To push, or not to push?

[MrsMerryHenry]

With DC no 1 I reached a stage where he was in distress and was told I had to push him out. Result: a great, big, lovely tear. Mmmmm. Just what I've always wanted.

I'm preg now and am planning a gentle HB but want to know - are you meant to push if you're labouring from a standing/ squatting position? Do you have to push, or does your body do it for you if you 'allow' it?

And where does the breath control come into the picture?

I think you push, whether you want to or not.. most esp if the baby is in distress.. Speaking from experience, and I was planning a gentle hypno style birth,there comes a point when really, pushing is the only thing on your mind.. Or maybe that was just me. Mention it to your dr,so he is prewarned about what style birth you want.

If birth is progressing normally, especially in an upright position, the 'Ferguson's Reflex' should mean that you will push (or rather bear down) involuntarily. However, if you are semi-recumbent and/or have an epidural in progress this reflex may not be strong enough and the midwife may ask you to carry out 'directed pushing'. Of course, if baby is in distress you just push like hell! (Technical term)
If you are following your body's cues you will naturally push more gently or more controlled as the baby's head crowns as it feels like a 'ring of fire' and is your body's way of stretching the perineum to prevent damage. If you are in distress or are doing directed pushing the midwife may ask you to pant of breathe through those contractions as the head crowns to give your perineum time to stretch.
As luxmum says, it's a good idea to pop this in your birth plan as many midwives in my experience slip naturally into directed pushing (and this may be appropriate in some circumstances). Good luck

Or you could have no urge to push, your body doesn't push naturally and so use 'directed pushing' for 6hrs, tear a muscle, burst some vessels and still have no baby to show for it until they send in the big boys with their big instruments.

My body really is a heap of crap.

oh yes, I've seen that too! But I'm pretty sure it is not because your body is a heap of crap and I'm amazed they let you push for 6 hours (no wonder you burst some vessels)

Reikizen - that makes perfect sense based on my past experience. I want to discuss this aspect of the birth with my MW/ consultant and so it's really useful to get such good info - I always thought your body should do that automatically at the right stage, and so thank you for confirming that! - are you a doula or something?

Baby was in distress (I believe) because I was semi-recumbent. Won't make that mistake again.

SOH -

Oh no I'm a big fat failure and won't be told otherwise. I was trying for a homebirth. The pushing was at my insistence mainly and dd was not distressed at all until I had a spinal block before the em cs.

reikizen, do you know anything about deep transverse arrest?

A (newly qualified) midwife. I am a firm believer that poor obsteric practice often leads to the problems that we pat ourselves on the back for 'saving' mums and babies from. No reason at all to be on your back unless epidural in progress and if you read around the subject (The Labor Progress Handbook is a good one, and the MIDIRS Informed Choice leaflets are helpful too) you'll find more and more evidence to support the beneficial effects of upright posture.
Some midwives are uncomfortable helping women to birth in alternative positions due to unfamiliarity - but that shouldn't be your problem!

"Some midwives are uncomfortable helping women to birth in alternative positions due to unfamiliarity - but that shouldn't be your problem!" - it's SO good to hear that from a mw. I was explaining this to DH, who insisted that they had good reason for keeping me on my back, saying "you couldn't see what I could see" otherwise you'd say the same - i.e. that my perineum was raised and blocking DS's exit. But I told him that the mw should have waited for DS to retreat up the vaginal canal, and then pulled the perineum down using her fingers to ease passage - at which point he went: "Oh, okay." . Maybe it's because there was an OB in the room that the mw didn't do that - or maybe they're just not used to that sort of stuff. But I've read my Ina May Gaskin, that's where I got it from!

In my case they got me on my back as I'd had a (painless) bleed and they needed to check what was going on - fine, fair enough. But I insist that I didn't need to stay there afterwards. And I am convinced that that "poor obstetric practice" as you say, is why I tore (and ended up with months and months of pain and crap healing and blahblahblah...)

Okay, I'll get off my soapbox!

What happens if you push when the MW's are telling you not to? Why do they do that?

