Very worried about pushing after 1st birth

[NeverGotMyPuppy]

Hi everyone
My son is a year old and we are planning number 2 quite soon. Nothing about pregnancy or labour scares me, I found labour quite exciting and feel I would be better prepared for less pleasant bits if they were to happen again (e.g. infected episiotomy). However - the pushing bit is worrying me.

With my first I was in a midwife led unit but had to be transferred due to failure to progress and meconium in my waters. I went from 7cm to 10cm in the ambulance but was then told to wait for an hour before pushing because baby was semi brow presentation. I pushed for an hour, then my contractions stopped, then I was given the drip then I pushed for another hour before I was given the episiotomy and ventouse. I've no complaints about any of it, I trusted that they would do what needed to be done.

However during pushing the midwife kept telling me that I wasn't trying hard enough, I needed to think of things that made me angry and I needed to put myself 2nd for my baby because I was a mother now. I really really tried - so much so I burst blood vessels in my eyes. I stayed calm throughout, I didnt make noise I concentrated on pushing but it just felt to fruitless- he wasnt coming out. The midwife said I needed to give 3 pushes per contraction and I just couldn't manage the 3rd. When he was weighed she said that I would never have got him out by myself.

In preparation for baby number 2 is there anything I can do to make myself better at pushing? I did quite a lot of birth prep but I always assumed pushing was just a case of going for it and clearly I didnt. The episiotomy really ruined my first couple of weeks of motherhood and it was clearly my fault so if I could avoid it 2nd time round that would be great.

Sorry for the essay and any advice would be great. I am aware, btw, that I'm not even pregnant yet and even if I do get to childbirth again I might need a c-sec etc, but this has been playing on my mind.

[Frizzy1986]

Really sorry that you had such a difficult experience. I'm going to tell you what I have been told by my midwife (and it fits in with the hypnobirthing I've done), but this doesn't mean it's wholly true and I'm sure others may have more info.

When it comes to the "pushing" stage of labour, you don't actually need to be pushing that hard. Your uterus works in a similar way to the muscles used when you empty your bowels. It recognises what needs to be done and the muscles themselves will contract and relax pushing the baby out.
Using good breathing techniques and gentle pushes, should be enough to support the muscles without needing to strain and push hard.

Think about when you go to the toilet, you know you need to go as you can feel it, and if you sit there breathing, you can feel your poo starting to move to come out. Even when constipated, straining doesn't help and actually breathing through it allows your body to expell it.

I'd recommend hypnobirthing when you have another. I'm hoping it will help when I give birth this time after having a bad tear last time, due to pushing to hard and too fast.

[NeverGotMyPuppy]

Thanks Frizzy

I did hypnobirthing last time which was why I wasnt too worried about the pushing stage! I went in with the same mindset you have described.

[TillyTheTiger]

I was told EXACTLY the same thing by the midwife at the time (pushing for three hours and also burst loads of blood vessels in my eyes and cheeks from trying so hard)... in actual fact they hadn't realised that the baby was back-to-back and had the cord round his neck and was utterly stuck and there was physically no way I could have pushed him out. I wasn't feeling even a remote urge to push because I think my body knew it wouldn't work. Not my fault. Sounds like it wasn't your fault either.
As I understand it, if everything is going smoothly the urge to push should be more of an involuntary reflex and not involve Herculean effort. I've done the Positive Birth Company online course and understand everything much better this time round (now 39 weeks) so fingers crossed for a better experience.

[Starstruck2020]

I’m sorry your midwife treated you like that, words need to be so carefully chosen. Her practice sounds quite outdated too. If your baby was in a difficult position of course your pushes would be less effective, because of mechanics not your physical effort. It sounds like you gave it 150%

I was fortunate with my babies that they were in good positions and I was able to stay upright during labour and pushing. I didn’t really have to push at all, my body just did it.

Have you had a debrief with anyone about your experience? It might be worth chatting to a counsellor or midwife about your first birth to resolve some of the thoughts you are holding onto and unnecessarily blaming yourself for

[OhTheRoses]

I think you just had a bitch if a midwife. May I suggest that this time you ask to discuss this with the Director of midwifery and write in your notes that you would like the position of the baby reviewed by a doctor at the start of your labour.

You could not have physically pushed harder; if you had burst blood vessels in your eyes you pushed as hard as you could.

What a stupid and ignorant way to deal with a new mother or labouring woman. I am so sorry you went through that.

[WatchingTheMoon]

Your midwife sounds horrible.

Mine has told me that I don't really need to push, that your body naturally pushes and that the only reason they tell you to push is to speed the process up for the doctor's convenience.

