate relaxed patient, ya know? Totally effective contractions, because they're not tensing up anywhere else (and diverting blood).

I think this is what I was trying to say. That is, if you are relaxed and comfortable enough, due to a variety of reasons, you may not have to push.

More feedback please, more stories!

[sweeetpea]

With my first, I had the whole hospital-directed purple pushing thing, plus an episiotomy (for a 4.5 pound baby!!!) that extended.

With my second, he slid down without being pushed. I was lying on my left side, then switched to my right, and immediately felt him head for the exit. I can still remember the awesome "filling" feeling of him moving down my vagina. Still in a hospital, they told me NOT to push, OB wasn't there yet. Um, I wasn't pushing...

With my third (homebirth with a lay mw), I was complete for about two hours (estimate, never had a cervical check) before the pushing force was overwhelming. I had done some mini pushes while walking around, frustrated that it was taking so long (#2 had been 2.5 hours start to finish). Finally, I got back into the shower and within minutes (I think, time was fuzzy) was groaning with mega-pushing. When the time for him to come really came, it was almost instantaneous - stepped out of the shower and pushed him into the mw's waiting hands.

[sapphire_chan]

Given the fetal ejection reflex, physiologically speaking I'd think that pushing would be for shaping the head and not really needed for getting the baby out except where things weren't lined up quite right.

Goodness knows there're plenty of MDC mamas who didn't push deliberately.

[amnda527]

Gosh I just loved pushing! I'm such a freak, I know. But my baby is 6months and still am always thinking about my labor,which was wonderful! I got to the hospital completely dilated. My midwife wasn't there yet, the nurse was asking me the standard questions, and I said, whoa! I'm pushing! I didn't have any control over it. When I had a contraction my body curled up and pushed. The nurse didn't even check me until right then and she said I was ready to go, and she ran out of the room to call my midwife. Before she got there the nurse told me not to push. I honestly tried not to, bc I really wanted my midwife to catch my baby, but it wasn't happening. When I felt a contraction coming I told myself to relax but I just couldn't. I ended up pushing anyway. I pushed about 45 minutes, on my side and ended up with a 1st degree tear. Lilah was 8lbs 4oz.

[meganmarie]

With my first birth I arrived in hospital fully dilated and already feeling that my contractions had changed to something else that felt very different - more purposeful, urgent and downwards-focused. I guess this was what we call the "pushing" stage. But like a pp, my OB hadn't arrived yet so I was told by nurses not to push. Well what I did was lie on my side (Bradley-relaxation-pose) breathe deeply and focus on what was happening inside me. It was very hard but I just tried to relax as much as possible. Still I could feel that my body was working without me adding any strength to it at all.

Finally the doctor showed up (whatever), and the nurse made me flip on my back and hold up my legs - I knew I wanted to push in ANY other position, I was asking her to help me get more upright but she gave me some blather about not being able to get the baby "over the pelvis" unless I was horizontal. If I hadn't been in full-out labor-daze I would have pitched a fit, but I was so focused inwards that it was a huge effort to communicate with anyone and I only had the emotional strength for one protest.

Anyway - now I was "told" to push but I had spent all that time listening to my body and I felt intimately familiar with the rhythm of those pushing contractions: how each one had 3 parts, which part was strongest, where they were focused. I felt as though I knew exactly how to add my strength to augment the pushing rather than work against it or alongside it. I think as a result, each "official" push I made was very effective. Also, I think my body had already done a lot of the work all by itself. It only took 15-20 minutes of this to get ds out into the world. But I did have a bad tear (2nd degree) as a result of being on my back.

Second birth, with a midwife in hospital I did the same thing - basically asked them to wait a while before starting to officially work on the pushing, and just lay there focusing on what was happening with the contractions in that phase. Again, it took me a very short time from when I finally really "pushed" with effort to when dd came out. But this time, I did it lying on my side rather than on my back and had almost no tearing at all. My sis the doula was next to me the whole time, telling me I was a goddess and that I was as strong as I needed to be - but no one told me how to push.

I absolutely believe that if you could force yourself to do nothing, baby would still come out. And I believe most women probably work against their body by pushing when they can't feel what's supposed to be happening. And that most nurse-led coaching of pushing, from what I've heard of it, is worse than useless - even counter-productive. And that aggressive/faster pushing can probably contribute to tearing...although I think the position you push in has a lot to do with that also.

