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#31 of 49 Old 04-30-2010, 03:13 PM
 
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I don't think that if I premature-pushed it would be like life-threatening. But I'm betting a swollen cervix would make labor much harder and longer, and wouldn't be fun.

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#32 of 49 Old 04-30-2010, 04:18 PM
 
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I don't think that if I premature-pushed it would be like life-threatening. But I'm betting a swollen cervix would make labor much harder and longer, and wouldn't be fun.
Yes, it does. I had one, not from premature pushing, but because my daughter's head was cocked sideways and could not come out even when I was dilated.

I don't think the OP is asking whether or not a swollen cervix is a problem, she is questioning the assumption all women should/must wait until 10 or else they automatically risk a swollen or torn cervix. That is what women are being told, that their bodies are broken, that if they feel pushy before 10 (or on the other hand don't feel pushy at 10) then that means something is wrong and they need to stop listening to their bodies and just do what they are told. Where is the scientific evidence that all women can not push until 10/must push at 10 and not wait? That is what we are asking.

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#33 of 49 Old 04-30-2010, 04:53 PM - Thread Starter
 
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That's a good flip point -- a lot of women get a break after hitting 10 cm and don't feel pushy right away. My midwife called it the "rest and be thankful stage."

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#34 of 49 Old 04-30-2010, 09:24 PM
 
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Yes, it does. I had one, not from premature pushing, but because my daughter's head was cocked sideways and could not come out even when I was dilated.

I don't think the OP is asking whether or not a swollen cervix is a problem, she is questioning the assumption all women should/must wait until 10 or else they automatically risk a swollen or torn cervix. That is what women are being told, that their bodies are broken, that if they feel pushy before 10 (or on the other hand don't feel pushy at 10) then that means something is wrong and they need to stop listening to their bodies and just do what they are told. Where is the scientific evidence that all women can not push until 10/must push at 10 and not wait? That is what we are asking.
I see what you're saying. And yep, I'd agree that not ALL women shouldn't push before 10 cm, and not ALL women should push before 10 cm, and definitely I don't think anyone HAS to push just because they are at 10 cm.

Probably a lot of "you're at 10 cm so you have to push now" attitude comes from the frequency of epidural. Because if you are numb you really DO need to be told when to push. But I think if there is no numbness, you shouldn't HAVE to push at 10 cm if your body isn't ready for it, as long as you and the baby are doing fine and there is no rush to get the baby out.

Although lord knows I HAD to push at 10 cm, there wasn't even any free will about it, my body was doing it like it or not, haha.

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#35 of 49 Old 05-01-2010, 12:03 AM
 
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With ds2, the unbearable urge to push came early. Actually, that whole period was the extent of my labor. I had 10 contractions that I can recall. I start labor pretty late in the game. I had been a stretchy 4-5 cm and 80% effaced for a week. After walking and spending time rocking and swaying my hips on the loo with some BH type contractions I got to 6 cm. I was getting frustrated that labor was not starting. I felt great. Fine. Just very impatient. It's typical for me to hang out at 6-7 cm with no labor. My midwife was very puzzled by it. But it was normal for me.

Well, contractions picked up while I was on the phone with my mom. I recall having about 5 contractions during our conversation. They weren't painful at all, but they were definitely not like the BH type I had been having for a couple weeks. These felt real and were coming about every 2 minutes. I had a feeling things were starting up. Then I started leaking blood and waddled back into the living room to tell/show my midwife. I was still feeling fine. I actually don't recall any contractions at this point. They had me lie on the bed to get checked. Babe was just fine, but my cervix was puffy and swollen, which was where the bleeding came from. I was relaying all of this back to my mom on the phone.

Then they had me roll onto my left side to take pressure off my cervix. I was still 6 cm. It seemed like within a minute I felt a contraction (last contraction I recall was before walking into the living room). It was pretty intense. Next one came about 10-15 seconds later and I felt pressure. Told midwife I was feeling pressure. She said not to push yet as my cervix wasn't ready. 3 contractions later, less than a minute, he was born. I was in such shock. A few minutes before I was talking on the phone with my mom telling her labor would get going soon (30 or so minutes in my mind). My legs were still closed when his head was born. He barreled through and shot out like a rocket.

She and her intern were completely stunned. My husband looked like a deer caught in headlights. I didn't know what to think other than "What the hell just happened?!

Yeah, from the time 'labor' started to birth was 15 minutes. Went from 6 cm and -2 station to birth in about a minute. Similar case with dd2, but labor was 47 minutes. I read up on maternal-fetal ejection reflex. That's exactly what I experienced my babies.

My midwife with ds2 said my pelvic floor and cervix just melted away and out he came. It was extremely forceful.

