"Premature" urge to push? Update post 46 - Mothering Forums
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#1 of 49 Old 04-28-2010, 01:17 PM - Thread Starter
 
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I've gotten really interested lately in the idea of the "premature urge to push."
So I had always heard that one of the Really Bad Things that can happen during labor is for the mother to start feeling pushy before she's 10 cm dilated. Premature pushing, I've heard, can result in all sort of horrible things like a torn cervix, swollen cervix that makes it impossible for the baby to come out, that sort of thing.
I've had a couple friends who had easy labors up until they had a premature urge to push, and were told that they couldn't push. They said their labors were fantastic up until the point where they had to resist the pushing urge.
But then lately I've also been hearing that maybe the best thing, in a low-intervention natural birth setting, is for the mother to listen to her body and push when she feels pushy.
This article tackles the topic and makes a pretty compelling case that there is no such thing as a premature urge to push.
"First let me say that a non medicated woman will never push so hard against her undilated cervix that it tears, because it will hurt. Pain is a natural deterrent to pushing too hard. However, when done in the correct manner, pushing to help rotate a baby and dilate oneself will actually eliminate a great deal of pain and cut hours off one’s labor and birth."
I also have a friend who is training to be a family practitioner, but before going to med school actually did midwifery training because she wanted to be more like a midwife than a doctor. She said that in the clinic she trained at on the US-Mexico border, they just let the unmedicated woman push as she wanted to, regardless of dilation, and that they never had any problems.
I'm wondering if anyone has any evidence-based information on this (not based on women in the 1950s strapped down and drugged out of their minds, but current information looking at natural births). Does it actually hurt women to tell them to resist the pushing urge at 5 or 6 cm? Will their body guide them through that grunty, bearing down stage and actually help them dilate faster? Are the Really Bad Outcomes that you hear about a valid concern?

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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#2 of 49 Old 04-28-2010, 01:53 PM
 
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"First let me say that a non medicated woman will never push so hard against her undilated cervix that it tears, because it will hurt. Pain is a natural deterrent to pushing too hard.
Well, this part is utter crap. In both my labors I had a premature urge, but it wasn't an "urge." It was an imperative. It HURT!!! but there was nothing I could do to stop it. My body pushed on its own and I couldn't stop it. I wish it had been as simple as not pushing because it hurt. Yeah, right.
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#3 of 49 Old 04-28-2010, 01:55 PM - Thread Starter
 
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Well, this part is utter crap. In both my labors I had a premature urge, but it wasn't an "urge." It was an imperative. It HURT!!! but there was nothing I could do to stop it. My body pushed on its own and I couldn't stop it. I wish it had been as simple as not pushing because it hurt. Yeah, right.
What happened? Did you have a bad outcome, like a torn cervix or problems with delivery? Or did everything wind up okay?

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#4 of 49 Old 04-28-2010, 01:57 PM
 
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Everything wound up okay, but my problem is saying women won't push because it hurts too much. I've read a lot of birth stories where the pushing reflex was out of control. And if the article is going to make a broad (false) statement like that, it unfortunately throws all its other proposals into question.

I'm not denying that there may be a benefit to that pushing. But that statement is so obviously FALSE that it puts my guard up.
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#5 of 49 Old 04-28-2010, 02:00 PM - Thread Starter
 
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Everything wound up okay, but my problem is saying women won't push because it hurts too much. I've read a lot of birth stories where the pushing reflex was out of control. And if the article is going to make a broad (false) statement like that, it unfortunately throws all its other proposals into question.

I'm not denying that there may be a benefit to that pushing. But that statement is so obviously FALSE that it puts my guard up.
Oh, no, I don't think that's what it's saying at all. She's specifying that women won't push so hard that they tear their cervix or cause serious permanent damage. She's saying that it's a good thing for women to push as their body directs them --pretty much the same as what you're saying.

