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Discussion Starter · #1 ·
In my noncertified doula/birth junkie opinion, a laboring/birthing woman should follow her instincts and push if/when she truly feels pushy. Furthermore, I think it is never okay to count while pushing, or to count at a birthing woman so she sustains a push.

I doula'd for my friend's birth 2 years ago, and her MD and her dh counted at her, and afterward, she reported she liked that, and said it offered her focus and guidance. She knows my opinon, which I hold as fact, that directed pushing is always wrong. A woman should not be told to or encouraged to hold or sustain a push. She had a second child 4 months ago, and purple-pushed with all her might. She herself doula'd for her friend, and counted for that woman.

I would love to learn the opinions of others on this matter--is this a difference of opinion? Is directed/sustained pushing sometimes an ok thing? Is it a for-sure good thing if a mother wants it? Could a woman want it not realizing it is unneccesary?

I guess I don't want to push (heh heh) my position as an anti-counter/anti-breath holder with this friend, if this topic is a matter of opinion. Thank you!!!!
 

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Good topic! For me as a doula the critical part in "directed pushing" that I am opposed to is this: 10cm dilation does not necesarily mean it is time to push with all of your might. Only when the woman FEELS that urge herself should she go with it. Being barked at to push before she feels the urge leads sometimes to looong second stage... As for being given direction or counting during pushing, that is a matter of preference IMO. Some women do want it, they like it and say it helps keep them focused (though I believe their bodies will do this too, if they can listen to just that). As long as the pushing stage is initiated by the woman and not arbitrarily by a 10 cm declaration...
 

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Discussion Starter · #3 ·
Quote:

Originally Posted by hippiemom
As long as the pushing stage is initiated by the woman and not arbitrarily by a 10 cm declaration...


yeeeessssssssss SO true. So much wasted energy and happiness forcing women to go ape at 10 cm rather than at 10 cm + pushy feelings.
 

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Most women dont need any direction while pushing..some are afraid and need it...it should be OK to let the mom try to follow her own feelings..but sometimes...moms WANT you to count to 10..for three pushes..especially moms who have epidurals.

Mary
 

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For me, with my first birth, my MOM kept telling me to PUSH! Over and over. ALL I could think of was "SHUT UP!!!! I AM PUSHING!!!"

I guess some people may like it, but it just got on my nerves.
 

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I personally do not like pruple pushing.. a 10 count of pushing without an in berath isn't very good for our bodies and can restirct O2 to our babez..if the mother will have a long second stage than denying oxygen early on makes little sens.. i think there can be a difefrence between *directed* pushing and purple pushing. Some women need direction, like a pp said especially with an epidural.

Working as a doula I try to discuss it before hand with the woman and see how she feels.. and while pushing I try to allow her the space to communicate her needs.

I found an important aspect of teh second stage in my own birth had FAR more to do with being aware of my vaginal muscles than anything else. I could push and keep my muscles pushign while breathing in and bacially resting before i tried again harder.
 

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For some clients, it does help. Most of the time though it is not needed. We are big believers of letting mom labor the baby down before pushing. With my last client we waited 3 hours after getting to 10 before pushing.
 

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I think it's one of those things that I keep in reserve, pulled out only when neccesary, like hip squeezes for back pain or nipple stim to bring on contractions. Few labors "need" those things, but sometimes it's useful to do.
It's pretty unlikely to be neccesary with a healthy, well-rested woman with an unmedicated, normal labor. Add in exhaustion, an epidural, and influenza, and it might come to a point where the mom only pushes when prompted and there is a reason the baby needs to come sooner rather than later.
 

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Discussion Starter · #10 ·
great responses!!!!!!!

I hear a lot of posters saying that it can help to direct a woman's pushing efforts, in some scenarios.

Does that mean the default attitude towards birth should be: no directed pushing?

Why is directed pushing bad?

+takes mom out of laborland
+takes power/control over birth away from mom
+deprives baby of O2
+wastes energy
and let's not forget this point:
+women might THINK they need to be told how to push, so they think counting is cool

other thoughts/ideas? do I tell my friend that she may like counting, but that it should not be the default function she does with her future doula "clients" (friends, sisters)....or is it her opinion and just as valid as my no-push opinion?
 

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You could do direction in a conscientious way, as in counting to three rather than TEN, my God, and reminding her to breathe in if she seems to be sustaining for a loooong time (i.e. purple). Again, the most important thing is to be sure SHE feels it is time to push..
 

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How do you override the nurses with this?? It is something I have struggled with in my first doula births. I can already see that I need to spend a little more time explaining this thoroughly but they have been pretty well read. So, in the moment when the nurse is literally telling the mother that she is not pushing correctly and that she has to pull her legs back and she has to push longer etc...is there a graceful way of handling this??? Same with positions for pushing. How do you get past the nurses saying that there is only one acceptable position?
 

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Quote:

Originally Posted by MothertheMother
How do you override the nurses with this?? It is something I have struggled with in my first doula births. I can already see that I need to spend a little more time explaining this thoroughly but they have been pretty well read. So, in the moment when the nurse is literally telling the mother that she is not pushing correctly and that she has to pull her legs back and she has to push longer etc...is there a graceful way of handling this??? Same with positions for pushing. How do you get past the nurses saying that there is only one acceptable position?
We discuss this at length in our prenatal meetings. I tell them to follow their body's lead. Your body KNOWS how to breath and KNOWS which position it needs to be in to birth. The breathing part is easy. She can just tell them to be quiet so she can birth her baby. For pushing, they can't force you into any position. It helps if the mom just says "I'll push where ever/however I want, please be quiet or leave the room."
 

