תלחצי תלחצי תלחצי!!!!!
𝐏𝐮𝐬𝐡 𝐏𝐮𝐬𝐡 𝐏𝐮𝐬𝐡!!! Stronger, you are not pushing right, stronger, don’t breathe, 10, 9, 8, 7, 6, 5, 4, 3, 2, 1, ok. Well done, continue.
In Israel, the majority of women are instructed how to push once they are fully dilated. Sometimes there are situations where a woman is told not to push, even though her body tells her to do so. The most common technique is the Valsalva method: women are told to take a deep breath at the beginning of a contraction, hold it in and bear down throughout the contraction. In spontaneous or physiological pushing, women are free to follow their instincts, usually push three to five times per contraction. In this method, most women choose to breathe while pushing or between pushes or use breathing techniques. Often women use their voice instinctively, making “ooooo” sounds or moan. Women who received an epidural usually have a weekend urge to push. In these cases, using delayed pushing techniques involve instructing women to wait to push until they feel an urge, or until the baby is presenting at the perineum.
𝐖𝐡𝐚𝐭 𝐝𝐨𝐞𝐬 𝐭𝐡𝐞 𝐞𝐯𝐢𝐝𝐞𝐧𝐜𝐞 𝐬𝐚𝐲?
According to a review from Cochrane, there is only low-quality evidence on this topic. The studies show no significant differences between directed pushing and physiological pushing. Some studies have looked at the women who received an epidural and compared the results between pushing when they develop an urge and pushing once they are fully dilated. These studies showed that delayed pushing increases the duration of the second stage (from when the woman is declared “fully dilated”), but reduces the time spent pushing, and increases the likelihood of spontaneous vaginal birth. Effects on important neonatal outcomes and serious tears are still unclear. Cochrane recommends: “Until further high-quality studies are available, women should be encouraged to push and bear down according to their comfort and preference.”
𝐖𝐡𝐲 𝐰𝐨𝐦𝐞𝐧 𝐬𝐡𝐨𝐮𝐥𝐝 𝐩𝐮𝐬𝐡 𝐡𝐨𝐰 𝐭𝐡𝐞𝐲 𝐰𝐚𝐧𝐭
“Telling a woman to push or not to push is cultural, it is not based on physiology or research. Worse, it disempowers women and reinforces authority and expertise of the care provider.” says Dr. Rachel Reed, a UK-based research midwife.
1. Physiological processes
The muscles of the uterus expel the baby. Pushing actively supports that movement which the uterus muscles do by itself – it’s an urge which women need to follow. Once the baby presses on nerves in the pelvis that initiate pushing, the woman cannot control the urge. Instructing women how to push, not to push, or when to push can be contra-productive to the physiological processes. In addition, authoritarian behavior (sometimes including screaming) creates a non-safe environment which can cause the body of the women to shut down and make physiological birthing more difficult or even impossible.
2. Trust in women’s abilities and bodies
Instructing women when and how to push gives women the message that they can not trust their instincts and urges. Birth is animalistic, it is an amazing and automatic process that the women’s body performs. Instructing and sometimes even screaming at a woman will not make her body work more effectively. One study found that women who use physiological pushing are more satisfied with their birth.
3. Protecting the woman and baby
The few low-quality studies about pushing do not see a difference in maternal or neonatal outcomes. Many women report that that directed pushing caused them to be exhausted very quickly. The pushing can sometimes be so aggressive that the woman will have bruises on her face the next day. There is also evidence that midwife-led births with continuous care, e.g. homebirths where women are not told how to push in the huge majority of cases, have much better outcomes for the women. The advantages include less hemorrhaging and a higher intact perineum rate with very few 3rd and 4th-degree tears. Letting women push how they want ensures that women listen to their bodies and do what their bodies tell them. For example, some women feel the “ring of fire” when the baby emerges at the perineum, so they automatically slow down and give the area time to stretch. In addition, holding the breath might cause reduced oxygen supply to the baby.
𝐖𝐡𝐚𝐭 𝐜𝐚𝐧 𝐈 𝐝𝐨 𝐰𝐡𝐞𝐧 𝐈 𝐠𝐢𝐯𝐞 𝐛𝐢𝐫𝐭𝐡?
First of all, learn about physiological pushing and breathing methods for the second stage of labor. Make a birth plan.
Secondly, speak with your birth partner(s), so he/she/they can help you to make sure the medical staff follows your wishes.
Thirdly, choose your birthplace wisely. Ask the hospital about their protocol concerning pushing, with and without an epidural.
Fourthly, if you choose to birth in a hospital, request a midwife who supports physiological pushing when you are admitted
.𝒀𝒐𝒖𝒓 𝒃𝒐𝒅𝒚, 𝒚𝒐𝒖𝒓 𝒃𝒂𝒃𝒚, 𝒚𝒐𝒖𝒓 𝒄𝒉𝒐𝒊𝒄𝒆! ——-Ahhhh, push it, push it real good.
