'push, come on, push' a OBEM question

[YuleingFanjo]

OK.

so every birth I see on OBEM there is some point where the labourig woman gets encoraged/told to push. Not always 'push, push, push!', maybe 'come on now, you can do it, well done, keep going' and so on.

is this normal?

is this what happens in labour?

it's just that when I gave birth I was transfered up to the CLU and did the 6-10 cm bit up there on my back. The baby's hearbeat was being monitored and they had to break my waters which had meconium in them. I clearly remember the doctor saying I was 10 cm dilated and I know I asked the midwife shortly after 'so should I push now?' to wich she answered yes. However I don't remember pushing as shortly afterwards I was prepped for a C-section 'as a precaution' and ended up having an episiotimy and forceps. I pushe 3 times (couldn't feel a thing) under instruction from the Doctor and my baby was born.

I just wonder why no one gave Me any encouragement to do the pushing bit?

*nb this is probably why I should never watch OBEM

I might do the notes thing, I have just put a request in to get them. I was on my back or side and being monitored with a trace thingy.

I did talk it through with a doctor a couple of days later but I still feel confused about the lack of encouragement to push.

I try and avoid the cheerleading, pushing style of midwifery but there is a place for it.

In an uncomplicated labour my general routine is;

once fully dilated wait for woman to have strong urge to push. Can wait for up to an hour.

Once active pushing commenced according to protocol women have an hour to push baby out.

I give a little talk about pushing like you're having a big poo, listen to your body and push when you have the urge, talk about aiming for 3 long pushes with every contraction.

Then lots of encouragement, bit more guidance if needed.

I start doing more cheerleading if it doesn't look like woman is pushing effectively, or if we're getting towards the hour limit.

Therein lies the problem Viva- you have to be sure that she has reached 2nd stage. My first labour 2nd stage was recorded at 6 hours as a student midwife did my exam and declared me 10 cm. In actual fact I think I was barely in transition, or even still at the end of the first stage. He was a big baby for a first one (8lbs 12oz) with a huge head and I really think he needed that time to come down slowly. So I "pushed" completely pointlessly for 5.5 hours. I had the stupid obstetrician looming at the bottom of my bed threatening pointlessly to take me into theatre (in the 3rd person as well, the arse).

About 1/2 hour before DS was born the strong urge to push and the right contractions finally came and he actually caught the midwife on the hop in the end still in the middle of pulling on his gown and gloves. I was on a drip by then, but the drip got knocked out of my hand in the brouhaha so it can't have been the drugs doing the pushing. It's unmistakable once it starts. I realised this next time around. I tend to have 10 mn 2nd stages, not 6 hours (!). So one error from a student midwife and I nearly ended up with a CS first time around due to hospital protocol.

I do prefer to examine to confirm full dilatation - for primips but not always for multips.

I don't bother at first but if a multip has been pushing for 30 mins and I see nothing then I'd want to examine. In those first 30 minutes I certainly wouldn't be cheerleading, directing the pushing - just let them listen to their body, etc.

And if external signs are good then I wouldn't be so bothered either.

Had a primip walk into labour ward the other day and say she wanted to push straight away. The sounds were very convincing, I never examined her and 15 minutes later she had a baby.

There's just no hard and fast rules really as every labour is so different.

It is crap btw Duchesse that that happened to you. I did similar as a newly qualified midwife, did a VE and said was fully. An hour later the reg came in to see why she'd not had a baby and found an anterior lip. God, I felt awful.

Ah -ok. So when they declatred '10 cm' I may have actually needed to push for ages? Instead they took me to the theatre and prepped me for a C-section before asking me to push . Then DS came out in 3 pushes.

Were they concerned about baby's heart rate Fanjo? If they were then yes going to theatre as a precaution is a possibility. You could have been pushing for ages in the room and got nowhere. So maybe they thought it was best to try pushing in theatre and see how it went?

Also pushing can cause a baby's heart to have decelerations so if they're already worried about the trace then maybe they didn't want you to push in the room.

It is possible that you don't remember them telling you about pushing because of the G&A, perhaps your partner might remember?

I found that I needed to stop using the G&A so I could concentrate enough to push, though I had quite a bit of instruction from MWs in both my deliveries about when to push and why.

...although I got an anterior lip in my 2nd delivery because the MW seemed to think it was okay to push at 7cm, I'm a bit baffled about that now, I think they assumed I was going to dilate the last bit really quickly (it was expected to be a very fast labour but ended up being 14hrs!) so it was fine to start, but it wasn't, I had to spend ages not pushing so the swelling would go down.

yes, the baby's heart rate had dipped and they had done tests on him by taking blood from his head while he was inside me. He was in Neo Natal for over a week as a precaution (meconium in the waters and suction at the birth) so I do understand there was a need to get him out but have been told it wasn't an emergency.

