Purple pushing & stirrups V active labour

[SarahLouH]

Hi,

Did anyone else feel they were steamrollered into a traditional birth? I was all geared up for a more natural "calm" birth process and had practised relaxation throughout. I was happy for pain relief! Because of this relaxation, it seems, the midwife I saw in our local Birth Centre didn't believe I was in labour - when I had been for twelve hours, on 2 paracetamol. She sent me to the delivery suite but said they wouldn't be able to do anything for me and would probably send me home. She put her hand on my stomach and watched me have a contraction - that was the exam. Upstairs I was told I was NINE cms dilated. An hour after that I was in stirrups and the doctor was threatening a cut and the venteuse suction to get the baby out. Luckily they didn't need it but I did tear and my baby was born sedated. I am very sure that if I'd been allowed to walk around, do it my way a bit more - none of this would have been necessary. But it seemed the two departments had two very different methods and they just did not communicate at all. The first midwife was very unfortunate timing. She was in the place I should have been having all the understanding and the non-intervention to do it more calmly. Maybe no tearing, definitely no stirrups or venteuse or the sedated baby who then would never breastfeed. But even so the whole experience just showed us what a rollercoaster it is when you're in labour and that a mum really doesn't have any say in anything. I felt like - who am I to argue with these professionals? When I should have had a say.

Does anyone else think something should be done about the choices we are given when delivering and if the midwives from both sides of the birthing philosophies could talk a little more? Maybe meet in the middle. I want to pursue this and see what the professionals say. My husband is really angry at what happened to me, though not at the people who did it. He says I had horrible things done to me by nice people. Hard to reconcile. He told the 3rd (senior) midwife that we'd practised breathing techniques rather than purple pushing and she just laughed and said "do what you want but this is a VIOLENT process and your wife needs to PUSH - PUSH that baby out." He argued when the stirrups came out that I was "pointing the wrong way for gravity to work". That did him no good either.

We had absolutely no control.

Any thoughts?

SarahLou (and angry husband)

SarahLou... I'm sorry to hear about your experience. I think that you need to find someone to talk it all through with... but have a complete mindblock to the website that will help. I'm sure lulumama will be here shortly.

birth trauma association

Told you so! Thanks luladoula!

sheila kitzinger's birth crisis helpline

purple pushing?

and eeeeek ! at stirrups

Sounds like a v. similar experience to mine. I had a lovely labour, wandering around the antenatal ward singing, telling the midwives to F off when they told me to lie down (they were too busy to care) and it was only when I told them that I thought perhaps I'd like some gas and air and it turned out I was 9.5cm dilated that they intervened.

And then they intervened big time. Having managed not to give birth in the lift down to the delivery suite, I tried to squat at the end of the bed to push. Was told not to.

So lay on my back in stirrups, grunting like a pig - was told to be quiet (although in a way they were right - a lot of energy that could have gone through my fanny was coming out through my voice) and then they waved the ventouse at me.

Luckily, I went to a school for Very Assertive Women and I remember roaring "Surely the best thing is for me to just PUSH THIS BABY OUT". So I did. On my back in stirrups. Huge tearing but ho hum.... baby safe, me okay now. But going for a home birth so I can be in charge this time, let me tell you.

You're right. It's as if there's a huge divide in midwifery and you either get the "eat your placenta" side or "the machine that goes ping!" side. Where can the two meet??

specialmagiclady..your post did make me chuckle....but you make a serious point, think you hit hte nail on the head with the 'too busy to care' comment...

yes, it is harder to care for a woman in labour who wishes to mobilise ( no CFm to make sure she and baby are ok) , to roar and vocalise or moo or shout or grunt ( god forbid she should frighten the other women or disturb anyone), and as for squatting or standing or any other position other than lying on the bed ( or we cannot get a really good look and get stuck in for an episiotomy when she has trouble delivering like that)

yes, selfish women in labour, wanting to listen to their bodies and be supported, when we have 6 or 7 other women to look after , much better everyone lies on the bed, drugged to the eyeballs, nice and quiet and stuck on the bed...

i genuinely believe a lot of this is not that midwives do not care, they simply have not got the time to spend, and have to bow to hospital protocol, which often can give a less natural and preferable outcome for the woman....

midwifery services are being cut left right and centre, and it is the labouring woman who suffers ultimately.

anyhoo, rant over, going to do the school run xxxx

sarah lou - I really don't understand why the profesionals don't listen to women in labour. My first dd was born in hospital, and when I went into the second stage, I insisted the midwife take off the stirrups that are routinely used in Belgium where I live, which she did. Then the doctor came in, who promptly told the midwife to put the stirrups back on, and he told me, and I quote ' all women in Belgium give birth on their backs'

Fortunately , labour made me extremely self centred and his orders made me very very angry, and I refused point blank to do what he told me - I had a 'back pain' labour and it was simply agony lying on my back.

