Why Do You Push with Contractions
Self-directed thrust has long been the type of childbirth recommended in midwifery manuals. Nicole Bennett, a registered midwife and director of the midwifery training program at Ryerson University in Toronto, points to studies that have found that self-directed flare-up can lead to better outcomes for the baby: fewer heart rate abnormalities, better APGAR scores after birth, and better pH levels of umbilical cord blood (less acidic). The possibility for women to work independently with as little intervention as possible is also part of the overall philosophy of obstetric care in terms of promoting choice and autonomy during childbirth. Leaning half back or lying down with stirrups on your back is still very common in many hospitals, especially if you have regional anesthesia or are receiving tweezers or a vacuum delivery. This position does not use gravity and increases the length of the thrust stage and increases the need for episiotomy, vacuum extraction and tweezers. You can apply for a different position if you are not comfortable with this option. Also keep in mind that frequently changing position and even walking (if you do not have epidural anesthesia) is considered an effective way to cope with this period of intense labor. Oppenheimer also says he would always return to the targeted push if there were concerns about the mother or baby. “While the evidence we have so far is that directed thrust doesn`t necessarily speed things up when we`re worried, doctors tend to want to take control and follow the traditional approach we`re used to,” he says. Romano, like most midwives, believes that it is more favorable and effective to let a woman follow her instincts when it is time to push than to give her strict instructions on when to do so. The uterus is already working with the rest of the body to get the baby out, and women who have not had epidural anesthesia will instinctively know when it comes time to push. To avoid tearing, you may be told to stop pressing when your baby crowns – then the widest part of the baby`s head passes through your vagina.
You`re almost at the finish line (or more accurately, baby) – but getting there will require a bit of pressure. So far, you haven`t been able to do much to speed up the birth process, but things will soon change. When cervical dilation is complete, it`s time to help your baby get through the birth canal by pressing. Also, women who don`t feel the need to push may need guidance to help them grow effectively. And if you`re so anxious or tense during work that you have trouble listening to your body`s signals, or if you`re too afraid to press because you don`t like the sensation, coaching may be more appropriate than spontaneous pushing. Obstetricians can have a significant impact on the safe care of mothers and babies during labour and delivery. Pregnant women and their families need accurate, science-based information to use themselves and their care in partnership with nurses, midwives and doctors. In addition to focusing on what to expect during labor and how to manage the pain and discomfort of contraction, pregnant women are often concerned about their ability to push their baby out when the time comes. They can hear their friends and family talking about long, exhausting hours of pushing, while watching televised performances of women who usually give birth after only one or two bumps. The information presented in the childbirth preparation courses provides a basis for expectations about how care is provided and what women need to know to safely complete the last part of labour before giving birth. There is ongoing research on the pros and cons of each method. The American College of Obstetricians and Gynecologists (ACOG) now recommends that women be encouraged to use the thrust technique they prefer and most effective.
It is particularly important to recognize unsoothing FHR patterns during the second phase of labor and intervene appropriately (AWHONN & InJoy Videos, 2006). A common myth suggests that despite the unsoothing FHR patterns during this time, it is better to “take the baby out” than to allow the mother to rest and recover the fetus. Many caregivers do not realize that their aggressive coaching techniques are the cause of unsoothing HRF models (Simpson, 2004). If the fetus does not respond well to pressing, the best approach is to temporarily stop pressing and let the fetus recover (Freeman, Garite, & Nageotte, 2003). If the fetus continues to react badly – as evidenced by abnormal changes in FHR and recurrent variable or late slowdowns – and there is a compelling reason to continue pushing, it is best to press alternative contractions. It may be necessary to squeeze the woman with every other contraction or contraction to maintain a soothing FHR pattern (AWHONN & Injoy Videos, 2006; Freeman et al., 2003). The woman should be placed in a lateral position. A basic FHR should be able to be identified between contractions. The “old way” of helping women during labour in the second phase is usually to press immediately at 10 cm, whether or not the woman feels like pressing; tell the woman to take a deep breath and hold her back (closed voice scratch pressure), while someone (partner, nurse, nurse, midwife or doctor) counts up to 10 for at least four to five push exercises by contraction, since the woman is lying in the prone lithotomy position (often with stirrups); and a caregiver who presses a woman`s legs against her belly (Simpson & James, 2005). These techniques can harm both mother and baby (Simpson, 2004). A full discussion of potential harm in the traditional approach and recommendations for policy changes are presented in the Association of Women`s Health, Obstetric and Neonatal Nurses (AWHONN) Evidence-Based Clinical Practice Guideline: Nursing Management of the Second Stage of Labor (2000). A recent literature review (Roberts, 2002) provides additional information.
It is crucial for obstetricians to keep abreast of the rigorous evidence regarding labour and delivery so that they can provide women and their families with the best available information to promote safe care. In most cases, a work and maternity nurse leads the coaching. You are usually told to take a deep breath at the beginning of each contraction, hold it back, and then tighten your abdominal muscles and push them down with as much force as possible while the nurse counts to 10. This is also known as the Valsalva method. (Some moms say this want to make an effort to have a bowel movement.) Once in active labor, most women will feel a strong natural urge to settle down. This is usually caused by the fact that the baby is pressed on the Ferguson plexus nerves, creating Ferguson`s reflex: the urge to squeeze. Not all women will feel this urge. Whether you do it or not can be affected by your use of regional anesthesia (epidural anesthesia), which can make you feel numb and unable to respond to your body`s signals. At this point, some doctors will remember epidural anesthesia so that the woman can support. The latent phase is an ideal time for the woman to prepare for pushing efforts at the right time (Roberts, 2002). When the time comes to push, the best approach based on current evidence is to encourage the woman to do whatever comes naturally; for example, holding it and holding it as long as possible instead of insisting that it hold its breath for 10 to 15 seconds to count 10 (AWHONN & InJoy Videos, 2006).
Prolonged retention of maternal breathing leads to maternal apnea and negative hemodynamic changes in the mother, resulting in decreased blood flow to the placenta and, ultimately, negative consequences for the fetus (Barnett and Humenick, 1982; Caldeyro-Barcia et al., 1981; Simpson and James, 2005). Three to four 6 to 8 seconds push tests per contraction are physiologically appropriate (AWHONN, 2000; Roberts, 2002; Simpson and James, 2005). If you are asked to hold your breath for a count of 10 during labor, press purple. The practice (also known as direct pushing) takes its name from the image of the poor mother becoming purple, her eyes arched, blood vessels breaking, and a room full of people shouting, “PUSH!” I myself am no stranger to the drama of the push phase. It took over three hours to get my first son out and a year and a half with my second. When it came time to push with my third baby, I was sure it would be an exhausting marathon. Imagine my surprise when it flew away in about a minute while the midwife ran around the room to catch him! When it comes to pushing, you really never know what you`re going to get, but working with your body rather than against it is the path you absolutely want to take. So tie these contractions and take the baby out. If the fetus does not tolerate pressure and the woman has received epidural anesthesia, the passive fetal ancestry approach is very helpful (AWHONN, 2000; AWHONN & InJoy Videos, 2006). There is evidence that in women with epidural anesthesia, a trained pressure that begins immediately at 10 cm does not result in a clinically significant decrease in the duration of the second stage (Fraser et al., 2000; Hansen et al., 2002; Mayberry, Hammer, Kelly, True-Driver, and De, 1999; Roberts, 2002).
Passive fetal descent results in about the same length of the second stage as the coached push approach in women with epidural anesthesia. .