To Push or not to Push...

[halfadozen]

I have had 5 babies and am pregnant with my 6th. The first was a hospital birth with all the "extras" (AROM, pitocin, epidural, forceps, episiotomy...YKWIM). My epidural was administered and they checked me and whoa, I was 10 cm dilated, so "you can start pushing!" (Of course, I couldn't feel a thing, and my pushes were "ineffective" so out the forceps came...).

Baby number 2 was in a freestanding birth center with a midwife. The only similarity was.... at full dilation I was to start pushing. I never did feel like pushing, but after an hour he did come out.

Baby number 3 was also at a freestanding birth center with a midwife, but different center, different midwife. This midwife never did a check of my cervix the whole time. We never knew how dilated I was. She just let me do what I felt like, and eventually I felt my body pushing that baby out! It was wonderful! Just 2, maybe 3 pushes and there he was :-)

Baby 4 was in a hospital with a certified nurse midwife (we have moved alot and are generally at the mercy of what is available in the area...). There again, I was checked and announced to be at 10 cm, and start pushing. Never felt the urge, but pushed anyways for about 30 minutes.

Baby 5... another birth center, another midwife. Same deal, you are now fully dilated and must push. 30 minutes or so later he was born, but I never wanted to push.

What is going on here? Anyone experienced this? Was this just a fluke of my body, that I only had the urge to push with baby 3, or was it because none of the other births allowed me to get to that point where I felt it?

I think I know the answer, but I wanted to hear from some other mamas who have maybe experienced this before I demand that my midwife this time not check me and let me push only when I want to. I don't want to look stupid, I guess, if that urge to push never, never comes

[momileigh]

Originally Posted by halfadozen

because none of the other births allowed me to get to that point where I felt it?

That would be it.

[MsBlack]

I agree. Full dilation doesn't equate with 'time to push'. There is full dilation....and there is 'time to push'. Sometimes they occur very close together, sometimes not. Without some reason to believe pushing should be forced, I never tell moms when to push--they tell me when that time has arrived (if I'm lucky!).

[Ruthla]

I don't think your body is "broken"- I think that you would have had the urge to push during ALL of your labors if your attendants had been more patient.

[halfadozen]

Are there any good reasons for moms to be pushing when they don't feel like it, and starting immediately after complete dilation? Assuming the baby isn't in distress. Is it really just impatience that drives midwives and doctors to tell us when to push?

[CarolynnMarilynn]

Originally Posted by halfadozen

Are there any good reasons for moms to be pushing when they don't feel like it, and starting immediately after complete dilation? Assuming the baby isn't in distress. Is it really just impatience that drives midwives and doctors to tell us when to push?

Yep. Maybe some fear that compels them to want the baby out?

[momileigh]

Impatience, perhaps.

I know that some midwives truly believe that it speeds things up, and you're sitting there in hell wanting this to all be over, so why prolong things? You can start pushing! Let's get this over with!

I once tried to encourage a fully-dilated mom to wait until she felt the urge, but w/ my preceptor standing right there, I had to offer her the possibility of starting pushing right then. She said something like, "You mean some people actually want to prolong this?" And my preceptor gave me this look, like, "See? Told you." And so we lead her into coached purple pushing, just like almost every other birth.

Once the baby's head is wedged in there good and you've got decels going on, you don't want that prolonged. So even more reasons to encourage hard, sustained pushing, whether you feel like it or not!

Personally, I believe that if we would just wait until the pushing urge got strong, 2nd stage would be a lot shorter, and we wouldn't have to worry about exhausting the mother just as the head gets to the point where it is compressed, the baby would handle that better and get past that point sooner.

[Limabean1975]

:

I am fascinated by this question. I have only had one birth; I never felt the urge to push...I think I pushed with all my might, as instructed by my wonderful midwife, but I remember not being sure if I was pushing, half the time. It never occurred to me that maybe waiting would have been better. Interesting.

[halfadozen]

I always felt like my pushing efforts were rather useless and disappointing, too - not only to me, but to the gaggle of people gathered around me "coaching" me as well. And if I tried to resist their "encouragement" to push... then I felt I was just lazy and didn't I want this baby to be born?!