[ShippingNews]

I'd agree with PP - you had a bad midwife ( and I'm one too so I do know !). You honestly don't have to push that hard. Your body does what it needs to do - the uterus contracts to push the baby out ,and what you do is just giving it some help. Even an unconscious woman can have a baby without pushing at all. You'll get the urge to push, so just go along with that . No need to visualise angry thoughts etc, it won't help. You'll be fine if you just do what nature tells you to do ! Good luck !

[NeverGotMyPuppy]

Thanks everyone. You kind of confirmed what I was hoping really! Yes she was a 'treat em mean' kind of woman. After labour she was quite condescending when asked for help to remove my dress- it came off over my head so I needed to remove the drip to get it off. I said this and she said 'are you being a bit slow?' When she took me to our postnatal room she said 'I will leave you here and you need do wait for someone to do your drip because you know even midwives need a break'.

Ok maybe she was just a bitch!

[sleepy78]

Hi.
I had pretty much the same thing with my first - the midwife said i had to push more but I felt nothing from the waist down because of the epidural... with my second, I felt it all because he arrived so fast! And the midwife explained something so simple that I had failed to understand... the first time I was somehow trying to push as if I was having a pee but in fact you have to push as if you are doing a poo! Sorry for the crude explanation but I was so happy that the pushing worked the second time that i explained all of the above to the midwife and thanked her profusely! She did look at me like I was slightly insane... but my ds arrived without forceps, unlike my dd so I was happy 😁

[NeverGotMyPuppy]

OhTheRoses I dodnt know you could do that - thank you

[Kittywampus]

I had a pretty similar experience with my first baby, ending up with a forceps delivery. I thought the same as you, that my pushes weren't effective.

When I was pregnant with my second I had a birth debrief and the midwife there explained that my baby had not been correctly positioned, and the forceps had been used to turn her before pulling her out. No amount of pushing would have worked.

The second time around I felt a very clear urge to push, which I couldn't have resisted if I had wanted to. My second baby came out in a few pushes with no conscious effort involved. He was bigger than dc1 as well.

[Magpiefeather]

I’m having similar fears OP.

My DD was born on a very very busy night at the hospital, so busy I later found out they closed the labour ward (after I was admitted).

They kept telling me I wasn’t dilated enough despite me using all my might to resist the urge to push. Then finally I just couldn’t help pushing, it was involuntary, them telling me not to push was like telling someone not to vomit when they’re in the throes of food poisoning or something.

Anyway they finally acknowledged that I was fully dilated and took me to delivery... as I say so busy they were still cleaning the blood off the floor from the previous birth when I was wheeled in. Finally “allowed” to push. I started trying to do what I thought my body wanted me to. After a while midwife is saying “you’re going to have to push harder than that.” “You’re hardly pushing at all”, and then “the heart beat is dropping, you’re going to have to push as hard as you can, you need to get this baby out.”

I was so desperate to avoid any further intervention that I think I took her at her word too literally and pushed with honestly all my might - dd popped out all in one go resulting in 3rd degree tear.

She was fine.

I healed well, but did have some bowel urgency issues and pain. Although this seems much better now (dd is 2.5).

We are kind-of trying for baby 2 now. And I am terrified that if I go for another vaginal birth I will do more damage and will make myself incontinent. On the other hand I have this feeling that maybe it would be different, I would feel less terrified of the physical feeling of giving birth, and I would feel more able to advocate for myself / properly listen to my body. And I feel it might be physiologically very healing if the birth went well. So I’m afraid I have no advice but I am comforted by PPs stories and experiences.

With my birth the cynic in me thinks the midwife made me push harder to get the baby out quicker so they could get the next lady in.

Midwives on the thread.... do ALL baby’s heart rates drop when they are moving down the birth canal? I’m sure I have read something to that effect somewhere.

[userabcname]

Hi OP, I don't think it was your fault at all! I had no urge to push whatsoever but was urged on by the midwife and doctor. Then they said I'd have to have intervention after 3 hours of unsuccessful pushing and I thought bugger it so pushed so hard I thought I was going to split it half (it was indescribably painful) and ended up with severe tearing that caused a pph. I don't think anyone was to blame - I think sometimes things just go wrong and thank heavens we have access to modern medicine and doctors when they do! If it's any consolation I've heard that first labours are much harder than subsequent ones as your body will know what to do next time around so hopefully it will all go much smoother for you.

[OhTheRoses]

Just to reassure, dd's birth, and she was 1.5lb heavier than ds was an absolute dream. But I had insisted on consultant led care and if I wasn't to have an elcs an experienced midwife.

