pushing out our babies, do we need someone to tell us how?

[happypoppy]

I am a student midwife and am interested because there is loads of research that shows that that midwives should not be 'directing' women how to/when to push (like taking big breath in and holding it etc..) as that actually might cause harm to the baby (it gets less oxygen) and may cause mothers to have worse tears.
We are taught that it is best to let a mother push if she wants but that the baby will be born anyway because of the expulsive contractions (and I have seen this quite a few times) but where I work most of the midwives still command the women HOW to push and that they should do it a certain way and often actually SHOUT at the women and tell them they are not pushing strong enough or in the wrong place!
This makes me a bit mad as I feel it undermines our confidence and belief in our ability as women to deliver our own babies!
And basically I was interested in finding out what you all think about it! (a waffly post, I'm not good at short and sweet!)

I think that this is a tricky one because it's often best answered with hindsight. To explain - I was directed to push during my first birth. Second stage only lasted 40 mins or so but I didn't feel that my body needed me to push. I didn't feel any urges but there was a tremendous sense of pressure that felt way beyond my control. In that sense, I can relate to findtheriver's experience - perhaps I was scared because all of a sudden, things had changed. However, I didn't find second stage hard work. Actually, I was also pretending to listen to the mws - I grunted a little to appease them, but didn't put much effort into it. I figured they'd put it down to a crap pelvic floor.

With my second, things had progressed very quickly and the mw turned up at the last minute (I was at home) and really saved the day for me. I was completely out of control. She told me that the baby was too low down for her to register a heartbeat and that I was ready to push and should do so now! I listened, gave a half-hearted attempt during the next two contractions and my little girl was born - no tears too! So here, the mw's expertise - or sense of urgency - was most definitely helpful in my opinion.

Marjean, I think you may be confusing directed pushing with the midwife telling you you are ready to push. I think - and correct me if I'm wrong Happypoppy - that Happypoppy is referring to the type of directing I referred to in my previous post (deep breath, chin on chest......)

I gave birth in a to my first in a mlu, on my back with no urge and a team if screaming medics and after a textbook labour so far, -despite putting in my birth plan that I wanted quiet at that stage!

I hated that I was shouted at during my first labour. I was pushing really hard and also pushing in the right way (the midwife did an internal examination mid-contraction to make sure - but I knew that I was pushing into my bottom anyway). I was very keen to get the baby out, I really didn't need someone treating me as though I couldn't care. DD1 failed to descend at all, despite using gravity and active labour, and I ended up with a horrible ventouse delivery where I was treated like a piece of meat.

So for my second, I had "no directed pushing" as a key part of the birth plan. DD2 also was failing to descend, despite using gravity and active labour again. I was pushing hard, but I was using very controlled breathing. The midwife suggested what was basically "purple pushing" and despite the fact that it was against my birth plan I gave it a go and that was what got DD2 to finally descend. She told me to hold my breath and do a couple of really hard pushes during each contraction, but she didn't shout at me, and she let me decide when to push and how many pushes to do during each contraction. She was also very encouraging.

I was very concerned about a quick second stage, resulting in tearing due to the perineum not having time to stretch properly. As it was, I should have been more concerned about a long second stage as I obviously have a difficult pelvis to deliver a baby through.

So after all that waffle, my conclusion is that I think that it really depends on the woman and the way that the labour is going. Shouting is never a good idea though, in my opinion.

All that 'keep it going, keep it going, keep it going' nonsense can be quite discouraging. Every time I stopped pushing in exhaustion I felt that my midwives were suppressing sighs of disappointment, as if I wasn't trying hard enough. Didn't occur to me to mind at the time, but afterwards I was a bit pissed off. DP was supporting me a lot of the time and said he could feel every single muscle in my body working as hard as it could - it's not like I could have done any more.

withh dd1, epidural with horrendous induction then ventouse, mw was screaming at me to hold breath and push while registrar pulled with ventouse. i refused to do so.

i pushed while imagining doing my weightlifting squats and exhaled slowly and steadily like you do with this sort of exercise. only a graze but awful bruising.

with dd2 - v swift water birth. no mw present, totally hands off dh. crouching over side of the pool, legs akimbo. i felt two quick urges to push but didn't push at all. completely intact and felt better right out of the pool than i did 3 wks after first time.