Even though those pushing sessions didn't last too terribly long, I didn't feel that rush of "I can do this!" and "I am doing this!" But quite a bit of performance anxiety, probably!

Except for my third, of course, the one that I pushed out with power! That was awesome! My midwife wrote down my actual words in my birth records. I said, "I think I'm pushing!" "I can feel the baby coming!!" and "This is like a dream!"

[Limabean1975]

I've been thinking alot about this question and about my birth experience with my first. (No second conceived yet, but soonish). I was swollen and purple-bruised for a long time after the birth. I did not tear, for which I credit my midwife's perineal guarding...but had I not been pushing before I was ready, would that have even been necessary?

I'm kind of posting to bump this thread - hoping to hear more thoughts!

[mamabutterfly]

nak...I agree w/pp's, that waiting for descent & urge to push is overall best. Ideally the sensations to move babe down and out come from the change in uterine ctx - literally from belly squeezes (opening you up) to a real distinct "down and out" feeling. Sorry for a crude analogy but as in the unavoidable urge in a bout of diarrea - can't be stopped, just go with it. :LOL

Last week I gave birth to my second, and my experience of the pushing stage was quite amazing - I was in a tub through transition, felt my water bag break, and waited for several ctx to get up. I stayed in the water, relaxing and lying down until I felt my body was pushing downward without me. Once I got up it was like she could fall out. I admit I was dreading crowning a bit, so I didn't want to add to the pushes *at all*. I literally did not push once - when I felt her head crowning I lay down (to better catch her and to have perineal support from the midwife). and her head came with purely the strength of contractions. I focused on not resisting or fighting them, but I didn't add to them either. She was born in 3 ctx/ maybe 10 minutes, and most of that was intentionally slow crowning. No tearing (yay!).
I did have to push out her shoulders. That was my first push!

My first came after an urge to push, but it still took some hard work on my part ... I 've also been to about 50 births as a doula, and I do think for most it takes some different pushing effort with your first. Still should wait until your body is pushing downwards, but I do guess that most women will have to add more 'oomph" with their first.

To the OP - I think with this 6th baby you should totally wait until you feel and unmistakable feeling of your body pushing without you. It's a very cool feeling!

[I think the exception to this may be in cases where the baby's heartrate is really variable or not recovering, and it is safest to help the baby be born more quickly.]

~ MB

[Limabean1975]

Fantastic, Mamabutterfly!!

[alli437]

From what I've read, I've heard that many women have a time after first stage labor (when they're fully dilated) and before second stage, when they don't feel much of anything. Some even fall asleep, as this is the body's way of giving it a rest before the hard work of pushing is about to start.

On a personal note, I gave birth to my babies (at home with a homebirth midwife) and didn't have vaginal exams at all. So we didn't know if I was fully dilated or not. I just pushed when I felt like pushing. It's not like the baby was going to stay in there forever.

You could always refuse the vaginal exams (or just keep putting them off over and over).

[JennieYoung44]

Limabean1975 I've been thinking alot about this question and about my birth experience with my first. (No second conceived yet, but soonish). I was swollen and purple-bruised for a long time after the birth. I did not tear, for which I credit my midwife's perineal guarding...but had I not been pushing before I was ready, would that have even been necessary?

I'm kind of posting to bump this thread - hoping to hear more thoughts!

I am not a birth professional but I just wanted to chime in that I fell asleep at my 2nd and 3rd births ...

my first birth was more difficult with pre-eclampsia and a lot of ineffectual pushing, never felt the urge in 6 hours. When I was done I had a lot of the purple bruising you are talking about. So much work. I don't think I was doing a thing but tiring myself out and making my body numb. (long story there)

With the second birth I woke a few times to some intense contractions but just groaned and rolled over and fell back to sleep.
With my last birth my midwife actually checked me just before I fell asleep and I was fully dilated; she encouraged me to rest anyway. I think I slept for about 30 minutes (I even had a dream).

Both times I eventually woke up with the undeniable urge to push.

After my first birth I had no idea what people were talking about when they said, the urge to push. It is probably the most incredible & powerful feeling I've ever had ... and so worth waiting for.

