full dilation = time to push? - Mothering Forums
1 2  3 
Birth and Beyond > full dilation = time to push?
cottonwood's Avatar cottonwood 01:24 PM 04-13-2007
Even here at MDC where people tend to be a little more educated about the physiological process, I hear this a lot. I thought it myself back when I had my first, but I didn't think why that might be, it was just because "that's the way it is". In other words, what I had been told. And then I thought something was wrong with me because I didn't feel the urge to push throughout that whole managed second stage -- not once. It was supposedly "normal", though, in that it took two hours to push my baby out.

To me, this seems on a par with the myth that episiotomies prevent tears. I can't believe that in this supposedly scientific age, people still believe this. It's just very frustrating because of how much harm it has the potential to cause. My voluntary (guided) second stage was awful. Okay, compared to lying on my back trying to not yell out (another great myth about what birth is supposed to be like) during excruciating contractions, it was a little better, at least I got to do something with that energy (since I wasn't allowed to move around and bellow) and know we were progressing toward something. But it was horrendously hard on my body and in itself caused injury, and it was hard on my psyche too as I was led to believe that I wasn't doing it "right" and if I only focused more or were a stronger person, it would go faster and be easier on me.

I'm still angry thinking about it (this was ten years ago) because it wasn't true. In reality, my body simpy wasn't ready. (Nor was I in a position conducive to helping it get ready.) I could have spared myself that whole two hours of ridiculous effort and indignity and hurt to my body if I'd just moved around and bellowed like I felt like instead of trying to force the baby out at some artificially chosen time (and risking distress to him in the process.)

"Full dilation" does not mean the body is ready for the baby to emerge. It means that one little part of it is ready. It doesn't mean that everything else is ready. When all is ready, the body will make it happen; there will be no mistaking or avoiding it. And it will be comparatively quicker easier and safer than if voluntary pushing had started earlier. So why are women still routinely told to push before then?

SublimeBirthGirl's Avatar SublimeBirthGirl 01:36 PM 04-13-2007
Yep.
the_lissa's Avatar the_lissa 01:39 PM 04-13-2007
Good question.

I also thought you couldn't push until 10 cms. I was only 9 cms and had to push so bad, and was trying to hold it in, but my mw told me to just go with what my body was doing, and my baby was born in less than 5 minutes.
_betsy_'s Avatar _betsy_ 01:42 PM 04-13-2007
I never felt the urge to push. I was told when to push, and it was awful. I was at 10 cms and all that, and I even asserted myself enough to take a few minutes to see if the urge to push would come, but it never did.
2bluefish's Avatar 2bluefish 01:44 PM 04-13-2007
Probably for the same reason when you are ready to push, they start yelling at you to wait and don't push. Failure to respect a woman's intuition.
twilight girl's Avatar twilight girl 01:47 PM 04-13-2007
When I birthed DD, after 72 hours or so of dilating ... I finally reached my 10 cm, and the midwife told me to take a nap and get refreshed, because DD hadn´t dropped down yet, so pushing would be futile at that point.

She let me sleep for 1/2 hour or an hour, and when I woke up she had me get up and do some squatting to help push DD down. I pushed 3 times for a total of 15 minutes and she was born.

