Questions about pushing

[halfadozen]

I would really like to not "push" this baby out (my sixth) in the same way I experienced pushing out four out of five of my babies. Those four were pushed out with coaching from my midwives upon the point of full dilation and without the "urge to push".

I believe now, that avoiding allowing frequent checking of dilation and just waiting for the baby to descend and letting my body push will bring better results (I did experience this one time, with my third baby, and it was SO much better).

My question is this: with this pregnancy, I have varicose veins in my vulva and seem to have an increased, shall we say, tendency towards hemorrhoids. I definitely notice that straining just a little on the toilet makes me feel really bulgy and uncomfortable But when I let things just happen "naturally" it feels *much* better.

Is this a sign to me that me pushing during birth is going to just cause me to swell up down there and possibly increase the risk of tearing, or even rupturing the varicose veins? Or do you think that just the pressure of the baby descending is going to cause swelling of the veins and tissues anyways, even if I don't "push"?

I guess I just feel like if I am squatting and pushing my bottom inside out with all my might would be nasty this time around and something I'd like to avoid. I'd like to convince my birth attendants of this if my concerns have any validity.

Any thoughts?

[MsBlack]

I would say that vulvar varicosities does indicate that it would be best for you NOT to 'purple push' and instead to go for a gentle birthing. Yes, let the baby labor down, breathe through as much as you can. If pushing urge is too great to ignore, just go with it rather than 'helping it' with extra effort; for the women I've seen, usually this means going with the push for a few seconds at a time (5-6 seconds maybe) then catching another breath before next push. Basically, it's 'breathe through contraction until you can't anymore and simply find that you are pushing involuntarily....allow that reflexive push to direct you, rather than trying to direct IT.'

And I just don't understand why some HCPs insist on pushing at a certain point! Or in a certain way. I can see that in some rare cases, it might be helpful. But the great majority of women's babies DO descend in time without instruction or added effort of bearing down--and birth is so much easier on mom and baby both when 2nd stage is allowed or accepted (by mom) rather than managed by someone else.

[tinyshoes]

halfadozen, I posted a similar question about not pushing just a month ago in the Birth and Beyond forum--maybe you'll find the thread informative/helpful.

who didn't push & just 'breathed' their baby out?

[Jane]

I think it sounds like a reasonable plan. I might suggest laboring/pushing (or not pushing ) in water - for the counter pressure of the water on your tissues. If you can reach your vulva around your belly, another possibility is to hold your tissues to get feedback on that "pushed out" feeling you're describing. And finally, you might think of a few ways to push that aren't the usually gravity-assisted ways recommended by everyone - for instance, I think a squat stool might not be a good place to birth if you have bad hemorrhoids or vulvar varicosities. Sidelying or hands and knees might take more pressure off. Not that you should be directed to certain positions, but that awareness of different positions in your mind is not a bad thing.

One more thought - if you restrict vaginal exams, you can't be coached from full dialation. I do think exams can be beneficial is someone is already spontaneously pushing and there hasn't been the amount of progress expected from the apparent strength of the pushing, but not just because you've heard grunting. I hope that makes sense.

PS - have you tried some of the pressure supports for your varicoties? Sometimes you can get a lot of relief from them.