With dd1, I started feeling pushy at 8 cm and it was intense. I was told not to push because I wasn't ready. Well, I wasn't sure how I could just not push. It was so intense. The nurses said getting an epidural might take the edge off the pressure. I ended up getting it even though I really didn't want it. I think I was 9 cm when the anesthesiologist finally came in to administer it. About 15 minutes after he was done I was complete.

Aeona - married to super hot nerd Toby . . . mama to Grace (9) Evangeline (7) Duncan 11.14.08   and Henry (4) born at home. Expecting again early December!  
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#36 of 49 Old 05-01-2010, 12:50 AM - Thread Starter
 
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Here's another really interesting article about pushing that mentions "premature" pushing urges: http://www.midwiferytoday.com/articles/pushing.asp
"It has become the paranoia of North American midwifery that someone will push on an undilated cervix. Relax, this is not a big deal."

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#37 of 49 Old 05-02-2010, 04:22 PM
 
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Originally Posted by fruitfulmomma View Post
That is what women are being told, that their bodies are broken, that if they feel pushy before 10 (or on the other hand don't feel pushy at 10) then that means something is wrong and they need to stop listening to their bodies and just do what they are told. Where is the scientific evidence that all women can not push until 10/must push at 10 and not wait? That is what we are asking.
I'm not saying that *everyone* *must* wait, by far. Women are not machines and labor is not a checklist, obviously. Every body is different.

But the assumption that if our body is telling us to do something it *must* be correct and beneficial is a dangerous one and is frankly wrong. Our bodies have a lot of reflexes and responses that are at best value-neutral and at worst *can* be damaging, and to say that ignoring the demands of our bodies is somehow always a bad idea is potentially dangerous.

I might have an overwhelming urge to scratch at a chigger bite. Does this mean it is beneficial to scratch? Does this mean if I scratch that bite until becomes a big open wound, that is what my body needs or wants? No. The urge to scratch comes from a reaction of my nervous system, but has no higher-order meaning or message about my body's destiny or the best way to accomplish a goal. It just *is,

savithny, 42 year old moderate mom to DS Primo (age 12) and DD Secunda (age 9).

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#38 of 49 Old 05-02-2010, 08:54 PM
 
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I didn't have the urge to push for my first two, because of the epidurals I received. With my third, a homebirth, I wasn't sure what to expect, and at some point I was just really tired and wanted to get the show on the road and asked the midwife if I could start pushing. She said, sure, why not? I believe I was probably 9 cm, but I don't exactly recall. Long story short, my cervix *DID* swell, and it prolonged the labor. In the end, the midwife had to manually hold back my cervix - - can we say painful??? I'm sorry I didn't wait until feeling an urge, and will definitely not try to do that this time!
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#39 of 49 Old 05-03-2010, 09:35 AM
 
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If the MWs/Obs aren't checking you then they don't know whether you are early pushing or not and surely that means the early pushing is something they all made up? Because if you don't check then how do you know if its early pushing or not???? Anyone see my point? That maybe there is in fact no such thing as early pushing, somebody just decided that pushing before a certain dilation is early when in fact it might just be normal.
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#40 of 49 Old 05-03-2010, 10:08 AM
 
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I had the urge to push way before the baby was anywhere near to coming out...and it felt good. It actually helped with the pain. I don't think it would have been the same kind of pushing as if one pushes a baby out though - but it was pushing.
All very interesting!

Mummy me : > Thats Ann! and my beautiful SONS Duncanand Hamish 19/09/05 & 22/04/10!
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#41 of 49 Old 05-03-2010, 10:54 AM
 
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Jen, I have a post saved from MidwifeStephPDX with some evidence on this issue. There are a wide range of dates with the most current being 2007 - http://www.mothering.com/discussions...2&postcount=24

Quote:
Here is the list of resources supporting the position that women pushing with an uncontrollable urge do not have increased rates of cervical injury, slow descent, maternal exhaustion, or fetal distress:

McKay S, Roberts J. Second stage labor: what is normal? Journal of Obstetric Gynecologic and Neonatal Nursing. 1985;14(2):101-6.

Roberts JE, Goldstein SA, Gruener JS, Maggio M, Mendez-Bauer C. A descriptive analysis of involuntary bearing down efforts during the expulsive phase of labor. Journal of Obstetric Gynecologic and Neonatal Nursing. 1987; 16(1): 48-55.

Aderhold KJ, Roberts JE. Phases of second stage labor: Four descriptive case studies. Journal of Nurse-Midwifery. 1991; 36(5): 267-275.

Cosner KR, deJong E. Physiologic second stage labor. American Journal of Maternal and Child Nursing. 1993; 18: 38-43.