Jenniey

[onetwoten]

I was reading to see if someone would mention what Alli did- the rest time.

When I did my doula training, the trainer said that *most* women, if let be, will have this- she calls it "rest and be thankful time", I think that's stolen from another author. She talked about how it's very likely that it's how our bodies were made on purpose, because it allows the mother time to catch her breath, gather her concentraion and have a bit of a rest and regrouping becfore her 'pushing' stage. Makes sense to me!

[tidalwalker]

i had the experience of being 9cm dilated for about 4 hours before my midwife (after breaking my water thinking it might help baby's head apply more directly to my cervix and finish dilation which didn't happen) instructed me how to push and helped move my cervix up over my baby's head. i had no desire to push, though after my water was broken the contractions were so bad that i was ready to have him out. my overall birth experience was extremely positive, but i do feel like i missed out on a big part of it by not having the urge to push and i also feel that i didn't completely follow my body's lead.
what are reasons to instruct pushing? does what my midwife did sound appropriate?

[momto4kids]

NAK ~
with my first 2 it was coached purple pushing, about 60-90 mins each time. With my 3rd hospital birth we were left alone since I was in early labor...rapidly progressed and she came out in 2 pushes (they were yellling at me tp stop since no Dr was there).

1st HB, checked once since MW needed to call her assistant (long drive for her). I labored, went into the tub ~ water broke and she was born a few minutes later when I had the overwhelming urge to push.

2nd HB, never checked ~ labored went into the tub again ~ water broke again and DS was born a few minutes later. I should add that I checked myself in the tub since I could feel DS moving down and told our MW that he was coming NOW since he was so low~ it was pretty cool!

I should mention that my first 2 were medicated to varying degrees (one epi) while the last 3 "were unmedicated. Also ~ I never got to have the "be grateful rest"......I wish ~ once the water broke it was all done for!

Dana

[hipmummy]

Originally Posted by momileigh

Impatience, perhaps.

I know that some midwives truly believe that it speeds things up, and you're sitting there in hell wanting this to all be over, so why prolong things? You can start pushing! Let's get this over with!

I once tried to encourage a fully-dilated mom to wait until she felt the urge, but w/ my preceptor standing right there, I had to offer her the possibility of starting pushing right then. She said something like, "You mean some people actually want to prolong this?" And my preceptor gave me this look, like, "See? Told you." And so we lead her into coached purple pushing, just like almost every other birth.

Once the baby's head is wedged in there good and you've got decels going on, you don't want that prolonged. So even more reasons to encourage hard, sustained pushing, whether you feel like it or not!

Personally, I believe that if we would just wait until the pushing urge got strong, 2nd stage would be a lot shorter, and we wouldn't have to worry about exhausting the mother just as the head gets to the point where it is compressed, the baby would handle that better and get past that point sooner.

I wish my midwives had that midframe. I "pushed for fours hours. In reality 1.5 I faked the first 2.5 hours. I just breathed ds down. I never felt the urge to oush until the gave me pit after the four hours of trying to get ds down. I really did not like my birth. I have never gotten over ds. Ds was shipped to the NICU (we were a hospital transfer)not sure if it was the long 2nd stage or the pit or the stress of the two combined. I hope the next time we do not have a repeat performance.

[halfadozen]

Thanks so much for all your replies. They have been so helpful! I don't think I will be letting anyone tell me (or even suggest... because as I reflect on it more, the midwives who "encouraged" me to push were not commanding me or telling me... but they seemed to be wanting me to and so being the suggestible person that I am I tried to please them. Crazy, eh?) What else was I supposed to do when they stood around watching me and "waiting"?!

This time... I will keep people's fingers out. And they hopefully won't know what I am doing until I tell them Although, since we are having a hospital birth, I imagine they will want to examine me upon arrival... so I will probably allow that, but not later. In 2 of my births, when I didn't live 1 hour away, but just a few minutes, I have arrived at the birthplace at 9 cm, so hopefully that will satisfy them that things are progressing until I am actually pushing! Do you think so?

[Limabean1975]

What is meant by "coached purple pushing"? I assume it means what I did - push till my vulva was purple & swollen I just want to confirm.