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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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edodgy · 03/01/2006 09:28

My first labour with my dd was 19 hours and i had an epidural 2 hours before she came so couldnt feel anything was told to push and i did but also pushed when i shouldnt have and tore badly. With my second child labour only lasted 40 mins (ds was born at 32 mins placenta came at 40) and there was no way i couldnt push i was telling the mw i was going to push whether she liked it or not!

notasheep · 03/01/2006 21:18

pupuce-my second stages were 30 minutes-does that make a difference.
I am finding this thread really interesting-all this talk of pushing !!
Both midwifes sounded a little urgent at times,but at the end dd gave me a mass of stitches and yet with ds not a single stitch

notasheep · 03/01/2006 21:19

But midwife caused the stitches!

gigglinggoblin · 03/01/2006 21:40

ds1 was 9lb 13 and i was pushing for over 2 hours, most of the time the mw was telling me to push with the contractions. i did have the urge some of the time but not always and by the time he came out i was so knackered i just wanted to sleep and have nothing to do with him. am sure that was the main reason i had such bad pnd.

with ds2 i was told not to push, the midwife was ready to pounce with the scissors and he flew out, tearing me quite badly in the process. is very distressing to be told you cant do something when your body is doing it without your brains consent so you cant stop! didnt get pnd that time thankfully, but did have a bit of a go at the mw (who also failed to put any batteries in her hearing aid so couldnt hear a word i said, stupid woman. made things very difficult)

ds3 was a water birth and absolutely fantastic, after ds1 & 2 i decided i would do it my way and if the mw didnt like it dp was instructed to tell her to sod off. i had a yoga video which suggested relaxing through contractions instead of pushing and it was so easy, it took no longer than ds2 and i was very chilled out and much less tired. i assume its cos i did far less work. i had 2 mw there the whole time (was a quiet day) and they both said how natural and relaxed the whole thing was.

i just wish i had the nerve to do my own thing with the 1st two births, i think women have far too little confidence in their own abilities - sadly mainly due to what they are told by the dr and mw 'looking after' them in pregnancy

Yummymummy24 · 03/01/2006 21:44

I pushed for 3 hours with 1st baby when i saw the forceps coming baby shot out haha. That was induced labour and epidural. they told me what dto do cos i couldnt feel a thing. 2nd time i had gas and air and was pushing when i wanted to was born in 10mins after a lot of swearing. I didnt realise it hurt so much!!!! This time i want them to leave me alone (put my legs in stirrups and led me on my back then invited half the town in to watch wankers!!)

CaptainDippy · 03/01/2006 21:46

Well I was pushing for FIVE hours with DD1 (bitch of a midwife!!) and got a third degree tear at the end of it all - great. Pushed THREE TIMES with DD2 - No stiches - I think you learn from experience!!

Kittypickle · 03/01/2006 21:48

Thanks for posting that. If I ever meet the midwife who said "I want 3 good pushes on each contraction" again I am likely to kill her ! I fully dilated, pushed once whilst the lovely midwife who had been with me since I arrived was there. She asked if I wanted her to stay as it was her time to go off shift but she was happy to stay. Stupidly I told her to go, what a mistake. After 3 hours of pushing I was whipped into theatre as DD was distressed. When I saw the orignal midwife the next day she couldn't believe I had ended up with a section.

sweetkitty · 03/01/2006 21:56

With me it was only when I started making "pushing noises" that the MWs believed I was in established labour. First they told em I was doing it wrong but then apparently I got it right.

I couldn't believe how primitive it felt it was as if my body and DD were doing it all and I was just there (in pain). Nothing could have stopped me from pushing I was shocked at how anal it felt like the biggest poo of my life.

Am due in a week hope this one slides out in 10 mins

Lilliput · 03/01/2006 22:10

Of course the worst thing is when you are told to stop pushing by examining doctor, surely he knows that when the primevil urge is there to push you are going to push and grunt like a caveman(woman)

spots · 03/01/2006 22:20

Really interesting, thanks pupuce. I was 'told to push' with DD and had no inclination to at all. Got a big tear which I can't help wondering could have been avoided if my body had had more time and space to gear up for the big exit. I wonder if I will have the wherewithall to disagree with m/wives if they tell me to push this time around, coming up in spring? Is this the kind of study that most m/wives, most places will have come across already or is it very new thinking? I would love to feel that big poo feeling!

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