Midwife (with 18 years experience) here.
Pushing is one of those things that you just cant predict until it happens. Some women do it instintively and baby comes easy, some women fight it and hold back so baby stays put, some women dont recognise the feeling and push all the effort into their face and some women cant feel a thing cos they have an epidural. So, lots of different situations to consider.
In an ideal situation, a woman is listening to her body's cues and when the urge comes it feels sort of like a dose of diarrhoea coming - you cant stop it and you go with the flow. As the baby's head is stretching the perineum it is in your interests to do this bit slowly so the perineum has time to stretch, although if you have had a baby already this will take less time! Imagine pulling a tight necked t shirt over your head and you reach the point where it is at your ears and then your head pops through. If the fabric is fragile and delicate rather than stretchy it might tear. Same with your perineum. So Midwives ask you to huff and puf and blow and breath through this last bit so that the stretching can happen and you have less chance of tearing. It will not prevent all tears but it does make a difference.
There are differing schools of thought regarding the midwife supporting the perineum with a warm or cold pad. Apart from the comfort it can give the woman in reducing the "burn" it can be useful to feel how fast baby is coming. I am a hands poised kind of person and watch, wait, watch, wait, watch and guide if I need to. All depends what's happening in that second.

Thank you traffic warden.
What if you have an urge to push before you are fully dilated? Can you do any damage to your insides?

i had massive urge to push when i had my 2nd dc last week. mw was worrying as she thought i wasn't ready yet ie not fully dilated. she called OB in. he wanted to give me an epidural to stop my urge to push. i refused. 1 minute later ds was born.

I didn't have to be told to push - was standing upright and just had no choice, diarrhea is exactly what it felt like (only mooooore so!) and the pushing was involuntary. I will only ever labour upright if I can possibly help it, it was (bloody painful, obv) but pretty easy.

Victoriascrumptious - what a marvellous name! Re: damaging your insides if you push before you are fully dilated. Well if you have been examined and you are told you are not fully dilated but still feel like you need to push, again it depends on the whole situation. If it's your first baby your cervix is not so stretchy so if you push on it, it can swell up and slow your progress. It can get very bruised and more likely to bleed so you can try lying on your left side or going on hands and knees with your bum in the air to try to relieves some pressure. Or using gas and air to breathe through. Or letting your jaw hang open and make deep aaaaahhhhhhhhhhh noises. Singing even! Swearing might help(I'm not precious about it!) But I know the feeling at that stage is irresistible and you want to punch anyone who asks you to try not to push.
Second or more babies your cervix is usually much softer and stretches easier so if you push before full dilatation it's not such a big deal but still worth trying the above tactics. Not much fun for the baby trying to force his/her head through a hole too small to fit.

MrsMH! I thought I would share my experience here, to add to all the lovely words from the MWs.

I was induced, left on my own with DH in the observation suite because I was only 1cm dilated and they were going to come back in 4 hrs to see how I was progressing. So, I was lying on my left side, in a semi-foetal position and semi-comatose when 2hrs in, I hit stage 2 labour (although only in hindsight did I know that was what it was). The first really big pushing urge, I tried to stop it because I didn't want to mess the bed - but that hurt like buggery so when the next urge to push came, I pushed. Or rather, I let my bod do what it was doing and sod the mess. It did feel rather like I was doing an enormous poo (I wasn't, I had emptied my bowels in the 5 or 6 trips to the loo in the previous 3 hrs) and fluid came out but I didn't care by then. After about 9 or 10 of these big pushes (and god they hurt my back! Twas like being squeezed really hard by a giant hand) I felt DS move down and told DH to fetch a MW - then it was panic stations as he had already crowned and within 3 mins he was out. They tried to stop me pushing while they got my legs out the way but there wasn't much hope of me not pushing by then and thankfully it al goesl went pretty smoothly, with only a graze and no tearing.

The MW who cleaned me up said that lying on L side is a good way to avoid tearing - worked for me. Plus I had taken lots of raspberry leaf for the 2 weeks prior to the birth (in a vain attempt to get DS out prior to needing induction) and that is supposed to help with uterine tone etc.

You can't be near delivery yet, can you?? It doesn't feel like that long ago you said you were pg...

This thread is great - have an appointment with the midwife next week to discuss birth plan for No 3 so it will be helpful (makes note to lie on LHS if possible). However, do any of the midwives on here have any advice for me? With both dcs I never had any urge to push at all. In both cases I had a natural birth with no pain relief so that wasn't the problem.

The only reason I noticed with dd (no2) that I was in the second stage was because instead of one big constant contraction I started having gaps between them, guessed things had changed and decided to have a shove with each to see what happened. In both cases I have had real trouble pushing the baby out (was in a sort of sitting up position so a bit of gravity, not flat on my back) and they both got distressed - seems like I can get to the second stage easily but then my contractions slow and then stop quite quickly. My sister had the same problem, oddly. In one case the doctor in attendance was pushing on her belly to shove the baby out, though that was abroad...

Wow, what fantastic, encouraging stories here!

