1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.

Urge before fully - to push or not to push???

Discussion in 'Life with a PIN' started by Mkunga, Jun 24, 2011.

  1. Mkunga

    Mkunga Guest

    Just wanted to spark a bit of a discussion.

    Should we discourage woman with an "early" (I.E. before full dilatation) pushing urge to NOT push??

    As a student in placement, I was always told that women should be encouraged to breathe through.
    At uni, we were told to encourage women to follow the cues their bodies are giving them.

    By telling women to not push are we effectively taking control away from them? Are we telling them that we know their bodies better than they do?

    And by not actively discouraging pushing, are we facilitating harm to mum or fetus?

    So, when caring for a woman with a spontaneous urge to bear down during contractions, which is it? Push? Not push?
     
    #1
  2. GrowingRoses

    GrowingRoses RM

    Joined:
    Nov 28, 2008
    Messages:
    2,222
    Likes Received:
    171
    Status:
    Not Specified
    #2
  3. MidwifeMummy

    MidwifeMummy Well-Known Member

    Joined:
    Nov 16, 2008
    Messages:
    3,427
    Likes Received:
    23
    Status:
    Student Midwife
    from my experience as a mum, i pused both times before i was examined.

    The first time the midwife said "are you pushing? your not ready yet" i was then VE'd to find in fact i was fully dilated. So in fact by body was right to want to push at that time.

    the second time i got to hospital after being told on the phone i couldn't possibly be that far along (pants contractions, like first time!) and i was examined afdter the midwfe could c i was in pain and pushing, she examined me and then pushed the buzzer, as i only had a lip left.
    She told as she held babies head then she said right BIG push two mins late baby arrived!

    so both times my body new wayyyyyyyyy before the midwives so i'm definate for the pushing!
     
    #3
  4. Mumkey

    Mumkey Member

    Joined:
    Apr 13, 2009
    Messages:
    594
    Likes Received:
    1
    Status:
    Midwife
    Very interesting link! Thanks for sharing, GrowingRoses. Definite food for thought.

    I have cared for a few women who have had urges to push before full dilatation, usually when the baby was in OP, and also one with a thick anterior rim. I wonder what the outcomes would have been if they had been labouring at home or in a midwife-led unit, and therefore probably more mobile and active, rather than in the consultant-led delivery suite, in which the two OP babies were born by section, and the anterior rim baby by ventouse...
     
    #4
  5. Lil Miss Sunshine

    Lil Miss Sunshine Well-Known Member

    Joined:
    Apr 8, 2010
    Messages:
    6,520
    Likes Received:
    773
    Status:
    Not Specified
    with my last baby i was told an hour before feeling a real urge to push that i was 6cm, i was in a lot of discomfort (to put it mildly) and asked for an epidural, i thought no way can i go on with this feeling for seveal hours. My husband was insisting that he thought i was fully just because of how i reacted with my son's birth previously and was asking them to please examine me before giving me the epidural. They wouldn't. Epidural needled went in my back, head crowned and she was born within 2 minutes of the epidural needle going in so i had no effect of painrelief but had also had that procedure done so close to actually giving birth.
    I remember pushing her out and shouting 'look at my toes the epidural isn't working' whilst wriggling my toes.
    So anyway, basically before the epidural needle went in my body knew i was ready to push but all that interference really did more harm than good. Had i been at home, i'm sure i'd not have asked for the epidural or had the pph afterwards, but that's another story eh.
    I think women need to be listened to more but to obviously notice those changes in a woman and in her individual behaviours/signs.
     
    #5
  6. Mkunga

    Mkunga Guest

    So what about the woman who has an OP baby on board, and you V.E and find her 8 or 9cm. She's pushing spontaneously and strongly and no amount of encouragement can get her breathing through?
    Even when a change of position makes no difference to the urge she's feeling.
    As midwives, do we encourage, or do we discourage?

    There is concern over premature pushing causing oedematous cervixes (cervi?), but the evidence of premature pushing causing this is actually rather thin on the ground. So why do midwives tell women not to push, when surely this is a variation on normal labour? Surely if her body is telling her she needs to push, then it's doing so for a reason?

    Sorry - am on my soap box a bit after being told by a team member that the woman I've been caring for shouldn't be pushing at 9cm with an OP baby. Now I didn't actively encourage OR discourage pushing, but I wonder whether I've done the wrong thing by not giving her direction. Or am I just a slave to the medical model/guideline system? Who knows.
     
    #6
    SuperGirl09 likes this.
  7. pickleumphus

    pickleumphus Member

    Joined:
    Oct 19, 2008
    Messages:
    316
    Likes Received:
    3
    Status:
    Not Specified
    Purely anecdotal...

    Had a woman the other day, active labour, into pool, urges to push at 7 cm, op baby, tried to breathe through, didn't work, pushed on cervix, eventually cervix dilated but ended in highish forceps about 4 hours after urges to push as contractions then went off completely. Presumably as her body was so knackered through non productive pushing. Twas hideous :(
     
    #7
  8. Lil Miss Sunshine

    Lil Miss Sunshine Well-Known Member

    Joined:
    Apr 8, 2010
    Messages:
    6,520
    Likes Received:
    773
    Status:
    Not Specified
    sorry i'm no expert obviously but what else could you do if she could not help pushing and she was that far along?
    What happened in the end? was the baby born fine? did the mum have any problems?
     
    #8
  9. Sapphire

    Sapphire Member

    Joined:
    Nov 10, 2009
    Messages:
    860
    Likes Received:
    19
    Status:
    Not Specified
    The only problem I've come across so far with urges to push before fully is the 'she's been pushing for an hour, why isn't the baby here yet?' trust policy. The women seem to do fine in the end but they don't fit the 'ideal' timescale.
     
    #9
    LadyMingYu likes this.
  10. Kings 10

    Kings 10 Well-Known Member

    Joined:
    Nov 5, 2009
    Messages:
    1,167
    Likes Received:
    356
    Status:
    Midwife
    Interesting, I think ( bearing in mind my limited clinical experience) I would opt to not say anything...., after all - just because the VE says she was 8-9 - whats to say she's not now 10/fully with the last contraction? Especially if a multip. Primips may be the sensation of the head so low. I have been told on delivery suite and heard women told ' to not push' - you're right - who are we 'tell' them what to do - it's difficult because you don't really want a woman to push against a non dilated cervix - BUT I do believe that most women - if left to their own devices - would follow their natural instincts with regards to when and how to push....I'm on the midwifery lead unit next week - there is less intervention then on the labour ward ( i.e VE's) - I can't wait to see how labour is dealt with there....I might change my mind! ;-)
     
    #10

Share This Page