Thomson AM. Maternal behaviour during spontaneous and directed pushing in the second stage of labour. Journal of Advanced Nursing. 1995; 22(6):1027-34.

Roberts J, Woolley D. A second look at the second stage of labor. Journal of Obstetric Gynecologic and Neonatal Nursing. 1996; 25(5): 415-23.

Roberts J, Hanson L. Best practices in second stage labor care: maternal bearing down and positioning. Journal of Midwifery & Womens Health. 2007; 52(3):238-45.

Roberts, JE. The “push” for evidence: management of the second stage. Journal of Midwifery and Women’s Heath. 2002; 47(1): 2-15.

Petersen L, Besuner P. Pushing techniques during labor: Issues and controversies. Journal of Obstetric Gynecologic and Neonatal Nursing. 1997; 26(6): 719:726.
HTH!
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#42 of 49 Old 05-03-2010, 11:03 AM
 
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Originally Posted by savithny View Post
I'm not saying that *everyone* *must* wait, by far. Women are not machines and labor is not a checklist, obviously. Every body is different.

But the assumption that if our body is telling us to do something it *must* be correct and beneficial is a dangerous one and is frankly wrong. Our bodies have a lot of reflexes and responses that are at best value-neutral and at worst *can* be damaging, and to say that ignoring the demands of our bodies is somehow always a bad idea is potentially dangerous.

I might have an overwhelming urge to scratch at a chigger bite. Does this mean it is beneficial to scratch? Does this mean if I scratch that bite until becomes a big open wound, that is what my body needs or wants? No. The urge to scratch comes from a reaction of my nervous system, but has no higher-order meaning or message about my body's destiny or the best way to accomplish a goal. It just *is,
I agree that it's not good to use terms like "must" but I do believe that the overwhelming majority of women in natural labor will not have their body telling them to do something wrong. I believe this because I believe that birth works most of the time for low risk women. Not 100% of the time, but the vast majority of the time. I think we do more harm by trying to prevent all women from pushing when they feel the urge "prematurely", before 10cm.

Chigger bites are not normal bodily functions. Chigger bites are a problem, an invader. Birth itself is normal, not a problem.

There are no absolutes but I believe it does more harm than good to check dilation in all women and use that as a criterion for when not to push. I think that's better reserved for when there are signs that there might be some kind of problem.
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#43 of 49 Old 05-03-2010, 12:10 PM - Thread Starter
 
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Originally Posted by savithny View Post
I'm not saying that *everyone* *must* wait, by far. Women are not machines and labor is not a checklist, obviously. Every body is different.

But the assumption that if our body is telling us to do something it *must* be correct and beneficial is a dangerous one and is frankly wrong. Our bodies have a lot of reflexes and responses that are at best value-neutral and at worst *can* be damaging, and to say that ignoring the demands of our bodies is somehow always a bad idea is potentially dangerous.

I might have an overwhelming urge to scratch at a chigger bite. Does this mean it is beneficial to scratch? Does this mean if I scratch that bite until becomes a big open wound, that is what my body needs or wants? No. The urge to scratch comes from a reaction of my nervous system, but has no higher-order meaning or message about my body's destiny or the best way to accomplish a goal. It just *is,
For sure, I hear you that our bodily functions and urges are not some cosmic message, and that they may be value neutral. But many urges are not value neutral -- hunger means we need to eat, thirst means we need to drink, lust means we need to perpetuate the species, fear means we needed to escape the cave lion, and so on. They're not urges, they're biological imperatives -- commands rather than requests -- and if we ignore them, we get bad outcomes.
I hear you saying that the urge to push is just triggered by certain nerves being pushed by the baby's position, and that it's value-neutral. I'm saying that I think it's entirely possible that it's not value neutral -- that maybe the pushing urge is more like hunger or thirst than it is like scratching a chigger bite. Childbirth is a natural process, a chigger bite is an injury, an anomaly. While birth can break down and problems can arise, it seems like in general, during labor, a woman's body does do a fairly good job of guiding her through the childbirth process. That's just evolution. Look at the amazingly complex interplay of hormones and chemicals and physical urges that make up childbirth, which evolved over millions of years and millions of species.
If a woman feels an overwhelming imperative to push, it's a lot more reasonable to assume that pushing is the correct thing to do rather than assuming that she shouldn't push.
The main thing, though, is this: if a medical provider wants to use an intervention, I believe the medical provider has the burden of proof to show that the intervention is needed. And I am still waiting to hear anyone indicate that you get better outcomes resisting the urge to push.

