Pushing stage - how long is too long?

[Sunsunsunnydays]

I have 2 friends who's babies were injured (oxygen deprivation & some sort of bleed on brain) during the pushing stage. someone commented that the pushing stage was probably too long in both cases and intervention should have been considered. I've also noticed guidelines that the midwife should monitor the heartbeat more frequently at this stage. So is the pushing stage the most dangerous stage for the baby? Should the pushing stage be limited to a certain length of time? Does a longer pushing stage increase the risks to the baby? How long is a normal pushing stage? The reason I ask is We were very lucky DC1 wasn't injured during birth so I'm quite sensitive to risks this time and really want to understand them so that I can step in at my risk threshold and ask for intervention. My midwife with DC1 apparently had a very high risk threshold it was terrifying in the end. I'd rather have had the intervention early than to have that kind of emergency.

[Mummyme87]

So 2nd stage should be no longer than 4hours. This includes a passive phase which is not actively pushing.
Baby should be delivered within 3hours of active pushing but mainly for the protection of your pelvic floor.
Yes active 2nd stage is riskier for baby hence why monitoring is more frequent. What you are looking for is that once the contraction has ended is the fetal heart rate returning back to baseline. It's normal to decelerate during labour even more so when pushing but the importance is how quickly that recovers.

[Junosmum]

Most babies are delivered within 30mims to an hour.

You go from midwife led unit to delivery suite at 1.5hours.

Intervention is discussed after 2 hours, unless baby is showing signs of distress. But can be delayed to 3 hours if mum and baby are doing ok.

After 3 hours risk to baby and mum increases. This is increased further (to 'significant') after 4 hours. Most mothers babies who die in labour do so with a 4hour+ second stage.

My DS was delivered by forceps after 3hrs 50mins of pushing. There is significant damage to my pelvic floor, requiring treatment but DS is fine.

The oxygen deprivation can occur due to either cord compression (baby is clamping the cord between self and vaginal wall) or the placenta detatching before baby has fully exited.

[pinguina16]

I had an epidural so midwifes let me be for one hour (helping me turn onto my left side) to see if anything would change (this is standard procedure for 1st baby with epidural).
In my case timings were different because we were coming close to 24 hours since my waters had broken (that's how my labour started) and therefore everyone was working against the clock.
Ventouse was used twice unsuccessfully and then episiotomy and forceps. I wasn't moved to theatre. They brought in lighting equipment in the room. At the time I didn't understand what they were doing and it seemed like they were taking flash photography. They weren't. They were adjusting huge surgical lights so they could see better.
And THEN I went to theatre because blood started pouring out.
And this was only the beginning of a long process to get me back to as healthy as possible. Thankfully my baby was fine.

I'd like to echo a point made by the other posters. Yes, there are risks for your baby but there are also risks of serious injury to you when instruments are used. Not many people want to talk about it but it is truly horrific.

Juno I have read bits of your story on other threads. It is horrific. I wish some of the realities of childbirth were more talked about.

[BaskingTrout]

reading these stories makes me very thankful that my hospital intervened after 2 hours pushing. I had lost all sense of time by this point (end of a very long labour) and couldn't have told you how long I had been pushing for, or even what time it was.
i think whether they intervene so decisively probably depends on whether it looks like progress is being made or there is a chance of a successful vaginal birth. in my case, dd (and her massive head) had turned transverse and were well and truly wedged, she hadn't moved at all during the 2nd stage. so it was off to theatre for a (failed) ventouse and an emcs.
but an earlier intervention has meant no pelvic floor damage for me and no distress for dd.

[Sunsunsunnydays]

Thanks everyone! This has been really helpful. It gives me a rough idea of what to look out for and why. Sorry to hear some of these stories.

[Sunsunsunnydays]

Instrumental deliveries are mentioned here. I've seen another thread on them that would make me think twice about consenting to it. But if the baby is that close to coming out is that the only option after 3-4 hours? Is emcs hard to before if the baby has descended so far. Is instrumental delivery always horrendous? Or can it be okay if the baby is not far off anyway? Do you always need an episiotomy for instrumental? Is there a big risk of tears and do they use a lot of force I heard a story of the Doctor, a fully a grown man using his full weight and strength with his foot on the end of the bed to do a forceps delivery. Isnt this going to hurt the baby? Maybe this is another thread...

[Junosmum]

Sunsun- there is a risk to baby with any intervention, but that has to be weighed up against the risk of not intervening.

With me I could feel DS's head when I put my hands between my legs so he was faaaar too down the birth canal for a section to be viable- the risk to baby of being pulled the wrong way through the cervix and out my stomach was much greater than the risk to baby of forceps.

[Sunsunsunnydays]

Yes that makes sense. In some circumstances they've got to do something and they have to weigh up the risks. I'm going to look at getting a doula or private midwife to support as I'm far too nervous about this. I need someone experienced there who I will trust and who can give a second opinion if I want one. Thanks for your help Juno!

[CremeEggThief]

My DS's head was visible at 8.30, but he wasn't born until 11.31. Naural delivery, but nothing I read before suggested it could take that long. He then slept for most of the following 24 hours, so he must have been exhausted. I foolishly worried he was the only baby sleeping on the ward that night. He more than made up for it once he came home!

[Rosebud05]

With my dd, the midwife got the medics in after 1.5 hours, then again when her heartbeat was decelerating. She had the cord tightly around her neck, which was getting squashed as her head emerged.

There was a definite sense that there would have been discussion/ decisions about intervention at 2 hours, although fortunately dd was born just before this.

[CremeEggThief]

The midwives got the consultant in to have a look at me too and he said I would definitely deliver within 20 minutes, but it still took another 40.

[pinguina16]

Some general links.

www.nhs.uk/conditions/pregnancy-and-baby/pages/ventouse-forceps-delivery.aspx

patient.info/doctor/delay-in-labour-and-instrumental-delivery

Unfortunately these two articles don't go into what would happen if midwives and obstetricians didn't intervene. So to balance them out a little here is a third link.
patient.info/doctor/birth-injuries-to-the-baby

Also there should be no more than 3 attempts with forceps. If all 3 attempts have failed to deliver the baby then doctors MUST move to a C-section. The balance of risks of serious injury or death for the baby then switches over at that point if that makes sense.

[ScienceRocks]

I was under the impression it was four hours. However, I was left at 10cm for six hours with dd1 before anyone got a rush on to do anything, and nearly another two before she was delivered by ventouse. At least I had had an epidural, but I tore badly and needed immediate surgery.

With dd2, I unexpectedly went from 4cm to 10cm very quickly. Nobody believed me when I said I wanted to push. Even after they checked, and realised I needed a ventouse delivery, it was five hours before dd2 was born. No epidural that time. No tear though, just a second episiotomy scar to contend with.

I am still very angry about what happened each time and dd1 is nearly 10.

[stairway]

I had an assisted birth with the vacuum due to apparent fetal distress. In my case it didn't hurt. They used some kind if local but I didn't have an epidural.
I didn't notice the pulling and my mum said the Dr was gentle. My son also had no marks or swelling on his head.
She did cut me and didn't give me a choice on that which I regret because I found the recovery from that awful. I'm glad I didnt get a severe tear though as I made a fall recover with no continence issues. In fact I had more issues with continence after my emcs.
However both births have upset me and I'm planning in elective c sections for any more births.
My friend had forceps for a twin birth. I think she did find it upsetting at the time but has made a full recovery except when doing star jumps!
Most women and will recover fully from an assisted birth. Hth