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#6 of 49 Old 04-28-2010, 02:02 PM
 
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Oh, no, I don't think that's what it's saying at all. She's specifying that women won't push so hard that they tear their cervix or cause serious permanent damage. She's saying that it's a good thing for women to push as their body directs them --pretty much the same as what you're saying.
IF that's what she's saying, then I don't have such a problem (although I'm not down with "never" - nature's not perfect!).
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#7 of 49 Old 04-28-2010, 02:13 PM
 
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Yeah, not pushing with a cervix dilated to 9.5 hurt like hell. I had the urge and against my will I did not push. I was in so much pain at that point when up until I had the urge to push I had been just fine. My body kind of half pushed anyway without any help from me. It'd have been such a relief to push along with it. After a couple of hours of agony being "stuck" at 9.5cm, (not surprisingly my being stuck coincided with the OB entering the room) the OB manually dilated me the rest of the way. Then it did not hurt anymore because I got to push with gusto. Well, not really, I had to purple push.

My second labor (home birth) I was on the toilet when my midwives arrived. One of them noticed a change in my moaning to start sounding like grunting. She asked if she could check me. I was 8cm. I returned to the toilet to push and then made it to the tub. I pushed how I felt and listened to my body. No agony this time. It was much easier to listen to my body. I did not swell my cervix or anything. I just gave birth without incident.

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#8 of 49 Old 04-28-2010, 02:28 PM
 
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I think my MWs would agree with the statement about just pushing as the Mom feels directed to. I was almost complete, with a lip of cervix left, when I felt the urge to push. It wasn't even an urge really... my body started pushing and I couldn't stop it! I was worried about swelling my cervix, etc., but my MW said just to go with what I was feeling. DD was born a couple of hours later, completely unmedicated, and totally healthy!

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#9 of 49 Old 04-28-2010, 02:39 PM
 
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At one point when I was in labor, I did get a little pushy. My MW told me to just go with it. If my body wanted to push, then push -- but see how it felt. It hurt. It didn't feel right. It almost felt like things just weren't lined up right, or like I was pushing and things were tightening up instead of opening. Even my sounds were higher pitched.

When I said out loud that I wasn't sure if it should feel like this, she wanted to check me real quick and found I was only at 8. So, even though my body was getting a little pushy (and prob just moving baby down) it also knew that it wasn't quite time.

I don't think I could have pushed for very long with that sensation. It hurt. I could see if you're told to keep pushing, your cervix could swell or tear, but I wouldn't have been able to do it on my own. It didn't feel right at all.

When it was time, it felt right. Everything was open, I felt the baby move down, and there was no pain at all during pushing.

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#10 of 49 Old 04-28-2010, 02:55 PM
 
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I had an uncontrollable urge to push at 9.5. Trying to not push was the most horrible part of labor, and I ended up with a csection. I firmly believe those pushes were intended to help rotate my completely posterior baby to a more deliverable position but it was handled badly by the hospital based midwives. They broke my water out of fear of the dreaded Swollen Cervix, it dialated me to 10 and wedged DS in a terrible position that he couldn't twist his way out of.

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#11 of 49 Old 04-28-2010, 02:56 PM
 
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This is something I have investigated a little bit this pregnancy because I did have a cervical lip that I was advised not to push against by midwives with my second birth.
It hurt a lot ot have them manually move my cervix (A LOT) and I had been having some issue with wondering why I would need to have someone's external validation and permission to push because that idea is not aligned with the my belief that my body knows how to give birth without intervention. So I had to reconcile that.
And what I've found is aligned with what you've found. This time, I am refusing vaginal exams unless there is a compelling reason for a vaginal exam. I am not going to wait for permission to push this time, or be checked once I feel like pushing.

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#12 of 49 Old 04-28-2010, 03:23 PM - Thread Starter
 
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These stories are amazing. Keep them coming.
Good luck with your HBAC, Allison.

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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#13 of 49 Old 04-28-2010, 03:34 PM
 
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I was a labor partner to a friend who had horrible pain from hours of the baby being posterior. She was only 5cm or so dilated and I believe she started pushing as a way to push against the pain (I feel even more certain of this now, because I watched her do it again in her second labor...she wanted to bear down almost constantly in that labor...the posterior position of the baby seemed to make her want to push, and she said many times that "she felt like she just needed to push" poop).

In the first labor, when her cervix began to swell, they gave her an epidural so she could get a break from the posterior labor pain. Once that happened, and she stopped pushing against it, she dilated quickly.

