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Childbirth

Share experiences and get support around labour, birth and recovery.

Coaching a woman to push.... not the best of ideas!

35 replies

pupucelovesruDOuLaph · 02/01/2006 16:58

For those interested... on the BBC website
news.bbc.co.uk/2/hi/health/4566682.stm

Calls to push 'do not cut labour'

Being told to push may not help a woman in labour
Urging a woman in labour to push makes little difference to how quickly she gives birth, and could cause health problems, research suggests.
University of Texas doctors found "coaching" was linked to a tiny reduction in the length of labour.

And when women were followed up, those who were coached were found to have an increased risk of bladder problems.

However the American Journal of Obstetrics and Gynaecology study only checked the women after three months.

We are moving away from active pushing in order to allow women to do their own thing
Dr Maggie Blott, obstetrician

The researchers from the University of Texas Southwestern Medical Center studied 320 women who were giving birth for the first time, had uncomplicated pregnancies and did not need epidural anaesthesia when they gave birth.

They focused on the length of the second stage of labour - when the cervix is fully dilated and the baby begins to descend.

Half the women were randomly assigned to be coached to push for 10 seconds during a contraction, while the rest were told to "do what comes naturally."

For those in the coaching group, the second stage of labour was shortened to an average of 46 minutes, compared with 59 minutes in the uncoached group.

'No alarm necessary'

Of the 320 women in the study, 128 returned for testing three months later.

Those who had been coached had smaller bladder capacity and a decreased "first urge to void" - the volume at which a woman wanted to pass urine.

However, the researchers stress that bladder function can return to normal over time, so this may not have been a permanent effect.

This report follows an earlier one that found a rise in pelvic-floor problems among coached women.

Dr Steven Bloom, an obstetrician and gynaecologist who led the research, said: "Often, it's best for the patient to do what's more comfortable for her."

Professor Kenneth Leveno, who also worked on the study, added: "Whether or not these functional changes have long-term consequences, I'm not ready to say.

"We don't want to alarm patients about this."

Dr Maggie Blott, an obstetrician at the Royal Victoria Infirmary in Newcastle, told the BBC News website: "People thought they were doing the right thing by encouraging women to actively push during labour.

"But we are moving away from active pushing in order to allow women to do their own thing.

"We try to have a passive second stage of labour and allow the baby's head to come down by itself before encouraging women to push.

"Pushing too much too soon causes the mother to get tired, increasing the risk she will need assistance during delivery, such as forceps.

"It can also cause the baby to get tired, which itself increases the risk of problems at birth."

She said it was possible that pushing too soon could increase the risk of bladder problems, but added other aspects of pregnancy and labour could also affect risk.

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NomDePlume · 02/01/2006 17:02

I have to say that my labour was incredibly fast and intense (3 hours from 1st contraction and membrane rupture to delivery of the placenta) and I don't remember being told/asked to push. I had one of those labours where my body just took over, there was no way on earth I could have fought the urge to push, it was very 'animal' and instinctive in that respect.

pupucelovesruDOuLaph · 02/01/2006 17:06

As it should be. And sometims the urge to pyush arrives later but staff get worried and ask women to push without any urges .
Was that your 1st child ? The survey is of 1st time mums... without epidurals (didn't think they had non-epidural births in the us ).

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lockets · 02/01/2006 17:09

This reply has been deleted

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NomDePlume · 02/01/2006 17:11

She was my first live birth (I delivered a stillborn 24wk DD almost 7 years ago), 2h 30 + 20mins pushing, no pain relief (my choice). It was fantastic actually. Just DH and I and one midwife with dimmed lights. Very low intervention for a hospital birth.

busybusybee · 02/01/2006 17:12

FWIW With dd i didnt push once - midwife kept repeating her request that i should - but there was absolutely no need - dd brought herself out entirely without my help!!!!!!! Clever girl

pupucelovesruDOuLaph · 02/01/2006 17:12

Brilliant

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Pruni · 02/01/2006 17:15

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busybusybee · 02/01/2006 17:18

Thanks Pupuce! Ill be telling that story and probably embarrassing dd until Im old and senile! but im so proud. It was such an amazing and liberating feeling

The best bit was when silly midwife said to dh "Can you say something to her to get her to push?"
Dh said "My wife obviously doesnt think there was a need!"
I think she wanted me to hurry up but i dont understand why cos i was only in labour for four hours and only 2 of those in hospital!