Gotta love a midwife who knows what she´s doing!
Shonahsmom's Avatar Shonahsmom 01:52 PM 04-13-2007
This is something I've never fully reconciled about my dd's birth.. but kind of on the opposite spectrum. Overall, it was a wonderful birth and I totally did my own thing. But my labor was fast and intense and my dd descended so rapidly and I had the most intense pushing urge from about 6 cm on and was encouraged by my mw to not to push, to blow through the ctx. I feel like I've heard a million times that women shouldn't push before full dialation and doing so can result in cervical swelling and swollen cervical lips that can prevent the baby's passge. I guess I've always felt a level of confusion about why my body wanted/needed to push so badly before all of my body was technically "ready". :
crunchy_mama's Avatar crunchy_mama 01:56 PM 04-13-2007
I wish someone around me had really focused on this the first time around. I was so tired and ready to be done that I wanted to push as soon as possible. Unfortunately I pushed and pushed and pushed without the urge for quite a while, I wish I had tried to at least rest. Unfortunately this meant by the time I actually pushed him out I was semi-reclining, I had already pushed while squatting and hands and knees for a couple of hours and just didn't have the energy anymore. I ended up with a small tear, I thank that could have been avoided.
2bluefish's Avatar 2bluefish 02:02 PM 04-13-2007
Quote:
Originally Posted by Shonahsmom View Post
I guess I've always felt a level of confusion about why my body wanted/needed to push so badly before all of my body was technically "ready". :
I always feel pushy around that point. I think it a psychological thing for me. I want to push through the intensity. I know I can't go back, so I want to get it done. When I do push at that point, it does not feel right (and I have had swelling and lips and all that stuff). I figured out with my second that that pushy feeling is a sign to go deeper (for me into hypnosis). The real urge to push was different - came on softly, I gave a little push and felt the baby move and then things picked up.
Shelsi's Avatar Shelsi 02:28 PM 04-13-2007
Quote:
Originally Posted by Shonahsmom View Post
This is something I've never fully reconciled about my dd's birth.. but kind of on the opposite spectrum. Overall, it was a wonderful birth and I totally did my own thing. But my labor was fast and intense and my dd descended so rapidly and I had the most intense pushing urge from about 6 cm on and was encouraged by my mw to not to push, to blow through the ctx. I feel like I've heard a million times that women shouldn't push before full dialation and doing so can result in cervical swelling and swollen cervical lips that can prevent the baby's passge. I guess I've always felt a level of confusion about why my body wanted/needed to push so badly before all of my body was technically "ready". :
A friend of mine had this happen to her from about 5 cm on and because of it she just could not dialate past that. Turns out she was tearing her cervix! OUCH! I don't know if it's psychological or what. She ended up getting an epidural (she's VERY into NCB so that was a huge leap for her) and she still says to this day that it was the only way she ever would have had her VBAC, she just couldn't stop herself. Like the pp said though it didn't feel good to her to be pushing but at the same time it wasn't something she could stop.


I had a very managed medical birth and I remember feeling pushy around 8-9 cm. I have a feeling I would have been just fine pushing then and I did a little bit because it just felt so freaking good.
Romana's Avatar Romana 02:47 PM 04-13-2007
Quote:
Originally Posted by fourlittlebirds View Post
I'm still angry thinking about it (this was ten years ago) because it wasn't true. In reality, my body simpy wasn't ready. (Nor was I in a position conducive to helping it get ready.) I could have spared myself that whole two hours of ridiculous effort and indignity and hurt to my body if I'd just moved around and bellowed like I felt like instead of trying to force the baby out at some artificially chosen time (and risking distress to him in the process.)

"Full dilation" does not mean the body is ready for the baby to emerge. It means that one little part of it is ready. It doesn't mean that everything else is ready. When all is ready, the body will make it happen; there will be no mistaking or avoiding it. And it will be comparatively quicker easier and safer than if voluntary pushing had started earlier. So why are women still routinely told to push before then?
(bolding mine)

I both agree and disagree. I think that almost all the time, you're absolutely spot-on right. However, birth is also the great humbler. Birth reminds us that every birth is different, every woman is different, and you just can't say *anything* will happen in a certain way during birth.

You've probably read my story or heard me talk about this before, so I'll make it really short, but bottom line, even after over 7 hours of pushing contractions that I breathed and bellowed through uninhibited and alone (except for dh, who spent part of the time asleep), even after that "lip" of cervix was pushed aside, even after all that, I still had no pushing urge. I was too tired to wait through another 8 hours of that excruciating pain for the moment that my body finally decided it was ready to give me an urge to push. So I pushed with the contractions despite having no urge to push. My baby was born 25 min later, and it would have been over an intact perineum if the doctor hadn't given me bad advice when birthing her shoulders (head was done slowly, carefully, controlled by me, and gently with no tearing).