I had no idea how to push with my first. I was induced and felt completely out of control of everything. Nothing felt natural and I was upset for a long time after the birth because I felt like I'd failed. I never had the urge to push and didn't understand what people were talking about when they spoke of it. The mw was directing me to push but I couldn't feel anything happening. Ds was born with a ventouse in the end.

Dd was completely different. Spontaneous labour, natural homebirth in a birth pool. This time the urge to push overwhelmed me; it felt more like my body was just doing it and I was going with it. I had a doula present at the birth and she was wonderful for keeping me calm. She's against directed pushing when it's not necessary, but the mws who were present didn't direct me in any way. I could have almost forgotten that they were there as they really didn't interfere at all. If anyone had tried to direct me I think it would have distracted me.

As others have said, I'm sure directed pushing has its place but not during a labour which is progressing well naturally ime.

i was told when and how to push with dd1 which was annoying. they didn't let me do it my way.

with dd2 there was no way they could tell me what to do. she was out in 10 seconds!

When I had DD1 the midwife and student midwife just stood back and watched me from a distance and went - 'We're hands off'. I was in a lot of pain and was crying and someone had taken my gas and air away and remember saying 'Can someone please help me and tell me what to do' It was horrible. All I remember is their two faces looking at me from the bottom of the bed and saying nothing.
(I really needed some direction so a bit of bossiness would have been good).
With DD2 I was fine (had walking epidural) so just breathed her out in about 2 pushes while the midwife panicked because she wasn't ready and kept saying 'don't push, don't push, I haven't got my gloves on!!!) Was lovely actually.

By the way I'm a trained midwife (don't practice now though) and do remember feeling quite uncomfortable being made to shout instructions about 'push into your bottom' constantly at women 'cheerleading' it's called isn't it?. I think you probably should play it by ear - some women need more help than others I think.
Good luck with the rest of your course.

Thanks for all the wonderful experience everyone is sharing!
I think you are right frazzled..., (feel it would be rude to call you 'old bag' so will leave it at that!!), playing it by ear is prob best and NOT giving someone support and guidance when they are actually ASKING for help as you were is clearly not the way to go!
The decriptions of screaming midwives/Drs and cheerleading(!) is all too familiar and I have rarely asked a woman how she felt about it all after the event, and its really interesting to hear how it makes people feel!

I should add that DH is now very about all the cheerleading and shouting that he did at DD1's birth. He was taking his cue from the midwife and has also told me "but that's how they do it on the television!".

He's right MrsTittleMouse, it is always like that on the tv. And women always give birth on their backs (plus they hardly ever make it to term and labour usually starts with waters gushing.) That is where many people gain their 'experiences' of childbirth so think that's how it should be.

Calling it cheerleading gives me visions of people standing round the bed shouting "Gimme a P, Gimme a U, Gimme an S, Gimme an H whaddaya do? PUSH!!"

Now that would be annoying!

have only read 1st page thoroughly as baby is waking up but as a Doula, I find the time when i perhaps work the hardest, especially on primips is at transisition, when the woman is feeling totally out of control.
I work throught his lots in my antenatal sessions, and we go through everything that may or may not happen inlots of detail therefore my couples are feeling very informed.

At pushing, If i need to , (ie if my lady is getting scared, out of control) I kneel at her head end, and talk very quietly, bringing her back to her focus, telling her there's nothing to be scard of. It's all good, and that her baby is on the way to meet her.
I tell her to listen to her body, breathe and visualise this little baby moving down through the birth canal and out into the world to meet mummy and daddy.

It may seem a bit airy fairy, and sometimes i do need to change the wording etc, sometimes i need to be firmer but onthe whole, it gets ladies back into focus, and gives them renewed strength to get it going.

