[AnnieA]

I agreed to be doula/labor support for my close friend. I've acted in that capacity for my sisters but not through the pushing phase, only the labor phase. So this was my first birth to stay through all the way to pushing.

She was 40+5 weeks this past Sunday and she started having bloody show. I encouraged her to walk but she was having a lot of low back/sciatic pain on her right side making walking very painful. She decided Sunday afternoon that she wanted to try castor oil. So I walked with her to the pharmacy which was about a total of 8 blocks roundtrip so she could buy the castor oil. She took it at 3:30 PM. She was having ctx about every 15 mins that were not painful for her. The castor oil kicked in around 7 PM and ctx immediately picked up to about every 5 mins or so and lasted for an hour. They decided to go to the hospital so I met them there around 9 PM. She labored beautifully all night long with only a minor breakdown around 3 AM when she asked for something to take the edge off. But she had instructed me previously to try to redirect her so that's what I did. She got past that and never asked for any pain relief again.

Her water broke around 7:15 AM Monday morning. She was 9 CM around 10 AM but didn't get to 10 CM until close to 2 PM. She started pushing at 2 PM. She pushed in a variety of positions including squatting with a bar on the bed, hands and knees, pushing in the tub, sitting on the toilet and slight recline with grab bars. She pushed for 3 hrs 45 mins before the baby was born. This was her first baby. What could we have done differently to shorten the pushing time? Or is it just a product of the fact that this was her first baby? Baby was 7 lbs 13 oz so it didn't seem to be that the baby was "too big". Baby was OA so that didn't seem to be the problem either.

Thoughts? Suggestions?

 

[nikirj]

Sounds like a variation of normal to me

. To get "average" you have women who push out a first baby in 5 min, and women who have labors like this. For some women it just takes a bit longer. Unless your friend feels like there was something wrong with her birth, it sounds pretty ideal from your synopsis; there's not necessarily anything bad about labor/birth taking longer (with progress happening) unless somebody makes it an issue.

 

[Contented73]

I agree that it is just a variation of normal. If this were a 2nd birth, I would think it odd that it took that long to get from 9cm to 10cm, to baby out. However sometimes for first time moms it just takes that long. Sometimes even though the baby comes out OA, it was OP or asynclitic earlier in the labor and thus and having trouble descending. Maybe her hips or pelvis was tight and just needed some time to loosen. Long pushing phases are hard work for everyone, but again, for a first timer (even unmedicated) it is just not that uncommon.

 

[April422]

What did baby's head look like right at birth? I'd have suspected malposition and been using OFP techniques. Also using the sheet pull or (tug of war) is a great trick to get baby down and under that pubic bone, and it's one I use often to shorten the pushing phase.

Of course I agree wtih the pp too, could have just been a variation of normal, but my instinct says some kind of malposition at least at the onset of pushing that resolved itself by the time the baby was born.

 

[AnnieA]

Thanks for the responses so far. WRT to his head, he had a slight bump/cone on the back of his head almost to the top. Does that make sense? It seemed to be a little lower than the very top of his head.

She did do the tug-of-war pushing technique with a sheet. One of the nurses had her brace her feet on the squat bar and they wrapped a sheet around the top of the squat bar for her to pull. She did o.k. in that position but the best work she did was when the OB would insert her fingers in the vaginal canal during a push to help her feel where to push.

I guess it's just how long it needed to take but part of the problem of reading all these birth stories on MDC is that I had an idea that an non-medicated labor should result in easy and quick pushing.

 

[MamaRabbit]

She may have needed those fingers to tell her where to push towards. I had one mom push for 1 hr with no progress and I suspected she was sucking in instead of pushing out, and so I asked her if I could have a feel while she was pushing. Sure enough she was not pushing down, and once I put my fingers on her perinum, she pushed down. Still took a total of 3 hours pushing though! Ended up with a slightly deflexed head and the head didn't mold. What finally worked was pushing in a squat holding the ladder in front of her with one foot up on a 6 inch step. Alternated feet every few contractions and that's what finally brought the head down.

 

[Paige CPM]

Could be so many of the things the op's said...fetal position, technique? Another thing would be that many hospital practitioners feel (or have been trained) that if a woman is 10cm's it is time for her to start pushing, when in reality, time to start pushing should really be when the baby's head is really low, and in most cases a mama will feel the natural urge to push, this saving her strength for when pushing is really effective. That may have been part of the issue?

 

[AnnieA]

Quote:

Originally Posted by Paige, CPM Could be so many of the things the op's said...fetal position, technique? Another thing would be that many hospital practitioners feel (or have been trained) that if a woman is 10cm's it is time for her to start pushing, when in reality, time to start pushing should really be when the baby's head is really low, and in most cases a mama will feel the natural urge to push, this saving her strength for when pushing is really effective. That may have been part of the issue?

I would have thought the same thing as well if I hadn't been there but the nurses and the OB were so great about letting her do her thing. In fact the nurses urged her to get in the tub at 9 CM so that she could hang out there until she felt like her body was pushing and she couldn't control it any more. Then when she felt like that, they told her to stay in the tub and start pushing there. They were so awesome. It was really great to see the medical side being so supportive of her desire for a natural birth.

 

[mamabutterfly]

Sounds like you offered wonderful support, btw, & sounds like the mama did a wonderful job!

Couple questions:
Did they mention baby's station before she began to push? Did she feel a spontaneous & overwhelming urge herself, or was it suggested that it was time to push?

 

[AnnieA]

Quote:

Originally Posted by mamabutterfly Sounds like you offered wonderful support, btw, & sounds like the mama did a wonderful job! Couple questions: Did they mention baby's station before she began to push? Did she feel a spontaneous & overwhelming urge herself, or was it suggested that it was time to push?

The last time I heard them mention his station was when she was checked at 9 CM and he was at -1 station. So he hadn't dropped too low at that point. She waited until she felt like her body was spontaneously pushing on it's own before she started pushing. The nurses did mention a couple of times after he was born that he had a big head but it didn't seem too large to me. I don't think they ever measured his head though because mama wasn't letting him go once he was out! She finally let them weigh him about two hours after he was born!

 

[Addie]

This sounds really similar to my labor. My early dilation was a breeze - I showed up at my midwife's office at 5.5 cm, then walked to dinner and back before checking into the hospital at 7 cm. But that was at 7 PM, and I didn't start pushing until 5:30 AM. It was that last cm that really got me - it seemed to take forever. I was also unmedicated.

I also pushed for four hours, and tried all sorts of different position. I had a lot of back labor and the baby was probably posterior - I had an anterior placenta, and the baby came out a bit crooked. This was my first birth, and the baby was a bit on the big side - 8 lbs 9 oz. He was also born at 41 weeks.

In talking to my midwife, there wasn't necessarily anything that went "wrong" with my labor... it just took a long time. Another factor was that my contractions were pretty spaced out during pushing - I usually had 5-7 minutes between them. It's my understanding that for some women, it just takes a long time. I too had illusions that a natural delivery would be quicker - it just didn't work out that way!

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