I agree that full dilation does not necessarily mean it's time to push. And I think it makes a lot of sense to wait a while for an urge to push - definitely take a nap if possible. But I just don't think it's necessarily true that your body will definitely have an unmistakable urge to push, or the fetal ejection reflex, or push the baby out on its own if you don't do it yourself. Sometimes, it just doesn't happen that way.

Julia
dd 1 year old
SublimeBirthGirl's Avatar SublimeBirthGirl 02:48 PM 04-13-2007
If you never get the urge to push, it doesn't mean you need people telling you to push. If you "never" get the urge (I'm guessing they didn't give you long to wait, betsy; you might have gotten an urge at some point), you wait and your uterus pushes the baby out. There's usually no need for directed pushing.
gini1313's Avatar gini1313 02:52 PM 04-13-2007
Quote:
Originally Posted by fourlittlebirds View Post
So why are women still routinely told to push before then?

I delivered in a hospital with an OB. She never once told me to push, or directed my pushing (until I got out of control with the pain, then she helped me focus by directing me until I was able to follow my body again). I was fully dilated for over an hour before I got an urge to push. She sat and did paperwork until I got the urge...

Off topic, but, that is one of the reasons why I hate it when people knock the whole medical field. There are good docs out there and we just have to find them!!!
Romana's Avatar Romana 03:00 PM 04-13-2007
Quote:
Originally Posted by SublimeBirthGirl View Post
If you never get the urge to push, it doesn't mean you need people telling you to push. If you "never" get the urge (I'm guessing they didn't give you long to wait, betsy; you might have gotten an urge at some point), you wait and your uterus pushes the baby out. There's usually no need for directed pushing.
(bolding mine)

. . . . Not always true. Not true for me. I waited. And waited. And waited. And waited. My body did not expel my baby without a LOT of physical effort from me. Once I started pushing, the baby was born within 25 minutes.

It was this kind of attitude (that it WILL happen, no matter what) that led me to not even try a little push at any time during those extremely painful 8 hours - because I was waiting, waiting, waiting for that pushing urge. I knew that when my body was ready, I would have the urge to push and I could deliver my baby. Except that it didn't happen.

I still have to ask the doctor if he actually did push a cervical lip out of the way . . . if that was inhibiting my pushing urge, however, I should have had an urge after it was out of the way. Or my body should have pushed the baby out spontaneously at that point. But neither of those things happened.

That doesn't mean I needed someone to tell me when to push (i.e., look, a contraction, PUSH!), but I needed to know that *now was the time to start pushing* (as opposed to the prior 8 hours, where I just suffered and waited for the urge, all the while breathing, relaxing, moaning, etc.).

Julia
dd 1 year old
kirk_heidi's Avatar kirk_heidi 03:02 PM 04-13-2007
I was told not to push with my 8 year old and my 3 year old because the doctor wasn't there. I was like...unmmm...I can't stop it, my body was doing it on it's own and I couldnt' stop. I agree that when the body is ready it will happen!
georgia's Avatar georgia 03:54 PM 04-13-2007
Quote:
Off topic, but, that is one of the reasons why I hate it when people knock the whole medical field.
I can understand your frustration, but no one is knocking an entire field of medicine on this thread It's wonderful to hear that there are physicians out there who attend lovingly and non-interventively to the women who have hired them. Sadly, this is not the norm.

Quote:
There are good docs out there and we just have to find them!!!
I think it's important to remember that many women around the world believe that normal birth does not require a doctor or 'medical' assistance and/or intervention. (Modern medicine is, of course, a blessing when necessary).

