Given an hour to push?? Why??

[HoweyWoloWizard]

Hi! Ds is 5 months now and I've been thinking a lot about his birth. I had an induction due to hypertension. Pessaries did just about nothing but give me very small contractions which were conducive to nothing. Waters were broken artificially at 1.30pm and drip placed at 2pm. At 5pm I was fully dilated. I was given an hour for the baby to get into a good position by himself, fair enough. Then I was told I had only an hour to push! Why was this? I've googled it and can't find anything about only being given an hour to push. I pushed him out by 6.51pm so had 9 mins to spare so I had a fairly quick labour end to end! But can't quite work out why they would have restricted me to an hour of pushing! Any ideas? At one point the doctor come into the room to offer intervention and I told him to fuck off because I wanted to do it myself! Thank you for your help.

Because after three hours pushing I was knackered, torn and needed serious intervention.

I know they interfered with my natural birth and stuck me on the drip because they declared my uterus was getting tired. I have no idea how they knew that, I felt fine In myself and was 9cm dilated.

I pushed for 2 hours and they said if I didn't hurry the dr would intervene even though baby was fine and not distressed. Who knows.

Excessively long second stage can put you at risk of things like prolapses and damage to your pelvic floor.
Of course this might be caused by something else (such as a poorly positioned baby) which is causing both the prolonged second stage AND the damage.

I had two hour second stage and then forceps and ended up with prolapses (at least two, maybe three) and a wrecked pelvic floor. It isn't clear when the damage occurred. Probably both during pushing and during the forceps delivery.

It's because NICE guidelines say that more than an hour pushing (two hours for a first baby) is a delayed second stage and may be indicative of a problem. Midwives should use their clinical judgment however as if someone is pushing effectively, baby is advancing and all is well there is no need to intervene just because the magic hour has passed. It's why many midwives will try and get women to hold off pushing, allowing baby to descend by itself and delay that clock starting to tick.

Could there have been reason to suspect that your baby was becoming distressed?
If not they probably assumed you were at a higher risk of baby becoming distressed due to hypertension and wanted to air on the side of caution.

I agree though, drs and midwifes can be so risk adverse these days, they tend to jump in and act when it's really not required most of the time.

Rainbow mine didn't, sadly. As soon as I hit 10cm I had to start pushing even though I didn't feel like it. Next time I'm waiting for the baby and my body to tell me to push.

Hmm I think mine was longer, somewhere between 1 and 2 hours, but it was my first. I was in a midwife led unit and there was never any suggestion of time running out or intervention needed (which would have requires an ambulance transfer). It actually seemed very quick to me. But I think it was clear progress was being made (ie could see the baby) so perhaps that's why no time limit was suggested!

Fugg - that's just bad practice IMO. Forced pushing achieves nothing, once your ready to push there is physically no way to stop it. Your body is designed to give birth and lot of labour is trusting your body to do what it's doing and trusting your midwife to step in if things go wrong. Time limits and tying to fit every woman into the same pattern is never going to work.

This might be slightly different but.. with dd2 I'd only been pushing for about 15 minutes, I think she was getting distressed. I'd been pretty relaxed until then, thought it was all going well. Mw whispered to me "if you don't push her out soon I'm going to have to cut you.." 3 big pushes later she was our.

Interesting. It was first baby so maybe I should have been given two hours! Now you mention it I was wriggling and squirming and the baby hrm kept going off. I wasn't allowing them to put the clip on his head either. Maybe they decided that was best to make sure baby didn't get in distress then. Thanks for helping me, I haven't been able to fathom that one. I had a second degree tear and a pph if that changes anything.

I didn't feel that I should push the only time I was told to start pushing. (3 dc) So I didn't. 25 minutes later I really needed to push and dc was born on the second.

I think it took so long as it was a compound presentation and he was back to back too. Lots of factors. But I agree, next time I'm following my body.

Agree with RolyPolierThanYou. They were most probably trying to shorten pushing and try to preserve your pelvic floor (ie minimise serious incontinence problems for you).

Scroll down to "inadequate progress"
patient.info/doctor/delay-in-labour-and-instrumental-delivery

Again agree with RolyPolierThanYou about the chicken and egg situation when baby is "stuck" and instruments might be needed. Instruments can cause enormous damage but some of the damage is already there because of the long delay in pushing.

For what it's worth, IMO, education (for laywomen like me ) about the pelvic floor and how pregnancy, labour and birth can affect it is greatly lacking. The taboo seems to win hands down over educating women.

I fail to see how they can attempt to stick to strict time schedules when it comes to childbirth surely if the baby isn't in distress and mum is still doing well, then you should be able to keep going until either baby is born or intervention is 100% necessary!
I was induced and the process was ridiculously quick. Midwife examined me at 7am and I was only 2cm dilated. At 11am I had an uncontrollable urge to push, so I told the midwife. She said "no you don't need to push, not yet"......cue my response of "yes I do! I suggest you check!". She goes "down there" and says "oh maybe you do need to push, I can see your baby's head" it's definitely a case of trusting your body and doing what it is telling you to do. The urge to push is unmistakeable, once you feel it, there's no stopping it!