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Originally Posted by me&3 View Post
I didn't have the urge to push for my first two, because of the epidurals I received. With my third, a homebirth, I wasn't sure what to expect, and at some point I was just really tired and wanted to get the show on the road and asked the midwife if I could start pushing. She said, sure, why not? I believe I was probably 9 cm, but I don't exactly recall. Long story short, my cervix *DID* swell, and it prolonged the labor. In the end, the midwife had to manually hold back my cervix - - can we say painful??? I'm sorry I didn't wait until feeling an urge, and will definitely not try to do that this time!
I think this is an interesting counterpoint -- pushing when you're not feeling the urge to push can be as damaging as not pushing when you do feel the urge to push. The women on this thread who resisted the urge to push have mentioned that that actually caused their cervix to swell, and pushing without the urge can also cause swelling, while the women who pushed through it are saying they didn't swell.

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#44 of 49 Old 05-03-2010, 12:11 PM - Thread Starter
 
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I agree that it's not good to use terms like "must" but I do believe that the overwhelming majority of women in natural labor will not have their body telling them to do something wrong. I believe this because I believe that birth works most of the time for low risk women. Not 100% of the time, but the vast majority of the time. I think we do more harm by trying to prevent all women from pushing when they feel the urge "prematurely", before 10cm.

Chigger bites are not normal bodily functions. Chigger bites are a problem, an invader. Birth itself is normal, not a problem.

There are no absolutes but I believe it does more harm than good to check dilation in all women and use that as a criterion for when not to push. I think that's better reserved for when there are signs that there might be some kind of problem.
Cross posted, but yeah, I totally agree, and thanks for the links. I'm excited to check them out.

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#45 of 49 Old 05-04-2010, 07:50 PM
 
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I wonder, in that situation, what would have happened if she had not resisted the pushing urge and continued to bear down? Would she have swollen to the point of not being able to push the baby out, or would it have been fine?
Well, she went from 4 to 7 (controllable urge), then 7 to a REALLY swollen 4 (uncontrollable urge), to a swollen 7 (lots of positions and 'blowing away the feather'), a less swollen 8 (same stuff), a less swollen 9 (more of the same).. then pushed baby down and cervix away.

OTOH, I always started the urge to push at between 8 and 9cm. It wasn't any big deal as I just followed my body's urge and pushed the cervix away and baby was out within a matter of contractions.

Back on the original topic - I would like to see better studies too... I have seen women w premature urges and nothing went amiss... other times, I have seen less-than-ideal occurrences manifest...

Cole Deelah
a mama of 5, wife of one, doula, MW apprentice, and childbirth educator
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#46 of 49 Old 05-16-2010, 07:32 PM - Thread Starter
 
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I posted a version of this question on Henci Goer's forum, and she wrote back with a really great and thoughtful reply.

http://www.lamaze.org/OnlineCommunit...c/Default.aspx

Jen, journalist, policy wonk, and formerly a proud single mama to my sweet little man Cyrus, born at home Dec. 2007 . Now married to my Incredibly Nice Guy and new mama to baby Arthur.
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#47 of 49 Old 05-16-2010, 08:36 PM
 
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That's great! Thanks Jen.

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#48 of 49 Old 05-16-2010, 09:53 PM
 
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While birth can break down and problems can arise, it seems like in general, during labor, a woman's body does do a fairly good job of guiding her through the childbirth process. That's just evolution. Look at the amazingly complex interplay of hormones and chemicals and physical urges that make up childbirth, which evolved over millions of years and millions of species.
as a biologist i want to address the issue of evolution.

because evolution is a PROCESS that is occurring every day it means that your instincts could very well be telling you to do something that is harmful. when evolution is held up as if where we are today is _the_ final product then assumptions are made that are not correct.

it is quite possible that pushing before full dilation is detrimental to our species BUT if it's not detrimental enough to stop us from reproducing then the trait/instinct is likely to be passed to the next generation. if pushing before dilation doesn't equal maternal death each and every time it happens then it the trait isn't selected against strongly. out here, lots of jack rabbits die from running in front of cars on the highway- that has been STRONGLY selected against for the last, maybe 50, generations of rabbits and the trait is still present to run toward the lights.

to really compare you would need to compare the outcomes of women with malpositioned babies that did and did not feel the urge to push early. how many women lost (or would have lost) their lives or their babies lives without intervention? perhaps it's neither beneficial nor deleterious but just looking at women that felt the urge and had positive outcomes doesn't really benefit the argument.

i'm not for or against your hypothesis but i do like scientific clarity and it bugs me when folks think that because we do something it must necessarily be a survival adaptation that benefits the species.

eh. who needs a signature?
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#49 of 49 Old 05-16-2010, 11:09 PM
 
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Thanks, PlayaMama!

RedOak ~ Momma to DS (8) , DS (4) , DD (3) , & DD 9/10 ~
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