I really like this explanation of birthing paradigms by Robbie Davis-Floyd


KiwiZ's Avatar KiwiZ 04:04 PM 04-13-2007
Very interesting thread! I remember during my VBAC, the nurse checked and said "10 cm! Time to start pushing!" so I thought OK, just figured that was it. Shortly into pushing, I got the "urge" to push and told my doc/nurses whenever I felt it (I think I just yelled "NOW" cuz I was concentrating so much). We worked as a team, my nurses were so great helping me change position and push and helped me take advantage of my urges there.
the_lissa's Avatar the_lissa 04:07 PM 04-13-2007
Quote:
Originally Posted by gini1313 View Post

Off topic, but, that is one of the reasons why I hate it when people knock the whole medical field. There are good docs out there and we just have to find them!!!
Well some people don't access to good caregivers, whether through insurance or geography. Plus, how many doctors have told women all the right thinsg, only to morph into something else entirely at the birth.
georgia's Avatar georgia 04:32 PM 04-13-2007
Quote:
full dilation = time to push?
This concept is just one more reason I totally believe that internal 'exams' are unecessary and in many cases, detrimental/disheartening/disempowering to pregnant and birthing women.
gini1313's Avatar gini1313 05:35 PM 04-13-2007
Quote:
Originally Posted by georgia View Post
I can understand your frustration, but no one is knocking an entire field of medicine on this thread It's wonderful to hear that there are physicians out there who attend lovingly and non-interventively to the women who have hired them. Sadly, this is not the norm.
I know no one was in this thread, thus why I said off topic. Just I hear that alot, and I know there are good docs out there and they definitely have their place
Jenlaana's Avatar Jenlaana 06:18 PM 04-13-2007
A woman in a coma can give birth vaginally. The body will push the baby out with or without active pushing. It may take "too long" considering the amount of pain many women are in during that stage of labor, or the amount of time spent in that stage, but it would happen eventually.

That being said, I don't knock anyone's experiences. If pushing before the urge hits you has worked for you, then I think thats great.

For me, I tried very hard not to push at all, but had a short point where the baby was so far down that my hips were being forced apart, and it felt very very uncomfortable (scary to be honest, since I Had not felt it before) and i pushed because I couldn't handle that wierdness for a moment longer than necessary. I was lucky, in that by the time I finally gave in, I really only had a few contractions and baby was out....it was definitely < 15 min. It was so fast that my DH was telling me "ok, take a deep breath, lets get ready for the next contraction" and I said "hold on, I have to catch the baby" (she was born underwater, and I was on my knees leaning back...DH was just outside the tub face to face with me) I had no tearing, and very minimal skid marks even, and I attribute it to breathing through every contraction as long as was humanly possible.
timneh_mom's Avatar timneh_mom 07:17 PM 04-13-2007
I'll have to go back and read the thread later when I get more computer time... but with both my kiddos, I felt the urge to push, it was so overwhelming... BEFORE I got to 10 cm! I think if I'd been allowed to give tiny pushes like my body wanted to, I might have dilated faster, at least with my first... I often wonder why some of us get the urge (like a HUGE urge) before we are 10 cm? There has to be a biological reason for it...

But yeah, I agree, if a mom doesn't feel ready to push the baby out, why not wait as long as everyone is stable?

Oops, OK, just read about how one mama here waited hours for the urge!! I have to agree that our bodies all work differently... I really believe that - not just in birthing, but in all other aspects!
AbbieB's Avatar AbbieB 08:14 PM 04-13-2007
I remember having a bit of a break after transition. DD's head was just kinda hanging there, at the cervix, ready to get moving down and out. (DH felt it while I was on a birthing chair and looked to surprised that there was a fuzzy head there-duh!)

It took a little while for the urge to push to kick in so I just relaxed. At some point my midwife asked if I wanted to try doing a hula like gyration to see if it would trigger the urge. I did about 2 circles and next thing I know I was in the biggest squat ever with my body pushing away (no conscious effort at all!).

After that the urge to push came and went, sometimes a little push, sometimes this massive, intense sensation (that felt incredible good).