I gave birth on my side, with a very small tear, fortunately avoiding a nearly routine episiotomy in this country.

I was lucky to have confidence - I had previously worked in the hospital, and knew I had the midwife and dh on my side.

The poor midwife got it in the neck from the doctor for taking off the stirrups

Similar horrible experience in Portugal. Funnily enough have just been posting about it this morning. (Post called "3 years on I still can't talk about the birth. Is this normal?"

I was NOT allowed to give birth in any other position. Episiotomy led to horrible infection and the whole experience was awful.

Can't even write about it, still shake when I think about it

that's really sad footprints. it's incredible women put up with routine stirrups and episiotomies isn't it?

At my 6 week check, my doctor told me I had been very angry during my labour. I wonder if he ever asked himself why?

My second baby was born at home.

By 'purple pushing' I would guess that you were being encouraged to do valsalva pushing where you put your chin on your chest, hold your breath and PUUUUUSH. This is known to reduce the oxygen supply to the baby (unsurprisingly) but unfortunately lots of midwives still encourage (force?) women to do it. Midwives in training are taught this, but this either doesn't filter down to the 'experienced' ones and/or the newer ones are taught by their mentors do get women pushing this way.

Have you been through your notes with anyone? Your hospital may have a birth afterthoughts service where you can do it with one of their midwives, but if you want independent comments on what happened it might be worth seeing if you can get an independent midwife to go through them with you for a one-off fee.

Were there any concerns about your baby during this, because it's quite unusual to only 'allow' an hour after 9cm dilatation before trying ventouse. Normally a woman labouring for the first time will be given an hour to push from 10cm dilatation, so I wonder whether there were concerns about your baby's wellbeing leading to the ventouse to get him/her out quickly.

I would encourage you to write to the Head of Midwifery and the Chief Executive and tell them your feelings - sadly I think the only way things will change is by women making a stand and complaining. I actually don't think there is as huge a divide in midwifery as people think and the newer midwives coming through the system aren't lentil-weaving, placenta-eating hippies, and just want to practise in an evidence-based, woman-centred way. It's the culture in hospitals which is the problem and these moderate midwives are bullied and pressurised into conforming a lot of the time.

Sorry, just to clarify, when I say midwives in training are 'taught this' I meant they are taught that valsalva pushing can cause problems with oxygen supply.

I'm quite concerned at the idea of ending up at loggerheads with the midwives over valsalva pushing. If I ignore them am I going to get grief from them? I mean, I know I can ignore them, but I can just do without being given a hard time over it.

hmmm//this type of pushing is not always the best way apparently...

Directive vs non-directive pushing

The most common type of directive pushing uses breath-holding to increase and focus efforts. This is commonly know as the Valsalva manoeuvre. It involves taking a deep breath, holding it and straining downwards. However, it can reduce the woman's oxygen levels, and increase her carbon dioxide levels, with corresponding risks for the fetus.

Studies have shown that maternal position in the second stage of labour is also significant because descent of the fetal head and maternal bearing down efforts are enhanced when positioning is upright. One benefit accrues from the other because an upright position encourages descent of the presenting part, which, in turn, augments the bearing down reflex.

"Evidence to date concludes that there are no data to support directed pushing in the second stage of labour and that spontaneous pushing, with a much shorter retention of breath (5-6 seconds maximum, compared with the 10 seconds of the Valsalva manoeuvre) has greater physiological effectiveness. Furthermore, the natural blowing out between breaths that occurs encourages her pelvic floor muscles to relax and reduces the risk of tearing.

Women left to their own devices will choose a variety of positions during the second stage of labour and these are usually the optimum for their own comfort. Whether or not a woman feels able to adopt an alternative position will depend on the birth environment."

wow ! have learnt something new today...

Sarahlou- your experience of the different methods of giving birth is very simiar to mine. I was booked at a hospital with a great birth centre (midwife led) but ended up in the delivery unit. I was due to be induced, but went into labour naturally and the ante-natal people (who asked me to come in to be checked over) sent me to the delivery unit.

From conversations I had had with midwives in the birth centre, they were all very pro-active birth and said that very few women gave birth lying down there (or even on the bed). On the delivery unit, I was stuck on the bed, constantly monitored, they broke my waters which caused the cord to become compressed so there was a bit of a panic about my baby's heartrate for a while, then (because of my position and them having broken my waters) the baby was stuck facing sideways, cue forceps and a section. The whole thing was a catalogue of interventions and the truth is that if they had let me move around I probably wouldn't have wanted an epidural early (or even at all) the baby wouldn't have got stuck, my labour would have progressed faster. I was horrified after the birth when I read on the internet that it is well known amongst midwives that if you want to change the position of a baby, you should change the position of the mother. The midwives who looked after me seemed to have no idea about that at all! And all this after my conversations with other midwives from the birth centre, following which I had concluded that the midwives at my hospital were a progressive and sensible bunch.