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It makes me glad I'm not having a hospital birth, because I'm quite sure my words to whoever was counting my pushes would be to "SHUT UP!" among other unkind words. Never been through abour before, but I really do not think having someone screaming at me while I'm trying to squeeze out a baby would be a pleasent experience. I hate it when people talk when I'm trying to concentrate, most people do. In any case, I'm with the pp who said it shouldn't be 10cm, but 10cm + the urge to push. Sometimes there's a gap in there, and pushing before you're ready seems tiring and counterproductive. I don't really like the timed count to ten either, it seems too long. My plan is to keep an open throat while pushing and remember to breathe, I'm hoping not to tear, and the open throat and self-directed pushing seems to really cut down on that.
 

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I think it depends on the mom. I didn't find it helpful for someone to keep telling me to push while I was pushing. I didn't like when someone tried couting to 10 and it was like a let down if I stopped before then.

Maybe if the woman wants a goal and you said you'd count, that would help her focus, but I think it's what she's comfortable with. When I had my epi birth, I didn't know when to push, how to push, how long to push for... but somehow only pushed for a short amount of time anyway. With my unmedicated birth, everyone in the room could have been counting and I wouldn't have paid any attention to them. I did what felt right.

My plan is to talk to the mom and let her decide and let her also keep her options open so that if she wants me to stop doing it or start doing it, she can feel free to do that. I don't want to push my views on them and make them uncomfortable, you know?
 

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I did not want to be directed for pushing. I wanted to follow my body and my mw so I didn't tear. however, I became very discouraged at some point, and a nurse said to me... how about we count to 5 this time? So she held my hand and counted to five with me. It really helped. They didnt' keep counting, and I pretty much pushed when I needed to and rested when I needed to. I knew what my body was doing, and didn't push or hold my breath past the point of my abilities because someone wasn't finished counting yet, but that nurse really helped me feel like there was something concrete and short term, instead of the thought in my head... you could be doing this for 3 more hours!
 

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With the two women I had this issue with, I just spoke really low and quietly to the mother. When she would have a contraction, I just pulled her closer to me, and spoke gently and quietly, "Your body is pushing, you can help, if you want to. If you want to wait, do so." I didn't totally ignore the nurse, just pulled the mother further into her laborland with me.

With one mama, she had to pee. She had been pushing with all her might on her back for close to 3 hours. We were getting to the point where she was exhausted, and the OB was getting antsy, and mentioned cesarean birth. I told the nurse, "_______ needs to use the restroom." The nurse actually told me, "Then we'll have to cath her, because she can't have this baby in the toilet." Oh, right. So, they'd rather her have a cesarean birth than birth upright perhaps on the toilet. Ooooo-kay.

I said to the mom, "They don't want you getting up, can you just stand in bed and pee?" She did, into an emesis basin, and right after that, her baby crowned. The nurses were not around, and she BEGGED me not to get them. I felt so sad for her, she just wanted to bring her baby into the world in peace. Her husband ran for the nurses, and the OB walked in, demanded she be turned to her back, and commanded her to purple push. Again, I just spoke softly to her, encouraging her to push as she felt, and her son was born a few moments later.
 

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Maybe this makes me sound dumb, and I swear I did tons of reading before going into labor, and yet, I did not know how to make effective use of my contractions when I got to the second stage. I had been in labor for a long time at that point and was exhausted, scared, and frankly not at my best, mentally or physically. While I never would have thought so beforehand, having someone "take charge" and walk me through what to do was a real lifesaver. Now granted, this was not what you see on TV--it was my hb midwife who took charge and she didn't do the counting to ten, she just reminded me to push, then breathe, and then push some more. Without her direction, embarrassing as it is to admit, I think I would have just sat there halfassedly pushing all night and ended up needing to transport for exhaustion. I was just too scared and out of it to try my hardest without some encouragement. So in that situation, it was the right thing.
 

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That's definitely not stupid at all belgiansheepdog.


When I felt it was time to push I tried different positions. I eventually decided to get in my bed, laying down to push. I think I pushed maybe two times before I said to my dh, "Count for me!" But I only wanted him to count to seven. It's so strange being in that moment. I would've never thought that I'd actually want someone to count during each cntx for me but aparently I needed it. I think I only had him count to get me through a few pushes and then yelled at him to stop. (
) I remember it getting annoying. But I must say that it really did help me focus.
 

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this has really made me think

with my first when i had an epidural, wasn't well read, just had no clue i don't remember anyone counting. i do remember being given some kind of direction as far as breathing. definately didn't do any purple pushing.

with my second i had no drugs, had read alot , taken a class, had a mw instead of ob, etc i started pushing when i wanted to no counting either. she did encourage me to push towards the end when i was tireing. i'm wondering if i had sat out a few ctx w/o conciously making an effort to push if i could have avoided the episiotomy?

heartrate was up for baby though so mw wanted to get him on out. i had had some swelling at the lip of my cervix too as well as a face up baby.
 
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