PUSHING at 9 cm?? - Mothering Forums

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#1 of 12 Old 10-12-2009, 04:29 AM - Thread Starter
 
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Has anyone here EVER experienced or heard of a woman being told to start pushing when she is only 9 cm dilated?

I have searched a lot of sites and they ALL say you should be fully dilated (10 cm) before pushing, and even then, oftentimes it is STILL too soon; you should wait until you feel the urge to push which can vary from 10 minutes to 1 hr AFTER you are fully dilated!

I know someone who had the birth story from hell (ended in C section) over 3 years ago. She says her dr said she was 9cm dilated but had her start pushing. He had asked if she felt the urge to push and she really didn't but said she did because she wanted the baby to come. She had been in labor for a long time and was in a ton of pain because they turned off the epi and had also been given pitocin so she felt everything and doesn't even remember a break in contractions- she pushed for about 3 hours the last 2 of which she was hallucinating from the pain. She never said anything to anyone at the time because she was trying to be strong. She did ask for them to turn the epi back on at one point, but was denied.

This dr not only made poor choices (nothing he did helped her, she ended with a C section) but also many rude comments the entire time. He was a very young dr and looking back on it, she feels he was inexperienced.

Anyway, assuming he was right, and she WAS 9 cm, and assuming her memory is correct and he DID have her start pushing at that time, I'm just wondering if there's EVER a valid reason to have someone start pushing before they are 10 cm? Please educate me. DOES IT EVER HAPPEN?

"All that is necessary for the triumph of evil is that good men do nothing." -Edmund Burke (1729-1797)
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#2 of 12 Old 10-12-2009, 05:53 AM
 
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I am not a birth professional, but I did read this article a while back:

http://www.midwiferytoday.com/articles/RuleOf10.asp

The key point, however, is that it may be appropriate to push before ten if the birthing mother feels the urge to. It sounds like that wasn't the case with your friend, though I am not sure if/how an epi can alter the urge sensations?

In my birth experience, I had a lip of cervix I asked my midwife to hold out of the way so I could start pushing. I don't know if I had what others call an 'urge' to push - I consciously wanted and felt ready to to start pushing because I wanted my baby to be born, but it wasn't an involuntary sensation like when I was really in the throes of pushing.

IMO, the problem with your friend's story is not necessarily whether pushing began at 9 or 10cm, but that it began because of a doctor's dictate instead of a mother's instinct.
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#3 of 12 Old 10-12-2009, 09:39 AM
 
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Some women have an overwhelming urge to push at around the 5-7cm mark and there is a theory that going with that urge will facilitate rapid dilation to 10cm. As far as I know though all the information about this is still anecdotal. And the mother has the urge.

Pushing before 10 cm may be appropriate is when the mother has a strong urge but still has an anterior lip remaining. A couple of pushes with the midwife easing the cervix over the head can resolve this and prevent an oedematous lip. Again, the key here is that the mother has the urge to push.

Some very premature babies may be born through a cervix which is not fully dilated, due to their size, but once again the mother must have the urge to push.

I can't think of any reason to push when not fully dilated and no urge.

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#4 of 12 Old 10-12-2009, 10:10 AM
 
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I have seen some of the worst looking strips. I think pushing even when complete should not always be demanded. When a baby is unstable with what ever is going on (usually tons of interventions) the options may be push through a lip (9+cm) or go back for a c/s. The fact that she was able to push for 3 hrs makes me think that is not the case.

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#5 of 12 Old 10-12-2009, 10:40 AM
 
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If the woman is laboring naturally and experiencing the urge to push at 9 cm, I think it is probably wisest for her to follow her body's cues. I experienced a pushing urge at 8-9 cm, and it was pretty much not possible to resist. I didn't push really hard, but I didn't resist the urge either. I allowed my body to push as it wanted to. I think that helped me reach full dilation, and I pushed with effort once I was "complete" to deliver the baby.

I honestly don't think a woman should be told when to push at all, unless she's asking for guidance or fully complete for a reasonably long period of time without a pushing urge (and then it should be given as an option rather than a command). Or if she has an epidural or is otherwise unable to tell what's going on.

In the situation you described, you said the doctor asked her at 9 cm if she had the urge to push and even though she didn't, she answered that she did because she wanted to be done. I completely understand why she wanted to be done, but I'm guessing from what you said that the doctor would not have encouraged her to push if she hadn't had an urge to do so- after all, why else would he have asked?

I'm not saying it's her fault, but she cannot expect the doctor to give her the best care possible with her not responding truthfully. If she WAS experiencing an urge to push, it would not be inappropriate for the doctor to "allow" her to push or encourage her to push.

I'm sorry that your friend had a bad birth experience. I do not think the doctor was to blame for that particular aspect of the birth, however.
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#6 of 12 Old 10-12-2009, 12:00 PM
 
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I was not fully dilated when my ob had me start pushing. I was at about 9 and was starting to want to push. It was 12 hours after she ruptured my membranes though so I think I was on a clock without knowing it. I only pushed for 4 or 5 contractions when she decided baby was in distress and called for a c-section. Dh later told me dd's heart rate was dropping with each contraction (and purple pushing) but never got into the danger zone. I'm been induced 30 hours previous to this so I think my ob was just done. Oh the things I would have done differently had I had even a wee bit more info!

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#7 of 12 Old 10-12-2009, 12:41 PM
 
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This happened to someone I know, at an army hospital.

She was induced, had an epidural, and the doctor told her to start pushing at 9 cm. Then her cervix swelled and the baby's heartbeat dropped during pushing but came up to normal in between contractions. She had to have an emergency c-section and says that she's so thankful the doctor saved her baby's life.