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#14 of 49 Old 04-28-2010, 03:34 PM
 
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I've always been pushy early and assumed that meant something was wrong with me. Also, I consider myself very well educated in matters of birth and my oldest was a homebirth, planned long before I was pregnant, and it wasn't until I was in my 5th pregnancy that I read that the body will dilate past 10. Wow, okay, maybe a duh moment but I had never read that anywhere in all my natural childbirth books. I read it when looking at breech birth stories and the need for them to wait longer so the head doesn't get stuck.

So then after my last one was born, and midwife was holding back a lip around 8.5 because I wasn't going to stop pushing, I found that article and was so relieved to hear someone say that. Thinking that you know if some women aren't pushy at 10 and need to go more, maybe my body needs to go earlier.

We don't treat all women the same in the midwifery care model except in this issue it seems. Why??? Glad to see some other midwives are listening and trusting these women's bodies.

Next birth I am listening to my body and putting away the fear of a torn cervix.

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#15 of 49 Old 04-28-2010, 05:48 PM
 
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I've read of women with footling breech babies feeling the urge to push because of the foot hanging through the cervix. In this case, there's a good reason to wait. But maybe if you feel like pushing "early" it's because of the way the baby is lying on the cervix? Certain angles need you to push to move the baby, so the system is mostly self-righting? It makes sense to me, I would love some sort of literature on it. Anyone?

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#16 of 49 Old 04-28-2010, 06:12 PM
 
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I wanted to push early at 7 cm's with both my kids. With #1 though I was given an epi shortly after having that feeling so that feeling went away. With #2 I had the urge to push at 7 again. With #2 I was left completely alone for almost the entire delivery. I told the nurse it was time to start pushing. She came in told me that it couldn't possibly be time I'm only 7 cm's along. I told her that my #1 son was born within 20 of my being 7 cm's. She kind of patted my leg said "okay hunny" in a patronizing way and left.

For me it hurt NOT to push. Since the nurse was clearly not listening I decided I was going to push with or without her. I wasn't pushing hard just little pushes kind of like the push you give when your trying to pee really fast (lol sorry if TMI) then all of a sudden I had to push HARD and dd was born in 2 pushes like that. Overall 13 minutes after I first told the nurse I had to push dd was born. I had no damage to my cervix and no tearing. Since dd was born so soon after I firmly believe that my body was telling me to push for a reason and that it helped speed up the process.
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#17 of 49 Old 04-28-2010, 06:51 PM
 
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interesting discussion! I have no idea how far along I was when I started pushing with my second and third... with my first I got to 10 cm, the contractions slowed down (and got less painful) and I had no real urge to push, at least at first... so really I don't know if it went past 10 or not. the last check I had with my second was around 7-8 cm, my baby was born about 20 minutes later, only 7 minutes of "pushing" (or rather, not pushing). My third I wasn't checked at all for the whole thing.

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#18 of 49 Old 04-28-2010, 07:05 PM
 
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I had an uncontrollable urge to push for 15 hours 3 days into my epically long labor. It was a homebirth. I had an extremely intervention free pregnancy and labor.

During those 15 hours my uterus convulsed and looked from the outside as though it was going to jump out of my body. I was stuck at 7 cms for that entire time. I tried pushing and I tried not pushing. I relaxed in the water (ha), called in a acupunturist, etc. We pulled out all the stops. We even had my midwife try to manually dilate my cervix while pushing as a last ditch attempt not to have a c-section (OWOWOWOWOWWWW). Let me just tell you, every second of these 15 hours was pure torture. My cervix was swollen and painful and it hurt to push with the contractions and hurt to pant them out and not push. My body also broke down after all that time and couldn't recover from the effort anymore. I felt like I was dying, literally I felt myself slipping away.

I have been a HB doula for 10 years, and my birth baffles me to this day. We have come to the conclusion that it was simply a fit issue, and my body was doing everything in its power to get him out and he just couldn't engage his head deeply enough to finish my dilation but my body was trying so hard to push him out.

Needless to say, he was enormous and his head was/is off the charts.

So, yes, in many senses I had a premature urge to push. But neither fighting it nor going with it was budging my baby.

