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Discussion Starter · #1 ·
This sounds weird but the last time I felt weird about helping Dads (like I didn't do a very good job) I got great advice and now I feel it's a stronger point of mine... so here goes...

I had a birth (VBAC) today and it went really well but I left thinking I need some thoughts on how to support Mommas at the hospital - and I don't mean ensuring the birth plan is followed or that interventions are avoided or lessened, I mean how to help with pushing in a more pro-active way. I feel like what I offer is fine, but maybe not enough? I'm wondering how you support a Momma who's pushing... what you do when they have an epidural, etc.

Any thoughts? I'd love to hear anything!
~Julie
 

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The biggest one of mine is reminding mama to breath!
They tend to hold their breath and that is okay for a few seconds, but sometimes they forget and try to hold it longer and that can be dangerous.

In all my years, pushing was the 'easiest' as a doula. The mom is usually quite ready for her baby, so, she doesn't need that direct 'link', she is busy pushing her baby out and that is really where her focus should be. Fear is usually gone and the excitement is back, and sometimes they want to push harder, thinking it will be quicker. I just remind them to take it easy and gentle and BREATH!


HTH
 

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Pushing is usually the most stressful time for me as a doula. My DONA trainers instilled in me to let the pushing phase belong in the caregiver's realm. So starting out, I didn't feel comfortable at all helping the mom with pushing because I felt I was stepping on toes.

Then comes the problem with a mom who has an epi and can't feel herself push. And what do caregivers say- hold your breath for a count of ten and push in your bottom, like you're having a bowel movement. Well, all of my "purple pushing" lectures aside, the problem is that I've never seen a woman with an epi successfully push out a baby with no coached pushing. Directed (by caregiver, not me) pushing probably does work better in this case, especially with a first time mom who has no idea what to do...right? I've never seen a woman with an epi who can push along with her contractions for the appropriate amount of time for her.

I've heard all sorts of things from nurses/caregivers on how to push with an epi: bring your legs back and push the baby up to the ceiling; push fingers out (when nurse doing perineal massage), push down in your bottom, etc.

The bottom line: I like to tell moms to push from their diaphragm and not from their face. To imagine their womb totally open and to ease the baby out. But it's hard in a hospital situation for a mom to listen to that when the doctor is saying "push harder! Don't stop at 8- go to 10! one more set! get that baby out! hold your breath!"

You'll learn as you go what works for you and your clients. Good for you for getting as much info as you can!
 

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Discussion Starter · #4 ·
Yeah, maybe it's partly that I don't know how to explain it very well. I explain it how it felt to me and how I've heard my MW friend explain it - but I don't know that we are any good at explaining pushing with an epi. I'm sure that's part of my problem. And then pushing in the hospital is hard - I have seen that Moms who have had a baby in the hospital before and been directed the way you're talking about - when they have a baby again they do it "that way", almost ignoring their body's signals to do it differently. Even if they have their baby at home the second time... (not that some people push that way, but not the majority).

Push with their diaphram... good way to explain.
~Julie
 

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I think one the things that helps with an epidural is being proactive and having the mom advocate for laboring down for at least an hour before begining to push. The other thing I do is do some pre-planning for position changes - "let's do 5 pushes on your back and then see if your side works better" or whatever her range of motion is. It helps break the hospital's pattern of patter and the mom often gets to do the first push her way because the nurse/doc isn't on target with the monitors yet.
 

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I think a good way to have the mama get into pushing is to be aware of her body, even if she can't feel what's happening. If you can, rest your hand on her abdomen, and when a ctx starts, tell her. Let her still breathe and connect with her body and baby. Perhaps when she begins pushing, then, she's at least aware of the patterns going on.

Laboring down is a good suggestion, too.
 

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If the epidural is effective than laboring down is their best bet. The longer the better! I work only with hospital mom's and the majority of them are medicated. I'm a hospital based doula, not private. If a woman is not able to rest during the time from complete dilation to active pushing then I encourage them to breath down with the contraction. Usually they can feel some type of pressure but if they can't then I will tell them when a ctx is happening. This enable them to get into a pattern of breathing. I have them take a deep breath in and blow it all away. Then take a focefull breath and breath it down through their body, past the baby and out the vagina. It is a more mental image with the exhale. I learned this from hypnobirthing couple I worked with. I love this method and find that most women find it very helpful. Especially the epidrual moms that are receptive. I also do not encourage holding breath to 10. I encourage a mom to breath when she needs to and to let all the air out. How many times I see a mom try to take another push without taking more air in.

If the mother is unmedicated then I have her go at it however her body tells her. If she begins to get frustrated then I may coach her a bit. If she gets even more frustrated I will ask her is she would like to do coached pushing with the nurse. I had one unmedicated mom that pushed for a while out of the bed on her own and then when I asked if she wanted coached pushing she said yes and it was helpful for her.

In regard to dad's. I encouarge them to particapate in the compacity they are capable. I try to keep them close to the mom in labor and after birth to touch their baby.
 

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I guess it sort of all depends on a lot of things- which hospital it is, what the parents/mother are looking for, and how the rest of the people in the room are behaving (or not behaving, as the case may be
) Every hospital birth I have attended has been so drastically different from each other, and each circumstance has been different.

One- I was there after having met the mother less than a week before she had the baby! It ended up being a C-section (the hospital in question is HIGHLY active management, and we both discussed the high liklihood of it being that way, as her caregiver was a notorious "slice 'em and get 'em the hell outta here" kinda guy- when the nurses tell you this directly, you know it's something big!) but I felt like I was so involved. She and I are still very much in touch- I helped her get a good start on nursing and helped explain pretty much everything that was going on.

Another- Back at the high management hospital, this time with a partner. The birth was chaotic at best, and choices were made that were vehemently opposed at the birth meetings. But, we flex and deal and work with what we'e given, right? Lots of lessons learned with this birth.

Another situation entirely- totally different hospital all together. The Student Supervisor actually brought nursing students over to talk to me about doula-ing, and they were all really enthused. Apparantly they had just done something on doulas in their class! The Supervisor took pamphlets and business cards from my partner (at the time) and I and we recieved quite a bit of good feedback from everyone at that hospital.

In other words, I guess every hospital is a learning experience, and it's very important to not only meet with the client and establish a good rapport (good enough to feel out the situation) and try to be flexible with what can and does go on in hospitals. It's not very clear advice, sorry! The main thing to remember is that you are NOT responsible for a mother's or parents' birth choices. Give information, offer examples of alternatives and their potential pros/cons, and then just do the best you can with what they let you do. And just when the medical personnel are all getting loud and obnoxious at "go-time," make sure you are speaking quietly but clearly to mom that she is doing it- ignore the commands and just go with her body (sans epidural). With epidural, help support her position and encourage dad to step in- this is a time that a LOT of dads sort of stand there with wide eyes, not knowing what to do.

Clara
 
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