One of my bug-bears in midwifery is hearing midwives and students (and partners!) acting as "Cheer Leaders" during the second stage of labour.

You can hear them from quite some distance shouting "Push, push, push!"..... "Go on, and push again!"....."Push harder, push, push, keep it coming!"

Is that you...??

Then you hear the woman scream back "I am b***** pushing!"

Rather than joining in this crazy game, I keep my voice low during the second stage. I encourage the woman to listen to her body and push hard when she feels the urge to push. I give lots of encouragement: "That's great." "Well done." "You're pushing so well." etc. As the baby's head descends and the woman gets to the stage where she really does not want to push, because it's so painful, I say words like "It's meant to feel like this." "Your muscles are stretching, to let the baby through." "Open up." "Let your baby come."

There are occasions where I need to be more directive. When a woman has a dense epidural block, for example. Or if I am concerned about the FH, I will raise the level of my voice and I become more directive. I think the change in my tone of voice helps the woman realise that she needs to increase her effort too.

So, what works for you? What phrases / tactics do you use to support women during the second stage?

I'd love to hear your experiences and maybe we can all learn a bit more.

Thanks

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Oh dear, I have done this and answered them back when they said this, although in my defence we were trying to save her from one of the horrible doc's (not a generalisation, this one really is not very nice) I am hoping you can teach me something as I have not seen or caught many babies without this method.

I had a bad experience once, and the day after was feeling a bit sick, upset and terrified of another delivery. The midwife I worked with though was the first I had seen then to say nothing as the woman pushed, she was doing the notes quietly in the corner, whilst the baby's head crowned! She was fabulous and taught me show much in one late shift and since the nI try to keep as quiet as poss.

Though this is making me think (anecdotal again, sorry) though. I was quietly 'coached' when pushing out my own babies and as I had my eyes shut and was 'entonoxed' ALOT! the quiet, but constant vocal encouragement was something i won't forget. And it really helped me believe I could do it and was doing it well!

Trouble is it is so difficult to know the right balance and know what is needed for each woman, something I feel is a long way off for me as I know so little. It is also influenced by your mentor and others in the room, and what is needed i.e after epidural, long first stage, lots of pain etc...

I would love to see normality more, and perhaps be able to keep quiet. I realy do think alot of women are not educated enough antenatally and really have little idea what they are going to have to do, when the time comes, there is little discussion antenatally regarding them pooing during pushing (which so far (IME) has been a real worry for alot of women. But then perhaps if they were at home or at birthing centre, with their known midwife, none of this would be necessary, as hospital interferes with so many complex aspects of birth.

Answer, I don't really know!

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smwife - I have to go out now. But I'll be back to post a reply later.

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Shoshana, I use similar phrases to you;
'just listen to what your body is telling you to do', 'well done, that's fantastic', 'you've really got the hang of this, carry on like that'. etc etc.
At the point of crowning, I usually say something like 'do you remember I said it would feel like this, and they only way to get rid of this pain is to let your body go with it, I might just ask you to give little pushes now or to stop and breathe the pain away, okay?'
If I have been able to prepare women and their birth partners for this before it happens, it is usually enough to just remind them that this is normal.
KS x

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Kentish Spitfire
Moderator, Student Services
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"It's better to be thought a fool - rather than proved a fool!"

I had been taught to be a cheerleader then one day in Year 1 my mentor was ill and I worked with the Ward Sister, her approach was like yours, it was such a lovely calm atmosphere in the room, the lights were dimmed and the woman birthed her baby with quietly spoken words of encouragment and praise. I remember thinking how few words were actually needed compared to the cheerleading that I had been taught.... that has stayed with me especially after learning about how oxytocin works etc

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Josie
StudentMidwife.NET Founder & Director



MidwiferyWorld.NET our sister site for Senior Students and Midwives is now live, tell your mentors and tutors!

It's good to hear of your experiences.

Like a couple of you have said, it does depend a lot on your mentor. At first the student becomes a "mini-me" to their mentor, copying their actions and using the same phrases. But, as you progress in your training and then onto being a RM, you will develop your own way of working, within your hospital's policies and guidelines.

There were several things that helped me, which didn't really include my mentors, who were mostly old school midwives. I read lots, but not the sort of books you need for your degree courses. The books I gained lots from include:
Spiritual Midwifery - Caroline Flint
Let Birth be Born Again - Jean Sutton
Birth Reborn - Michel Odent
Rediscovering Birth - Sheila Kitzenger.

- These are not accademic books and they are not highly referenced. But they are really good for learning from people with lots of experience.

Attending study days and discussing such things with experienced midwives, who had a heart for more sensitive care also helped me. Midwives like Soo Downe, who I had the pleasure of working with on one occasion, have been a great influence.

My training as an NCT teacher and working with women during classes has also helped me to see beyond the "patient" to the real woman.

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I have done the old cheerleading, I'm not ashamed to admit it though, as at times it does seem that it helps some women, thats not to say I've been like RA RA RA with the pompoms on at the top of my voice!! But when I started I did this, then I wentot a study day where they re-enacted a typical 2nd stage scene, one woman laid on the bed, the others were arms round her shoulders pushing her forwards-chin to chest etc.. saying "come on big deep breaths, thats it hold it for as long as you can and push etc etc as you can imagine, many of us sat there blushing!! Even though I had never been as bad as that, some of it was embarrasingly familiar!!
Afterwards the woman said she felt violated, it was awful, and really hit home, needless to say it completely changed my ways and the same offer gentle encouragement, sometimes words are not required at all are they? Just a gentle nod, a smile etc.
Great post though, good topic.

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Have you just been offered a place? If so and you want a mentor please post in post this forum (also post here if you would like a mentee)

It is difficult if your mentor uses this method. Now I have learned alot more, I try to keep as quiet as possible. Though sometimes you enter the room and straight away your mentor is off, thinking that as it's quiet nothing is happening!

I don't then join in but it is difficult when you are supposed to be catching and you need to be talking to the woman about what feelings will come and when the head crowns etc

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Yes, that is true. A friendly face, with a confident approach, is really important and matters more than words.

Thank you. It's good to share our experiences.

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I agree. I have always had memorable eye contact with the women, I always come away remembring the way we locked eyes. Sounds a bit daft but its true so much care and reassurance can be given non verbally.

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Josie
StudentMidwife.NET Founder & Director



MidwiferyWorld.NET our sister site for Senior Students and Midwives is now live, tell your mentors and tutors!