A corker of a subject..... I looked after a multip (a woman who has already had a baby = multiparous woman, one who hasnt is a 'primip' primiparous woman) who when I examined her vaginally was 7cm. Within 15 minutes she was telling she wanted to push. My mentor (who had checked and agreed with my VE) advised the woman to blow/breathe through the contractions. After a few minutes the woman was yelling 'I HAVE to push', my mentor still advised 'blowing the contraction away'. With the next breath the woman said 'I REALLY HAVE to push' her voiced strained all the way through that sentance, her body was pushing involuntarily, she was trying not to push. Minutes later the vertex was visible (the babies head was showing) and she birthed her daughter into my hands with the next two contractions.

So was my mentor right?

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This is a definite dilemma of a subject and one that really makes my blood boil . I remember I once worked with a mentor who was really strict about her 4-hourly VEs. We were looking after a primip, who at 8pm we had examined, and she was 6cms. Three hours and fifty minutes later, she said that she had an uncontrollable urge to push. Yet my mentor, much to my annoyance, told her to wait as she was due to be examined in ten minutes, at which point my mentor would confirm to the woman that she was fully dilated, which she would be expected to be, and if indeed she was, she would then be allowed to push. No surprises when we found she was fully and that the head was so low down, she could practically cough the baby out, for want of a better phrase.

Yet I have worked with other midwives who just let the women get on with it and go with what their instincts tell them. I know which one I would rather be!

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So by the above, I mean, no, your mentor was not right. Using the words of my university lecturer 'has anyone actually seen an oedematous cervix from pushing too early?'.... This is the point where I hope noone says 'erm, yes I have' lol!

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Well you say that, and then this happens to you in practice....

Primip aged 17, in the birthing pool, coping and progressing well. Last VE 6cm 3 hours previously. Is starting to show the signs of wanting to push, she was was grunting and had stopped talking, she appeared to have drawn within herself. She said she needed to push, mentor advised she hold off but on the second request to push my mentor said 'Ok go with your body'. She was pushing for about 20 mins, I think, (this was early in my first year and Im rather sketchy) and nothing seemed to be happening (no visual signs of the vertex, as much as you can see in the pool!). My mentor was concerned and helped her out the pool for a VE. She had an oedemitus cervix (the cervix had become swollen due to pushing on a cervix that was not fully dilated). She ended up with an emergency section after a failed forceps delivery.

So you can see why I asked the initial question? so is it a multip/primp thing? an every woman is different thing?.....

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Ally! Stop being in my head will you!! I didnt even see you post that! great minds, again... I was writing that and faffing about the house and meanwhile you were posting that reply..... seperated at birth lol

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Great! The first person to reply, and you've seen the elusive oedematous cervix. Great minds indeed! You've just completely obliterated my argument. I'm going to have to seriously rethink things and become a dedicated stickler to the 4-hourly VE, and waiting to push!! lol

I think you're right, everyone is different, and you have to make a judgement at the time based on all the information you have to hand. I think it does make a difference whether you're a primip or multip too, whether it be with regard to the differing anatomy and physiology, or the experience of giving birth. Multips have laboured before and so know what to expect from their bodies in labour and are probably more sure of themselves.

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3rd year Student Midwife

Erm... yes I have. But I think its about position, if someone is pushing too early I think it is because the baby is op. And if you have done your abdo palpation and can get position from that and the last ve you know when to say, no, don't push and when to say go for your life! If you see what I mean. Plus, I happen to think if you have an involuntary urge to push it makes not the blindest bit of difference if you say don't push or not, because you can't help it!

Definitely right on track there about those OP bablets. Naughty babies!

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They are naughty them OP ones! Tut tut! If a woman wants to push, and she's getting to the point where she can't stop herself-let her! You should have a good idea about babys position on palpation and from previous VE's, so unless you have a feeling it may be OP and therefore may be wanting to make her push sooner,just let her go with it.Anal dilatation's a good indicator that they're nearly there,without keep examining her.
xx

The midiwfe I had when I was giving birth to my eldest son very rudely told me 'I certainly wasn't ready to push yet, and to just breathe through the contraction'

She hadn't even examined me at this point, I told her in no uncertain terms that 'yes, I DID need to push, I had already given birth once, and knew what was happening'

At which point she did examine me and the look on her face was a picture when she realised I was right lol.

Pauline

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