WhatAcow · 02/01/2006 21:26

Good for you busybee - great to hear of people feeling confident to do their own thing and allow our bodies to do what they are designed to do, despite interfering know it all medical 'professionals' who dont know their arse from their elbow!

my first two births were equally lovely. v relaxed for the most part and midwives were excellent (am v lucky, and happy)

having a home birth, hopefully in next couple of weeks, and really like my midwife this time too so am hoping it is her who is on call when it happens. anyway, my mum will be there and shes a v good midwife too so if anyone tries to give me any crap she'll sort them out for me

a very interesting article pupace, thanks for sharing

blueshoes · 02/01/2006 21:30

Pupuce, I found it reassuring to read your original poster. The human body has to be designed to know what to do without coaching.

Unfortunately for me, my dream of an active birth was cut short due to a e-cs following induction. But it is still nice to read the ladies' positive stories here.

morningpaper · 02/01/2006 21:52

It's a bit like shouting at a woman with food poisoning retching over the toilet to "VOMIT!"

hunkermunker · 02/01/2006 21:56

PMSL MP!

I was told to push when I had DS - midwife kept saying "come on, let's have a third push" when I'd already pushed three times that contraction - gah. I don't think I would've pushed less without the coaching though - the urge was totally overwhelming.

morningpaper · 02/01/2006 21:58

The only thing that got shouted during my recent birth in the hospital birth pool was me shouting "TURD!" at the midwife as she sat there doing her thing with the little fishing net.

georginars · 02/01/2006 22:01

I always feel really sorry for women I see having babies in the US, when they do that counting to 10 nonsense for every contraction. I'd have lamped anyone who tried that on me.
How can every contraction merit exactly the same length and type of push? It just doesn't make any sense. Like breastfeeding a newborn every 4 hours, as my mum was told to do and kept recommending me to do. Mad.

notasheep · 02/01/2006 22:04

Urge to push-what is that? when i had dd and ds(both on all fours) i NEVER had an urge to push!!
Dont know if that was a good thing

QueenVictoria · 02/01/2006 22:07

PMSL MP

My MW kept telling me not to push at first. I couldnt help it, it was just happening, its the most bizarre thing. Then when i could push, she kept asking me to pull my knees up more than asking me to push.

pupucelovesruDOuLaph · 03/01/2006 08:35

QV that is what is regarded as managed pushing

Notasheep - how long were your 2nd stages?

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Pruni · 03/01/2006 08:37

Message withdrawn

pupucelovesruDOuLaph · 03/01/2006 08:39

Pruni - most of my clients tell me they did it wrong 1st time around.... and usually they say this as this is what the MW told them (how positive and empowering of her)!).... what a load of s... from the MW!

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QueenVictoria · 03/01/2006 08:45

Managed pushing?

pupucelovesruDOuLaph · 03/01/2006 08:48

Managed pushing is knees up and asking you to push.
Unmanaged is where no one tells you anything and you just can't resist the pushing (as per the article below).

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staceym11 · 03/01/2006 09:08

is it wrong that i never really got the urge to push with dd, no pain relife (excpet gas and air at the begninning) but just never felt the need to push, then when i got told to i did ( as felt i should) and was told i was doing it wrong and to push in my bum!!! where the fuck else she thought i was pushing i dont know!!!!!!

pupucelovesruDOuLaph · 03/01/2006 09:15

Usually if you haven't got the urge to push - UNLESS the baby is distressed - you should be left alone (i.e. not told to push). It may be that the baby is coming down quickly or that you aren't YET ready to push. But in today's NHS.... we haven't got time to wait for you or baby

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saintnik · 03/01/2006 09:19

Really interesting article, thank's for posting it! Thinking back, the worst bit of my labour was when I felt out of control. I'd laboured at home till I felt a lot of pressure so went to hospital & was told I was fully dilated & pushed for an hour only to be re-examined and told I wasn't fully but still had an anterior lip. Grrr. Had an ARM and just lost the plot a bit after that as I didn't want to push at all cos I could feel this head coming down and it was blooming sore - cue lots of shouting at me to push and me wailing "I don't want to - it's too sore".

I wonder if it would have been better being left to my own devices.....or maybe I needed the encouragment and would have ended up with forceps otherwise? Once the baby crowned I felt totally in control again as I could feel what was going on with my hand and I just shut out everything except guideing the head out.

Funny how you can labour very instinctively but it goes out the window once you're in hospital!!

sparklymieow · 03/01/2006 09:20

I was told to push with dd1 and it was a very fast labour and my first natural deliverly. With dd2 the midwife asked me if I wanted to push and I said no, so she just waited for me to be ready.

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