I can't imagine having someone stand over me, telling when to push, how to push and when to stop. Yuck!
cottonwood's Avatar cottonwood 09:37 PM 04-13-2007
Quote:
Originally Posted by twilight girl View Post
I feel like I've heard a million times that women shouldn't push before full dialation and doing so can result in cervical swelling and swollen cervical lips that can prevent the baby's passge. I guess I've always felt a level of confusion about why my body wanted/needed to push so badly before all of my body was technically "ready".
Another myth. Obviously if you're trying to push the baby out before the body is ready, it can cause problems (exactly the point of the OP.) It's actually very common for women to start doing little grunting pushing before full dilation, and bearing down as your body directs you to (only as much as relieves the urge, no more and no less,) will only help position the baby and dilate the cervix.

I felt bearing down urges for three weeks before the birth. It felt wonderful to give in to that, absolutely wonderful. And it didn't create problems at all -- in fact once it was actually time for the baby to be born it only took four contractions for her to traverse the birth canal.

Quote:
Originally Posted by Romana9+2
You've probably read my story or heard me talk about this before, so I'll make it really short, but bottom line, even after over 7 hours of pushing contractions that I breathed and bellowed through uninhibited and alone (except for dh, who spent part of the time asleep), even after that "lip" of cervix was pushed aside, even after all that, I still had no pushing urge. I was too tired to wait through another 8 hours of that excruciating pain for the moment that my body finally decided it was ready to give me an urge to push.
If you had no urge to push, what do you mean by "pushing contractions"?

Quote:
I agree that full dilation does not necessarily mean it's time to push. And I think it makes a lot of sense to wait a while for an urge to push - definitely take a nap if possible. But I just don't think it's necessarily true that your body will definitely have an unmistakable urge to push, or the fetal ejection reflex, or push the baby out on its own if you don't do it yourself. Sometimes, it just doesn't happen that way.
How do you know? By your own admission, you didn't wait to see. What if you had started pushing much earlier? Maybe you would have just pushed that whole time with no progress, wearing yourself out and hurting yourself. Maybe that 25 minutes of pushing that you did do just happened to coincide with a relatively high degree of readiness on the part of your body, even though it was not yet fully ready to spontaneously move the baby down. I was able to push my baby out (in two hours of pushing) without a pushing urge, too; that is certainly a choice, but it doesn't mean that I had to. But please understand, I'm not saying that the choice you made is not valid. I don't know enough about what your body was doing to be able to make a judgment about it, and I didn't say that there is never any reason to try to get the baby out as soon as the cervix is fully dilated. I am only saying that the assumption that the mother must push at full dilation even without an urge is wrong, is contrary to the natural unfolding of labor, and usually makes for a longer, harder pushing stage than she would have otherwise.

Quote:
Originally Posted by Jenlaana
The body will push the baby out with or without active pushing. It may take "too long" considering the amount of pain many women are in during that stage of labor, or the amount of time spent in that stage, but it would happen eventually.
That being said, I don't knock anyone's experiences. If pushing before the urge hits you has worked for you, then I think thats great.
Aw heck, if I'd just read through the thread first, I could've just said, "yeah, that!" You said basically the same thing I was trying to get across, only much more succinctly.

Quote:
Originally Posted by Georgia
I think it's important to remember that many women around the world believe that normal birth does not require a doctor or 'medical' assistance and/or intervention.
Okay, now I get my chance. Yeah, that!