Firstly - thumbwiiiiiitch! No, not due till the spring, but am already preparing...nearly bought a Moses basket yesterday! But have decided to stick to mental preparation instead. Your story was so encouraging, and I will remember the L side bit - why don't people bloody tell you that before you f***ing tear?? . The OB in my case could see that I was going to tear, so he decided to cut me and then I still ended up with a 3rd degree anyway.

Secondly, trafficwarden you are fantastic. Everything you've said supports what I always thought should happen, so I am immensely encouraged. Could you be my mw? Pleeeease? Pleeeeeeeeeeeease??? I'll give you cake.

One question: why lie on left, not right side? Since we're meant to lie on our right sides during preg to encourage the baby into the correct birthing position, how come during labour it's better to switch sides?

jaype - perhaps a squatting position would mean you'd need to force the baby less then with your prev births? If you squat right now (go on, do it!) and then compare it to sitting as you did during birth, do you see how your muscles are engaged in the squatting position? This will help you enormously when it comes to birthing. I am crossing my fingers for you and for myself, that we both have 'baby diarrhoea'!

Thankyou lovely ladies - I am going to practice my squatting (!), and suggest this is put in my birth plan, or possibly delivering on all 4s but bum down a bit... As long as they know my body is useless when it comes to actually expelling the baby it may make a difference to what they expect of me?

I'm 38 weeks and baby is OP but have been told to lie on left side to encourage correct birthing position. Is that not correct ?

MrsMH - I really wanted to labour in an upright position with dd. I did all the first stage whilst walking around (and leaning over moo-ing and a bit of sitting the wrong way round on the toilet ) and that went really well.

I was then told I was fully dilated and that I needed to lie down to push. I really didn't want to lie down (DD was OP and sitting/lying was really uncomfortable).

Everytime I tried to stand up, squat or go on all fours, the midwifes "gently" encouraged me back on to my back so that they "could see what was going on".

I pushed for 2 and half hours and ended up with a midwife holding each leg and pushing it toward my head. DD was 9lb 12 oz, I had a nasty tear, stitches front and back, inside and outside and a spectacularly knackered pelvis ready for DC2

I was so frustrated but being a non confrontational sort, it being my first baby and my not having found mumsnet at the time, meant I just went along with everything the midwife told me, even though it went against my instincts at the time.

It still wasn't a bad birth but I definitely intend to be much more vocal this time.

for you at having mws who put their needs before yours, Tilly, that's appalling! And from one bad tearer to another, I'd call that a bad birth!

Good luck this time around.

Ooooooh, cake always appreciated but afraid I'm overseas at the moment, sorry!
As for the right/left sides - left side is better for helping baby rotate in the majority of cases as that is the most common way they turn (could go into more detail but its tedious) Either side relieves pressure of the uterus from major blood vessels so better oxygenation for the baby and most simply lying on your side takes pressure of your bum! In either case the change in position is useful in aiding descent and rotation. There's a lot of physics and mechanics involved in the whole process if you want to analyse it but the reality is you keep trying changes of position until you find one that works!
Good luck all of you, will keep checking in.

It's really good cake, I promise you!

Please do go into details - my previous preg yoga teacher told us all about the mechanics of how the pelvis + head work together in harmony, but that was 3 years ago so I think I need a refresher course!

Traffic can I ask you something.

I was 8cm and about an hour and a half later I absolultely lost it because the mask came off the gas and air. Nobody realised accept me and without waiting for anyone I like a derranged banshee fixed it myself and got back on.

For some reason, a couple of seconds later, the midwife turned me onto my back and started to scream 'PUSH' in my ear. And there I was for 3 hours, with NO URGE trying to figure out how to push a baby out of my fanny. In the end an SHO came and jumped on my abdomen and blasted the baby out.

Now my question.

Could it be, that I was mistakenly judged to be in transition when I had the gas and air mishap and therefore was being directed to push far to early. I kept asking to stand up because I was uncomfortable, and they would let me for one contraction (by now coming very very very infrequently) and then insist I got back on the bed. They made me hold my legs and the sorest thing and the only thing I could think about was the muscle-burn in my arms.

2children - it's really hard to know what was going on without being there or seeing your notes. Is it possible they were worried the baby was stressed? Although in that case they should have examined you to confirm you really were fully dilated AND explained why to you.
And if your contractions had dwindled, you were the one with the right idea, getting up and mobile would have helped but again depends what else was going on. If they were worried about the baby it would not have continued for 3 hours so I haven't really got a clue what they were up to.
If the baby is fine there is no reason to push (even if you are confirmed as being fully dilated) until you feel the urge. Lots of women get a resting phase around transition (sometimes called the "rest and be thankful" phase!)
I would ask to see my notes with an experienced Midwife to debrief.