ETA: Which is to say, there are no absolutes nor rules when it comes to things like this. Labor has variables and it's presumptuous to think anything else, IMO.
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#19 of 49 Old 04-28-2010, 07:34 PM
 
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I think it is reasonable and not presumptuous to say that based on the evidence, our bodies birth without intervention the great majority of the time. While it's unfortunate that some women experience true anomalies, that's what they are--anecdotal anomalies. This goes for all sorts of other birth issues too, not just cervical dilation. There are always exceptions. But they don't justify intervention in every case because overall the interventions themselves are more likely to cause more harm than good.

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#20 of 49 Old 04-28-2010, 08:47 PM - Thread Starter
 
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I've read of women with footling breech babies feeling the urge to push because of the foot hanging through the cervix. In this case, there's a good reason to wait. But maybe if you feel like pushing "early" it's because of the way the baby is lying on the cervix? Certain angles need you to push to move the baby, so the system is mostly self-righting? It makes sense to me, I would love some sort of literature on it. Anyone?
I've heard that it happens most frequently with posterior babies. I think it does make sense that the body is trying to move the baby.

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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#21 of 49 Old 04-28-2010, 09:39 PM
 
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I had an urge to push with my dd at 8 cm. I wish I'd known at the time I wasn't the only get that urge. I so wanted to push a little but the nurse checked me, told me I was 8 cm, not to push and that it could be HOURS yet before it was time. Hearing that totally broke me down. I'd gone through hours already of hellish pitocin-augmented labor and thought I was doing just great. Then she told me that and I just gave up and asked for the epidural. If only I'd had a more natural-birth-friendly hospital staff.

Reading this thread is somewhat healing. It never made sense to me that my body would want to do something that was so wrong. It's nice to hear others had the same experience.

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#22 of 49 Old 04-28-2010, 10:33 PM
 
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I think it is reasonable and not presumptuous to say that based on the evidence, our bodies birth without intervention the great majority of the time. While it's unfortunate that some women experience true anomalies, that's what they are--anecdotal anomalies. This goes for all sorts of other birth issues too, not just cervical dilation. There are always exceptions. But they don't justify intervention in every case because overall the interventions themselves are more likely to cause more harm than good.
Was that a response to my post? I'm very confused, if so, because I of course agree that the majority of labors do not technically need intervention. What I said was that categorical, 100% never-always statements just can't really be made when there are so many variables. (Such as, a mother will *never* push so much it tears her cervix.) Believe me, with all of the mind-blowing pain my freak labor was causing me, tearing my cervix would barely have been a blip on my radar.

And ahhhh how humble that birth has made me.
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#23 of 49 Old 04-28-2010, 10:51 PM
 
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Well, since the "urge to push" is an involuntary reflex, triggered by pressure points on the cervix and/or the vaginal walls, I think it is definitely possible that a poorly positioned baby could cause that pressure at a time in labor that is not optimal.

The urge to push isn't some kind of consciousness of the body sensing that it needs to rotate the baby or do something extra. The baby lands in a certain position on a certain nerve and there's your urge. Ideally, it occurs at the righ time when mom's body is ready to move from dilating to expelling, but if it doesn't, it doesnt' mean that it is *good* that it was triggered, and it *could* mean that a woman is faced with an uncontrollable urge to push that could cause problems if she goes with it.

Think of it like coughing. Coughing is a reflex. Sometimes its a good thing - we're triggered to cough up things we've inhaled so they don't go into our lungs. But sometimes something like constant post-nasal drip can trigger that reflex and cause us to cough and cough until we hurt ourselves. Coughing is value-neutral, and most of the time we cough appropriately, but we can have a reflex kick in at inopportune times that are not ideal,too.

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

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#24 of 49 Old 04-28-2010, 11:05 PM - Thread Starter
 
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Ideally, it occurs at the righ time when mom's body is ready to move from dilating to expelling, but if it doesn't, it doesnt' mean that it is *good* that it was triggered, and it *could* mean that a woman is faced with an uncontrollable urge to push that could cause problems if she goes with it.
Well, I guess the question here is, will it really cause problems? We've all heard or been told that pushing before 10 cm will tear or swell the cervix. But is that evidence based? Is it true? It seems like the women on this thread who gently pushed as their body instructed had better outcomes than those who resisted the urge to push.
I do totally get that pushing is value-neutral. But what's being posited is that some women, especially those with babies in less than optimal positions, may get the urge to push before 10 cm as an evolutionary tactic to shift malpositioned babies. Our bodies have tons of tricks like that which evolved over millions of years. I think it's plausible.