Quote:
Originally Posted by AbbieB
I remember having a bit of a break after transition.
Yes, also very common and normal. I had a break of about an hour after the baby dropped. The "rest and be thankful" stage Sheila Kitzinger talks about.
Full Heart's Avatar Full Heart 11:38 PM 04-13-2007
The "urge to push" and uncontrollable pushing are 2 different things. I've had pushing contractions and uncontrollable pushing or fetal ejection. While both are competly natural and normal they are different. And its a completly different thing altogether from forced pushing. Uncontrollable pushing or fetal ejection your body just wraps itself around the uterus and pushes the baby out. Kinda like vomiting lol. Pushing contractions or the urge to push is like needing to go potty. You feel the need to push. They are different. If you wait through those pushing contractions and never push you might get the fetal ejection reflex. You might not.
2Sweeties1Angel's Avatar 2Sweeties1Angel 04:53 AM 04-14-2007
With my VBA2C, I never really had an urge to push. I was fully dilated for well over an hour, closer to two hours, and didn't have the urge. I don't know if it was because my epidural was blocking the urge (even though I had it turned down) or what. I ended up deciding to just try pushing, so I called my doctor and the nurses in and started pushing. DD2 was born within half an hour, maybe less. She did have a nuchal hand--maybe that effected the urge? I don't know. They kept telling me I'd "just know" when I needed to push and it didn't happen for me. I was a little afraid of rupturing during pushing so maybe I had a mental block on the whole thing.
pamamidwife's Avatar pamamidwife 05:11 AM 04-14-2007
maternal efforts in pushing make up about 30% of the descent of baby. BUT, another poster was right when they said your uterus could do the job itself...it just takes a bit more time.

nobody HAS to push - for most women, the "urge to push" isn't an urge at all - their body just does it. it's like saying you have an "urge to vomit". you know? (and I just noticed that FullHeart said nearly the same thing - but not quite!)

in quite a few cultures women bear down with EVERY contraction all through labor. they do NOT swell their cervixes closed.

a swollen cervix and a very early strong bearing down urge has more to do with a head that is malpresented (asynclitic or posterior, or both) than pushing too early.

what I'm amazed with is the number of women with epidurals that are told to start pushing as soon as cervix is gone. wouldn't it make more sense to labor the baby down to where it's starting to emerge under the pubic bone?
pigpokey's Avatar pigpokey 06:52 AM 04-14-2007
Amen Linda.
lizabird's Avatar lizabird 09:33 AM 04-14-2007
I feel very fortunate to have had 2 births at an awesome freestanding birth center. The midwives there pretty much just let me do what nature was telling me to do.

First baby I started pushing right about 10 cm, totally involuntarily. 2nd baby, I was fully dilated for probably 30 minutes before I started pushing. Midwives both times were just going with the flow and it was great.
My wonderful dh said "Push!" once during my 2nd birth and I practically screamed back at him "DOn't tell me to push!"

I hear so many bizarre stories of hospital birth experiences.
Evergreen's Avatar Evergreen 10:44 AM 04-14-2007
Thank you for posting this. With my second child born this October, I felt very well educated about birth and already had one homebirth under my belt. I also knew that sometimes a woman's body goes into a resting period between being complete and needeing to push.

I just didn't know it could be for eight hours. During her sister's birth I'd been 2 cm for over 28 hours and dilated completely and pushed the baby out (2 pushes) within an additional hour, so I was very unprepared for what happened almost four years later. I was complete when my midwife arrived at my house at midnight. It was about 29 hours into labor. Everything had been long but much easier. However, and I am kind of resentful of both myself and my midwife the way things turned out- though there were other circumstances happening in the background that made us both want to hurry up including two other clients in labor who lived pretty far away.

She held back a lip andI tried pushing in every position, birth stool, tub, squatting, semireclined, knees to chest (my mother's wondedrful suggestion "How about just pushing normally"), side-lying, squatting holding onto the couch...

I never felt the urge. I remember saying, "With Dylan it was so strong, I couldn't have stopped had I tried." Shye actually told me that it was more difficult with some babies and to keep trying. Of course I exhausted myself trying when I shouldn't have been. She was eventually born 30 minutes after arrriving at the local hospital ( almost eight hours after having been proclaimed "complete") in two pushes again.

I know I get a strong urge to push, and I know that next time I will wait patiently for it.
1 2  3 

Up