Am thinking of training to be a mw but am thinking i am a better Doula,

I'm not sure I'd have recognised the urge to push if I hadn't been told. The sensation wasn't what I expected. Once I'd got the hang of it though I found it annoying to be told to push as I felt I'd do it in my own good time.

My doula was invaluable for keeping me calm and focused. Like you Liahgen, she spoke in a quiet calming voice. She spoke a lot about breathing, relaxing into it and visualising everything opening up. It helped me to focus on what was happening, rather than just feeling the pain. Somehow she knew just how to touch me too, yet when she had to go to the toilet my husband did just what she did yet I felt irritated by his touch.

Doulas are wonderful

thanks Ginger for the vote of confidence. Thing is we spend alot of time getting to know our families, (as opposed to mw's who may or may not even have met labouring couple before noe)and we get to know how to talk to them, how to touch, (as you found)and when to just shut up

don't know why but we can do the same thing as partners but they get told off for being irritating, sods law i suppose, poor blokes.

As a midwife I have facilitated many births where the woman has spontaneously pushed her baby out, it often works to not interfere. I do agree that shouting at women is not appropriate. However sometimes a woman will not get her baby out without active pushing. Even if you don't have time limits. Some women just don't feel the urge to push. Some women are too out of control and need more guidance at this stage. The important thing is to take an individualised approach and be an evidence based practitioner.

maxbear can i ask you something please?

[email protected]

thank you

I didn't have the urge to push first time round - or didn't recognise it (or was told to push too early ....) I ended up with a ventouse after several hour of the second stage although no mark because my last push was a BIG one.

2nd time was a home birth and my official second stage time was 6 mins - boy did I push then! However, actually I'd probably been feeling it before that, but I have to say it wasn't that clear. It wasn't the 'omg I have to push' feeling that others describe, I was jsut keen to get the birth finished!

Oh Liahgen - I wish you could come and whisper sensible things in my ear when I'm in labour next time. I think that would be brilliant. Bet you don't live in Scotland do you?
[looks hopeful emoticon]

Hi, I think it just depends. My experience sounds a bit like findtheriver. I had a 2/2.5 hr second stage and in that time never felt the urge to push. They said push when you feel a contraction, yet I couldn't feel anything except that my fanjo was on fire and I was terrified of splitting in two. Frankly it was very painful. Anyway they directed my pushing and in the end got a bit strict I was begging them 'to help me' though not knowing what they could do, I also threatened to cry (v embarrassing).

In the end an older starchy midwife said, 'come on you can have this baby by yourself you don't need an episiotomy but if you don't get on with it it might come to that.' So in the end I just pushed really hard like she said/directed (not on a contraction though as I really hadn't had one for at least an hour and a half) and my baby was born. She also held my hand and supported my knee. It sounds horrendous and if someone told me that they would be so stern/school marmish I would have said how awful and rude etc, but actually she judged it just right, I was empowered by her faith in me and her confidence that this is what I should be doing. I also only had bad bruising and a graze which I guess is a bonus.

So I guess it's one of those it depends on the person/labour type answers.

oh frazzle, I'm sorry, couldn't be much further away. I'm in Kent. Thanks, it does feel great to make a difference for someone.

I am having someone whisper nice things in my own ear when i do it again, (which will be approx ten months hopefully)

Hi happy - well, I had my first just seven weeks ago, I didn't have an 'urge to push' as people call it, so much as my body just taking over and doing it anyway. I didn't even know that I WAS pushing. The MW's thankfully were lovely, and just said 'you've got no control over that have you?' and let me get on with it (my sister had the same involuntary pushing, but her MW's were yelling at her to stop pushing, and ignored the fact, that she COULDN'T stop) The MW's were happy to let these natural pushed do their work, until they saw that there was meconium in the waters, and told me to push three times to each contraction. Don't know if that helps at all, but I guess I'm saying that it only was necessary at the end when they wanted me to push 'artificially' (iyswim) to get him out as fast as possible.

Oh well Liahgen - . If you fancy a holiday to Scotland in May let me know [grin}! And good luck with your next one too! (sorry - hijack)