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#25 of 49 Old 04-29-2010, 12:28 AM
 
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But what's being posited is that some women, especially those with babies in less than optimal positions, may get the urge to push before 10 cm as an evolutionary tactic to shift malpositioned babies. Our bodies have tons of tricks like that which evolved over millions of years. I think it's plausible.
Not in my friend's labors (see my earlier post)...truly, she was pushing at a really, really BAD time (only half dilated). Her cervix was getting so swollen that her homebirth-loving doctor TOLD her she should strongly consider an epidural, or things might progress badly and quickly. I can't express how strange it was to hear that particular doctor suggest an epidural would be a good idea!

And, despite all her premature pushing, in both labors, both of her daughters were born sunny-side-up. Her body's urge to push did not reposition either of them...not even a little.

It makes sense to me that, with posterior babies, the pressure on the cervix would cause (as a pp suggested) a premature, and incorrect, urge to push. I can see how pushing at 8 or 9 centimeters might not be so bad...but 4? 5? Something is wrong there.

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#26 of 49 Old 04-29-2010, 01:49 AM
 
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There's grunty pushing at peaks of contractions and there is PPPUUUUUUUUUSHING. I get grunty and growly and pushy with my voice catching etc.... around 6-7 cm. This lasts for about 15-45 minutes and then there is "the baby is coooommming!!!!!!!!!!!!!!!" in earnest full on pushing that lasts a couple contractions before baby is out. I've been this way since baby #3, as long as I am unmedicated.
I have never been told to stop, I have never torn my cervix nor had my cervix start to swell. It tends to freak out the L&D nurses a bit but my midwife and OB who are experienced with grand multips say it is very normal and just fine.

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#27 of 49 Old 04-29-2010, 08:12 AM
 
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I've read quite a few birth stories here about swollen cervix, but none about torn cervix.


It's probably an individual thing. Sometimes it's okay to push, and sometimes it's not the right time.

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#28 of 49 Old 04-29-2010, 09:39 AM
 
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I get an early uncontrollable strong pushing with my births. Swelled the cervix and other tissues a bit and I had to hold back as best as I could and have my MW apply arnica. Everything went fine though, the swelling went down and baby popped right out.
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#29 of 49 Old 04-29-2010, 04:33 PM
 
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I attended one woman who had a premature urge to push at 4cm. She couldn't not do it, even with grunty, mom-led pushing only at the peak, she swelled considerably.

Baby was in a stubborn low-transverse arrest, mom had an ample pelvis, and it took all of her concentration not to all out push that early.

Babe ended up moving at about 9cm into a better position and descended rapidly after that point.

Cole Deelah
a mama of 5, wife of one, doula, MW apprentice, and childbirth educator
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#30 of 49 Old 04-30-2010, 02:13 PM - Thread Starter
 
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Quote:
Originally Posted by wonderfullymade View Post
I attended one woman who had a premature urge to push at 4cm. She couldn't not do it, even with grunty, mom-led pushing only at the peak, she swelled considerably.

Baby was in a stubborn low-transverse arrest, mom had an ample pelvis, and it took all of her concentration not to all out push that early.

Babe ended up moving at about 9cm into a better position and descended rapidly after that point.
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?
That's what I'm saying. I can't find any actual evidence based studies looking at what happens in a normal birth setting when the woman can push as along with her body's urge. It's like it's conventional wisdom that you can't push unless you're 10 cm, and I'm hearing stories from birth professionals saying "it was really hard for her not to push, good thing we were there telling her to not do it." But what if they woman just pushed as she pleased? Obviously it's all anecdotal on this thread, but it seems like the women who pushed when they felt pushy had better outcomes than the women who refrained.
We ask OBs to challenge the conventional non-evidence based standards like continuous fetal monitoring, epesiotemies, lithotomy position and the like. Is this in the same vein? Is preventing women from pushing when they get the urge to push actually an intervention that in many cases hurts more than it helps, but we continue to do it out of habit?
I'm not a medical professional and I don't know the answer to that question, but I would love to see real, evidence based information on the topic.

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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