How can I avoid coached pushing?

[hefner]

I'm pregnant with DC2 and I'd really like to avoid what I've heard described as "coached pushing" or "purple pushing". In my first labour the pushing stage lasted about 3 hours. At first I was kneeling or standing, feeling nice and calm and pushing with contractions but after a while (when the midwives changed shifts) they became concerned that my pushing wasn't effective as it was taking a long time. They made me lie on my back, hold my breath and push with the midwives shouting "keep it going, keep it going" etc. I found it really stressful and now when I see something similar on one born every minute it makes me feel a bit panicky and tearful.

Has anyone got any tips on how to make my pushing more effective next time so that I don't end up in the same situation? I'm only 23 weeks at the moment but I'm trying to plan ahead in case there's anything I need to read up on!

Have you the funds for a doula? If you get a good one she can help fend off the midwives for you

They let you push for 3 hours?!

I was told they would be intervening after 30 minutes of pushing!

I don't think I was pushing for 3 hours- it took 3 hours from being fully dilated to dd being born, but I think I had only been pushing for about an hour before they intervened. I'm not sure of the timings, it's all a bit hazy.

Thanks localeditor but I'm not sure I could afford a doula, and I don't fancy having an extra person there during labour although I know they would be there to support me. I don't want to resist the midwives suggestions if intervention is necessary, I just want to reduce the chances of them needing to intervene.

30 minutes! I pushed for 2 hours

OMG holding your breath and pushing is not good for you. It tenses your muscles and makes it all much harder and increases risk of tearing. Get hold of a hypnobirthing book or take a class. The breathing methods they teach you for dealing with pain and also the pushing (or breathing down) method really worked for me, but I didn't really employ much of the visualisation techniques. Good luck.

The 3 hours from fully dilated to birth would have been to allow the head to descend - you should only push/bear down when your body takes over with expulsive contractions.

Make sure your birth partner (DH?) knows how you want your birth to go. You can listen to the MW, but you do not have to do as she/he says if you are not comfortable.

Being flat on your back, holding your breath and having MW shouting "keep it going" is the worst possible way to give birth. Were you told to "push into your bottom"? There is nothing worse than two MW holding onto your legs as you try to push your baby out - uphill. Poor and lazy care IMO, no wonder you don't want to go through it again.

The best advice given to me was to remain active. Keep trying different positions and avoid lying down on your back on the bed as it is difficult fighting off a persistent HCP from this position (IME).

Put it in your birth plan for a start. Something like:

"I would like to push based on my own instincts and not be coached to push. However, I would appreciate assistance/advice on guiding crowning to minimise tearing"

Then point this out to your birth partner, and what it means.

Just be careful though, I had difficulties pushing with DC1 (epidural, uphill, etc) and DC2 shot out like a speeding bullet because I was automatically pushing too hard! Took me to no. 3 to do it hard enough to work but gently enough not to need stitches. Am not attempting no. 4

Oh, and would waterbirth be something you consider? it can be a good way to get space.

Coached pushing is bad midwifery. And unfortunately common in some hospitals. Can you give birth at home or in a birth centre? Or make clear antenataly what your wishes are- sometimes if they are aware what type of birth you want they will allocate you a midwife of the same persuasion!

Shimmy thanks I'll look at hypnobirthing.

Onethird yes that sounds like what happened, it was like my body waited a while while the baby descended and then almost pushed automatically and I just went along with it.

Pic yes they did tell me to push into my bottom, as well as chin on your chest, hold your breath and all the other clichés!

Thanks for the birth plan advice penguins. It's nice to know that coached pushing is not best practice. I had been using lots of breathing techniques, staying mobile and upright and felt like it was happening naturally, but when that didn't work fast enough the midwives said I needed to lie down, legs up etc as that would make me push more effectively. I assumed they were correct but I will be more confident to challenge it next time.

Home birth would be tricky as my parents will be at my house with DD while DH helps me, and I think the lack of privacy would stress me out. I'm planning to go to the same hospital as last time. I was on the midwife led bit of the ward and I was really happy with it until the last bit - before the midwives changed shift it was really calm, quiet and hands off.

Definitely look into Hypnobirthing - I had no directed pushing at all (and I didn't even need to mention it to my midwife, she was just fantastic without needing written instructions!) The only time she spoke to me during the second stage was to say that I should think about changing position because I was on all fours with my bum in the air - she suggested I might get more upright, which I did and it worked a charm. I didn't actively push - my body expelled DD2 and she descended as soon as I was standing up. I didn't tear.

It's likely to be a lot quicker second time round. My DC1 was an hour and a half of pushing followed by EMCS; DC2 was 20 minutes pushing and DC3 was out in three pushes (would possibly have been two but I still had my knickers on). No one even looked as though they were thinking about coaching me with #2 and #3.

Interesting thread. I don't want coached pushing but also I want an epidural again this time (DC2). Not sure what to do!?

Yep, I was flat on my back (would ask next time to have bed tilted more up to make it easier), told to hold my breath, keep pushing pushing pushing into my bum. I asked midwife if I could try pushing differently as I didn't feel it was working and it made me dizzy. She said no . She was otherwise a very good midwife but that annoyed me.

I split like a melon when DS crowned and needed lots of stitches.

In my hospital they let the head descend on its own for 1 hour if you have epidural (I presume if I hadn't had epi I would've had desire to push during this time), and then 1 hour pushing on my own before they use instruments. ie you are allowed to push for 1 hour with epidural, 2 hours without.

Can breathing techniques from hypnobirthing and other sources help with pushing with an epidural?

You could try lateral (on side) rather than on back it's how I had #2 and #3 (sort of rolled into that position with #2, liked it and refused to move). I didn't have an epidural, though if you do you might need someone to hold the top leg for you (actually that might help even without the epidural).

Shelia kitzinger is good on how to understand how your body pushes. She also talks about the rest and be thankful phase, which is when you are 10cms but don't have the urge to push.

Just ask that you be allowed to push on your own terms. I got to 10cm without the midwives realising so by the time they checked, I was so ready to push and the pain meant I couldn't get up onto my hands and knees like I'd wanted, I was propped up but on my back from having the drip and DD having the clip on her head for monitoring - the midwives were great; I hadn't requested anything but they said they weren't going to tell me when to push unless they absolutely needed to. It was relaxed, all on my terms and she was out in three pushes.

I'd definitely recommend asking the midwives if you can push when you're ready, at your own pace for as long as possible.

I would always recommend that you tell the MW how you want your birth to progress. Asking a MW implies that you need permission

I wasn't examined (premature rupture of membranes, then they didn't believe I was in labour bloody was) so the first thing I knew of it was when my body did a weird uncontrollable contraction. I was quite frankly too lazy tired to actively push so just let nature take its course. My friend is a pig farmer, and she pointed out that she doesn't coach the pigs to push - animals are designed to get a baby out so let your body do that.

I would guess asking for exams to be kept to a minimum, and just going with the flow would help.

Strikeout fail