Hope that helps - a very interesting discussion

[newtonscricket]

My first thread here was "Help me push out babies better" and it was enormously helpful, the general theme being "don't push" which was great advice and led to a much better birth with a much faster recovery than my three previous births

The end of the thread contains my birth story link

http://www.mothering.com/discussions...d.php?t=319287

[NatureMama3]

I did no pushing with my youngest son. It was all my body. I won't try it any other way again! It was MUCH more effective and fast that way. I *knew* it was pushing, but it wasn't me doing it, make sense?

I have no idea if I was 10 or not or how long I may have been there since I refused VEs after 5cm or so (too depressing).

[hubris]

#1: no urge to push, 4 hours of directed forceful pushing in semi-lithotomy position, vaccuum extraction (and I do mean extraction), episiotomy that extended into 3rd, nearly 4th degree tear

#2: lovely sensation of descent but cajoled into directed forceful pushing in semi-lithotomy, never felt "urge" once that started. vacuum "assist" and 2nd degree tear

#3: labored that baby all the way down and out in the water at home. no directed or forceful pushing at all. no hands on my perineum. no tears, not even a skidmark.

[3for3hb]

I only pushed with my first two because I was so done with labor i wanted to sort of hurry things along.
I was worried about pushing with my second (didn't want a cervical lip or anything and my midwives didn't think I was as far along as I was) and so I asked them for "permission" to push. They sort of laughed and said my body already was. I just joined it consciously at that point. And I felt him slip under my pubic bone and just sort of stay there. Like I said I was just ready to be done so I "pushed" him out on the next contraction. Didn't take much effort at all as far as getting him out, it was more mentally challenging. I felt like I needed to restrain th urge because I didn't want to tear (have horrible fears about that as I heard about my mom's fourth degree tear with my breech older brother... all. my. life.)

Didn't tear either time and I had 8 lb 4 oz and then a 8 lb 12 oz babies.

[redhotmama]

Originally Posted by sapphire_chan

Given the fetal ejection reflex,
Goodness knows there're plenty of MDC mamas who didn't push deliberately.

Can you tell us more about this reflex?

[sapphire_chan]

Nope, but Dr. Odent can via the California College of Midwives:

http://www.collegeofmidwives.org/pra...1/MFer_01a.htm

(Although, oddly they misspelled his name, but the info itself looks like what I've read earlier. Other useful Google terms are "foetal ejection reflex" and "physiologically normal birth")

[granola_mom]

It's obviously possible that you wouldn't need to actively push, as you have experienced, and I've read about many times. But I dont think that we never need to push... we have that instinct for a reason. I started to have the urge to push before I even knew I was CLOSE to that point in labour, because I wasnt having vaginal exams. And my body just started pushing. I do think though that maybe we think we have to push harder than we're supposed to, from conditioning, etc. Before I told anyone about it, I was not pushing very hard but when the midwives knew I really got into push mode and I just wanted that baby OUT asap! I wasn't coached though, and didnt have any perineal damage.

[Red Sonja]

With DS, I pushed because I was complete and told "you can push now". My body wasn't ready to push and it was hard, even though DS was only 8lb 3 oz.

With DD, my body just started pushing on its own. I didn't try to push, but it was completely involuntary and I couldn't have stopped it if I tried. 10 lb DD came flying out in about 7 minutes, it was easy.

[redhotmama]

Why isn't this "listen to your body and it will push on it's own" more common knowledge? This should be the core of wisdom shared in birth class! No one EVER told me about this until I had a wonderful new midwife halfway though my last pregnancy. Even she had not seen a birth like mine, only read about it in Odent's books.
I want to grab ahold of every pregnant woman I know and tell them this glorious news!

[sapphire_chan]

Originally Posted by redhotmama

Why isn't this "listen to your body and it will push on it's own" more common knowledge? This should be the core of wisdom shared in birth class! No one EVER told me about this until I had a wonderful new midwife halfway though my last pregnancy. Even she had not seen a birth like mine, only read about it in Odent's books.
I want to grab ahold of every pregnant woman I know and tell them this glorious news!

Because HCPs frequently feel like they have to be seen to be doing something.

Ah, for a doctor like the one who attended mom's VBAC, "I find that the results are the same no matter whether I pretend to be doing things or whether I sit back and drink orange juice. I'd rather sit."