I was in a similar position to you and looked into it myself. From what I can see it is an arbitrary time limit. The ideal is less than an hour for pushing and they can let you go longer if there is progress. Also induction is more tiring as it happens artificially rather than the slow build up of natural labour, so they take that into account as well.
I made it to just over an hour as I flat out refused intervention as they had a consultant come in at the one hour mark and hover menacingly with a knife telling me if this didn't get moving I'd need intervention...A friend who works in obstetrics told me this is a technique some use to basically scare you into getting a move on
TBH though I didn't have a particular urge to push until near the end so reckon they told me to start pushing too early.

Peppermintinfusion I think the scare tactic is definitely true....I was terrified of episiotomy the entire way through my pregnancy, and when I was pushing the midwife had her scissors at the ready and said "if you don't do this yourself, I'm going to have to cut you".....that got me pushing harder!!!

As a pp said its Nice guidelines which are evidence based.

What normally happens in practice is the midwife will inform the Dr that a woman has been actively pushing for an hour. If there's still "nil visible" then the Dr will generally come in and make an assessment. The Dr will be wanting to make sure that baby isn't in an awkward position where it's unlikely to deliver. If the baby is in a deliverable position and there's been some descent the Dr will want to consider if contractions are effective and also is baby coping with this ok. If it's all looking fairly positive then they will usually say carry on for another thirty mins and then they'll come back and see what change/progress there is.

The drs will be thinking about a few things. Second stage of labour is the most stressful time for a baby and even if baby's HR is ok now it doesn't mean it will be ok in ten mins, 20 mins, 30 mins. The more descent there's been then the more dangerous for both mum and baby an emergency section is as baby can be so engaged it can be a bit impacted. But baby might still be too high for a forceps. So if the Dr in their mind doesn't think it's going to happen then they may want to go to a section earlier rather than later.

A prolonged second stage as well as buggering up your pelvic floor also increases the risk of a PPH. So even if baby is doing well this will be something the Dr will also be thinking about. So again if you other risk factors for a PPH then they may be less inclined to allow things to drag on for ages.

My mw told me two hours (it ended up being 1.40 for me and I was knackered by then but wouldn't have wanted to stop if there was no reason to!).

My mw friend told me it totally depends on the situation and if someone takes over 2 hours but is progressing that is okay - it's the failure to progress and the risk then to the baby that leads to intervention.

I'm shocked at how many women have said the midwife or doctor has been hovering about waiting to intervene! What's their issue?

I was pushing for about an hour (I was only in labour at hospital for 2hrs). Thought everything was fine. Then the midwife ran out and a doctor ran in. They tried to get me to push, but I couldn't feel any urges or contractions (my son's head was just there apparently)

I was then told she was cutting me! I had no idea why she did it. She quickly said 'you're getting a bit tight'. Bullshit, like I cared! I later found out after a debrief (years later) that I was losing blood rapidly and my son's heart rate dropped and didn't recover - why didn't she tell me that then?

I would have preferred to be told 'your baby needs to be born now' and I would have given informed consent. It really wasn't handled the best way it could have been.

As others have said, guidelines are baby born within 1/2 hours of pushing.

According to my notes, i had a 12 hour pushing phase. 'Push' first mentioned in my notes at 6am, baby born at 6.06pm.

However, that's not strictly true. I was in transition around 6am, and an ove-keen midwife noted that. However then at the shift change, the new midwife freaked me out (she couldn't find the heartbeat when she came to check me, a close family member lost their baby through an un-noted mismanage birth so that really frightened me).

Everything slowed and stopped. Contractions still coming but only every 10 mins or so, and weak. As well as being afraid i was also running a temperature (undiagnosed illness), cold (room cold, they couldn't warm it up), tired and hungry (had been in active labour for 24 hours by 6am).

I needed comfort, warmth, to eat and sleep.

What i got was a stream of different midwives telling me how to push. Doctors appeared and started piling on the pressure at about midday. I did then ask to be allowed to sleep. They gave me half an hour. I was just about starting to drop off when they crashed back in 27 mins later to announce 'this isn't really working is it'

Put me on the induction drip, didn't work (contractions didn't feel any different to me). Coached pushing in exactly the position i didn't want to be in. In the end i requested a ventouse help, i knew i didn't have it in me and sooner or later it would be a crash c-section.

I had an episteoemy and PPH. Lost 1.5 L of blood. But no prolapse or any concerns whatsoever about mini-dougal.

The whole thing still pisses me off TBH. A warmer room, a pool, someone, (ANYONE) who had supported me to get what i needed (comfort, warmth, food, sleep) and i would have delivered much sooner, myself, with less trauma all round.