I wasn't there, I can't judge. Tried really very hard not to judge the doctor or the situation. It's hard to make any choices when you're in the heat of the moment and when you trust your doctor 100% with no other info to rely on. It just makes me sad that another woman was deprived of a peaceful birth and on top of that went through all the extra stress worrying about her baby's dropping heart rate.

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#8 of 12 Old 10-12-2009, 02:08 PM - Thread Starter
 
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Thanks for the link - that is incredible!! I always wondered about that myself... like when a woman has a great urge to push and is told NOT to. That never seemed right to me, and I wondered why the woman would even have this urge in the first place. Surely God doesn't make mistakes? (What would have happened to such a case centuries ago I wondered?) I searched a lot on the net and never found anything even remotely like that page. Seems a world apart from mainstream medicine. (They all said there would be damage to the cervix)


I do agree she never should have lied about the situation. However, she was suffering terrible anxiety at the time (she was treated horribly and made rude comments by not only the dr but nurses too!) and I could understand wanting to be out of there! She did have the epi at one point, but it was allowed to wear completely off (lack of progression I guess) and pitocin was started at some point too (to get labor going again I'm guessing)

She wanted the epi again but was told no. So it had wore completely off hours before she started pushing. I was just so surprised to hear that a dr would have someone start pushing at 9, given all the things I read on the net. It's like, didn't he learn anything in medical school? Do you think its possible they are teaching different things now- like maybe it is ok to push when less than 10 if there is a great urge? (it contradicts all the mainstream medical pages I recently found online) Or maybe he simply happened to observe a case where the lady successfully gave birth (with the urge to push) at 9cm? (He was very young she said, so likely hadn't great experience)

her words and keep in mind this is a first birth and she was not at all educated about birthing, she thought they would take care of her: "the doctor asked me if i was ready to push way before I was ready, and of course i said yeah because i wanted the baby to come. He asked me if I felt like I was going to have a bowel movement and I said I think so, but I didn't feel like that at all, i just didn't know what to say, i wanted the baby to come. I wanted to try different position so bad but I hardly had anytime to verbalize my wants because the pain was so intense i really couldn't speak."

I do feel like her pushing for 3 hrs with nothing happening was overkill. I mean, surely the dr would have tried something different after 20 or 30 minutes, you know? Even given the urge to push, which he THOUGHT she had, surely he could see nothing was happening and that something was wrong?!?

I also feel if she had not been under the influence of pitocin her pain would have been more manageable and she would have been more in her right mind to speak up and tell the truth about things esp. regarding the urge to push. It would have given her a break between contractions to talk at least. I'm just thinking back to my own labor (had a epi hospital birth but luckily I had a good birthing experience overall, 10+ lb baby) but if I would have had no epi AND given pitocin? I shudder to think of it.

Anyway, I greatly appreciate the link - simply incredible!! Love it

"All that is necessary for the triumph of evil is that good men do nothing." -Edmund Burke (1729-1797)
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#9 of 12 Old 10-12-2009, 02:22 PM
 
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I birthed naturally at a free-standing birth center with midwives, and I pushed at 9 cm.

I had some urge to push but not a TON. Honestly, it took me 11 hours to go from 6 to 9cm, they were taking hospital transfer due to exhaustion, and I wanted DD OUT. In other words, I guess there was some physical urge and a whole lot of emotional urge. I pushed (at my own pace) for 2 hours and out she came. No meds, and I don't remember any pain at all. I used hypnobabies, FWIW, and she came out with a hand up there, so I guess that's why dilation was so slow-going.

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#10 of 12 Old 10-12-2009, 09:56 PM
 
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I would have to say that babies come in all shapes and sizes. The cervix only has to be opened enough for the largest part of the baby to pass through. Though this is generally at 10, I am guessing it can be at a number less than that and still be perfectly acceptable.

I don't have my cervix checked before I start pushing, I just start when I have the urge. However, I know that for my last birth I was at a 7 when I was checked, and within 60 seconds of that check I felt the urge to push, uncontrollably. I began pushing and delivered my son 10 minutes later. So, I actually began pushing at 7. I had no choice. And it was the "right" thing. I would not, however, push without the urge.

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#11 of 12 Old 10-13-2009, 11:52 AM
 
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With my 2nd birth, 5 weeks ago, I was in labor throughout the middle of the night. Did not realize I was in labor, thought it was pre-labor. I was at home, and was not checked at all. During contractions about 4 hours before I delivered, I felt really constipated, and would sit on the toilet and push thinking I had to poop. This happened a bunch of times. During transition I pushed about 3 times, and it was entirely unavoidable- i HAD to push. The he started crowning, and I lay down, and he literally just slipped out w/o anymore pushing. I have no way of knowing what level of dilation I was at, my midwife was not able to get to my house, and DH delivered!
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#12 of 12 Old 10-13-2009, 12:02 PM
 
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If a momma feels the natural urge to push with her body then I don't see what the issue is. I think when someone is demanding her to do it, that's a different story.

Though when I wound up pushing it was because my body started doing it. I wouldn't doubt that for my last birth I wasn't at 10 cm when I started, but I wouldn't honestly know because nobody checked. But, who knows, maybe I was. I only had a few painful contractions and they never did get super close together. I remember leaning onto the wall with the pain, and noticing that my pushing made it feel better. Next thing I knew I felt the baby move way down. That was my first indication that nobody was making it to the birth.

I've heard midwives say sometimes that women are 'stretchy to so and so'...so if the cervix is really strechy then maybe that's all it takes--the pushing, the moving down of the head to put direct pressure on the cervix to finish off the last few cm. My baby here was WAY high up when my water broke 8 hours before...he did not move down much until that one push. And, I think after that, there were like two more pushes during a contraction and he was out.

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