Can any midwives explain why the birth position cord are not more rigorously established. DS was posterior and had the cord wrapped round his neck - the midwife did not realise the position, nor did she take seriously that my baby was struggling three times. Three times his heartbeat disappeared and three times it was blamed on a faulty belt. After the third it was my husband who opened the door and belted "I want and dr in here right now". Midwife 1 arrived and hit the emergency button. The room filled. I was given one push while the surgeon prepared the forceps and hauled by two midwives onto a birthing stool. He was too far out to push back in and they had to cut the cord before he was born. Actually I did manage a super human effort and pushed him out at that point, breaking blod vessels. His apgar score was very low, he was blue and took time to resuscitate.

Neither dh nor I fully understood the extent of the trauma until dd's birth. It was not natural trauma. The midwife should have k own he was posterior, there could have been a qyick portable scan to check cord in early labour, their could have been a discussion about vaginal v caesarean in the circs, the midwife shoukd have acted on the fact the heartbeat was lost, if not the first time, certainly the second.

They weren't busy, it was Christmas day and there were more staff than women.

My advice: insist everything is checked by a doctor and be the squeaky wheel. There was no comparison between that labour and dd's.

And it is important from a resource perspective, I had to have prolapsed bladder repaired and now have a rectocele and a weak anal sphincter. Much of these later problems could be prevented by better obstetric care. If men gave birth these standards would never be tolerated.

[AnxiousFTM]

I don’t have any advice to offer you, just wanted to say that I was treated the same by my midwife telling me I wasn’t trying hard enough or doing it properly and asking why was I giving up, she was even telling me how long I had left to push before they would have to intervene. I literally couldn’t push any harder! Ended up with forceps and a bad tear (which 5 weeks later I’m still suffering with), but I can’t help feeling it’s my own fault for not pushing properly thanks to her comments! x

[Kittywampus]

@Magpiefeather would you consider a home birth this time around? I had one the second time and the midwife took a much more laid back 'watch and wait' approach, partly I suspect because there weren't the same pressures on time and beds as there would have been in the hospital.

[Magpiefeather]

@Kittywampus in theory I would consider a home birth, but my big worry is we are now quite rural and 45mins to nearest hospital should it all go pear shaped....

That’s great to hear your experience. I do think the pressures of beds, numbers etc have a bearing in hospital. Which is inevitable really I suppose. I’m going to research the midwife led units/birthing centres nearby as maybe that would be a happy medium.

[Kittywampus]

@Magpiefeather if the midwife unit is closer to the hospital then that sounds like a good solution.

[GrumpiestCat]

Your midwife sounds horrendous! I reckon if your birth plan just specifies you don't want her and her pep talks anywhere near you you'll feel an awful lot more confident. You are forearmed with knowledge this time: if it's not happening you can't magically push harder. I'm sure you did nothing wrong and I think it sounds sensible to work on the things you can control and hypnobirthing was helpful for keeping calm so defo try that. Good luck OP. The first time is such a steep learning curve.

[NeverGotMyPuppy]

Thanks all, this has been really helpful.

I think I'm going to ask for a debrief and see if I can understand it a bit better. Does anybody know if there is a time limit? DS is just over a year old.

[Kittywampus]

I had my debrief when I was pregnant with dc2, the midwife said that was a common time to have one. That would have been about two and a half years later.

[BlahBlahBlahh]

I know what you mean. I was pushing for 3 hours and I honestly didn't think I could carry on I was so exhausted

[WhoArtinHeaven]

Oh bless you OP! The episiotomy was not your "fault", so please don't think that!

My first birth was a toned down version of yours by the sound of it. I pushed fruitlessly for around 1.5hrs and in the end needed a cut (at which point baby practically flew out). Narrowly avoided forceps. I had pushed so hard that I couldn't move without significant pain afterwards - I had strained muscles that I didn't know I had!

Consequently I was nervous for my next birth.

Honestly it could not have been more different and baby came out so easily in three or four contractions. I tore a little bit, but honestly didn't know it had happened until the midwife told me.

I panicked just before I started pushing and told midwife I wouldn't be able to do it "again" but now wrong I was!

DC2 was bigger than DC1 too.

I honestly think that everything was stretched out during first birth and so was much easier second time. DC1 was stuck in the birth canal and it was the last little bit that I couldn't quite manage. I couldn't believe how easy it was second time around, it still feels surreal now thinking about it!

I hope you have a similar experience.

[Vintagegoth]

Similar story with my first. Very slow second stage and pushing for over 2 hours. Had gas and air taken away as I was told I had had "too much" and was not pushing hard enough. For DD2 I did not push at all and "breathed" her out as I had torn badly with DD1 and was advised not to actively push. She came out in under 2 mins.

So much pressure is placed on labouring mothers to somehow labour "correctly". Untimately your body will do whatever it wants, you can only help it along the way.

[Sparkey47]

You’re allowed to ask for a different midwife if you feel yours isn’t going to be beneficial to your labour/birth, for whatever reason. It’s your birth after all, they’re catering to your needs!