"You could have been pushing for ages in the room and got nowhere"

I remember really clearly chatting and laughing with the midwife between contractions (Before the spinal and on gas and air) and not ever being told I should push. Maybe I was pushing and didn't know it? All I know is I heard the doctor say '10 cm' and then I said 'should I be pushing now then?' and the midwife saying 'oh, yes'. DH can't remember them giving me any instruction to push either.

This is very interesting, as I've just taken my first Mongan-method hypnotherapy class, where the philosophy is - as someone said up the thread - that what we normally think of as coached 'pushing' is detrimental, as the body is expelling the baby in its own time. On the other hand, maybe what the Mongan book terms instinctive 'breathing down' the baby is much the same as 'pushing'?

My 34 weeks with my first pregnancy so speaking from a position of total ignorance...

If they were worried about the babies heart rate then I imagine Viva is correct and they wanted you to be in the OR before you started pushing, so that they could go straight in if an emergency did occur. I've heard this sort of set-up being mentioned a lot for breech births for the same reasons.

HardCheese - possible they are making a distinction between the wrong and right kind of pushing? As when you push you are only supposed to be pushing with your bump muscles so to speak?

Yes, basically, hypnobirthing doesn't call it pushing as that's too interventionist and aggressive, but the idea is to breathe down through your pelvis, imagining the tummy muscles working in sync with the breathing (there's a lot in the books about how the muscles work and how to visualise them working). Didn't work for me at all...I had a back labour, with an OP baby that was trying to turn constantly, but utterly failing to, but it does for many. I think it all happened so quickly and painfully I just panicked. Waters gone to 5min regular contractions in 20mins, baby turned OP 5mins later...

As duchesse said, when it happens it is unmistakeable but it doesn't seem to happen to all women. I don't know why. The most reassuring thing is that if you manage it with your first, your body tends to more efficient next time and recognises what is happening.
Disclaimer - there are always exceptions and no guarantees.

Thanks, Oeisha and TeWihara - that's very helpful. I was a bit puzzled by the centrality of being told to 'push' to almost any film of birth I've ever seen, yet being told by my hypnobirthing book that this is the wrong approach, and that my body will figure it out...

With DD after a long labour, at the very end her heartbeat started to slow, at which point the MW said "right, this baby needs to come out now", so there was a lot of the push push malarkey at that point.

It didn't feel like pushing to me either. Apparently I was but it didn't feel like I was accomplishing anything.

I pushed all three of my babies out with spontaneous pushing urges and none took longer than half an hour. I was very lucky though. Many first time mums do need direction to push. Hypnobirthing is great for second third etc time mums on the whole but many first timers need to be directed in their pushing. (I am a hands off midwife who does not like to direct pushing if I don't have to)

It is fab when the body takes over and just gets on with it which is what usually happens with people who have had a previous vaginal birth. (as long as they don't have an epidural)

Yes with dt1 I had 3 mws telling me to really push, don't yell (wastes energy) and get ANGRY!!! Which was really interfering with my hypnobirthing voice of the baby will come out like me on a mat at the fast slide at harrow leisure centre. We got there in the end mainly thanks to my amazing souls. By dt2 I'd got the hang of it.

I had very strong pushing urges, had stuck at 4cm for 6 hours and then threatened to give birth to a 7 1/2 lb poo and not in a silly cardboard thing as I'd just broken 1 by sitting on it. I also had a not quite working epidural which I convinced the ob of by holding her hand in theatre (they took my g&a away!). I still think it's not fair I wasn't allowed to scream.

For souls read doula

I was coached with DD1 (induction and so much epidural I couldn't have felt it if they had chopped a leg off). I hated it and was so out of control it took 2 1/2 hours of pushing before I gave up and they had to get the ventouse out (she was crowning but I had no strength left).

My birth plan with DD2 (and DD3) said no coached pushing. DD2 was born in 4 mins on the futon at home (I was upright on my knees resting over the back of the futon). I didn't need to be told to push I couldn't have stopped it for any reason.

DD3 I had to control it as she had a very large head (which we knew from a late scan). She was born in 17 mins in the same position as DD2 was but this was in hospital as DD3 had passed mec. inside me so we transferred in. MW was baffled as to why I wanted the back on the bed up if I didn't want to sit down. The Doula had to use words of one syllable to explain what the heck I wanted to do as the MW just couldn't comprehend why I would want to give birth upright!

I read an article on Michel Odent's Birth Ejection Reflex and it happened for both DD2 & DD3 right down to the random wobblings (with DD2 I was convinced everyone was watching me and expecting me to 'perform' only had DH, Doula and a MW in the house! with DD3 I had an irrational hatred of the G&A mouthpiece and kept throwing it away only to demand it back!). Hoping it happens again with DC4