I think it comes down to this: the good midwives like to work in midwife led units. The "bad ones" (or less enlightened) seem to end up working in city consultant led departments where if you don't labour in line with the NICE guidelines a doctor comes along and intervenes.

My midwife even looked at me before I started pushing and said "I will need to cut you when the baby comes out". I asked "why" and she told me it was usual! I was soooo tired or I would have suggested to her that tearing can be minimised by having a decent midwife who controls the baby's head.

I am normally a pushy woman, but there was something aout being in such a vulnerable position that made me utterly suggestible. If there's a next time, I am going to take a doula to defend me and some flash cards with "feck off!" written on them...

Sorry I just don't agree with your generalisation that the bad ones end up in consultant led hospitals. I've given birth twice (and had a late miscarriage) in our local hospital which is a consultant led unit. The midwives have consistently been fantastic. They have not "allowed" me to move around but positively encouraged me to stay upright and mobile, basically in whichever position I felt most comfortable and in control. Result was one water birth and another delivered on all fours.

Whilst I have utmost sympathy and respect for those who have had awful traumatic birth experiences, it is unfair to say hospital midwives are either bad or not enlightened.

Sadly this hospital is ear-marked for closure.

SarahLouH - which part of the country are you in?

The use of stirrups for pushing is just horrendous. As a midwife I only get stirrups out when assistance is needed with ventouse or forceps. Women in the midwifery unit mobilse as much as possible. Women who need monitored are encouraged to sit on pezzi balls where possible.
As for 'purple pushing' I am appalled that you were forced to do that.
Why did you need a ventouse delivery? Do you know? Were there concerns about the baby's heart rate? Were your waters broken artificially?
You need to write it all down and if you can, write a letter of complaint to the hospital. Care is supposed to 'Women centred'. Yours certainly doesn't sound as though it was.

Hi very sorry to hear your story Sarahlou, the 'campaign for normal birth' makes interesting reading aswell wish I had time to read it all before I'm induced tomorrow. Anyway, this made me think of something the midwife said at our antenatal classes she said at the moment there is a trend not to push at all, I don't really understand how this works but apparently the baby will come out eventually even if you don't push????

The first part of my birth experience with DS was great - MW led unit and they encouraged me to keep active etc etc. Then my waters went at 9cm dilated and I had meconium. I was transferred through the door to obstetrics because of 'protocol' but luckliy my mw led mw came with me as they weren't busy. They insisted I lay on my back and DS was monitored. Things slowed to nothing... I was offered morphine for the pain which I took. I then felt out of control. The only way I could get any purchase to push was to have a foot on my mw's shoulder. I was encouraged to push until each push was making my lips turn blue. I was told that'protocol' said that if DS wasn't out in an hour of 2nd stage then the dr would come in with the foreceps/ventouse. However, my very good mw lied about the timings... and I took almost 2 hours. Basically the early pushing was getting me nowhere as I wasn't ready!

Rant over sorry. Sorry to hear your experience SarahLouH. Going for a homebirth this time as quite honestly I managed better without all the medical nonsense!

What your midwife means is that you go with your body's natural urges and you bear down naturally without taking a big breath fairyandbump. Good luck for tomorrow

I meant to say that it was only a long while after that I looked at the experience I had retrospectively and saw that it wasn't right. I wish I had complained nearer the time but it all seems too far away now. At the time I was just glad to have DS there and since 90% of the experience was good, I didn't have any tearing etc I sort of forgot about the nonsense at the end.

Defiantely get your notes, get someone to explain them and then write your complaint accordingly.

Really interested to hear about this Oovavu pushing (or whatever it's called) and that it's known to restrict oxygen to the baby. My boy was officially having some foetal distress - and this is the way I was encouraged to push. No wonder he was distressed if he couldn't breathe, poor wee bugger.

Anyway, on the more esoteric matter of culture clash in midwifery/obstetrics, it seems to me that that's the problem. There's midwifery and obstetrics. Why aren't they all singing from the same hymnsheet? Surely obstetricians don't discourage mother-led labour so they can get more practice!!

Actually, the obstetrician at my son's birth was fantastic - he gave me really clear guidance and his voice floated above all the other noise in the room. Good for him.

Hi, I´m 29 weeks with my first and this is something that I have worried about. I´m sorry if my question is very naive and I certainly have no desire to offend but I genuinely want to know - to what extent can they stop us from taking up the position we want or force us into a position we don´t want?

Can they MAKE us i.e. lie down and use stirrups?

maveta - I suppose they can't physically manhandle us into a position we don't want - but they can make it very hard for us to argue with them - the professionals have an awful lot of power, when a woman is lying there in labour and in pain.

If you read my earlier post, you can see that I did argue and did get my way- (but it wasn't nice to have to do that)- and i could do that because I had the confidence of having worked in the health profession in that hospital.