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Thread: When and How to Push: Providing the Most Current Information About Second-Stage Labor

  1. #19

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    What a great article. DS was an induction with the works - epi, pushing when told to on my back and a nice second degree tear on a bub who was 6lb 14oz......DD was a water birth with a midwife who did one VE on my request and after an hour of labour I was 7cms. In the next 15 mins I hit transition and I assume got to 10cms - when I asked her if it was "safe" to push she said "your body won't tell you to do something it isn't ready for". So I got on my knees and gave birth to my 7lb 6oz DD without even a graze!

  2. #20

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    Do women usually make different sounds when fully dilated and pushing?
    Yes, absolutely. There are so many external signs of progress that it is not necessary for VEs to be routine in any normal labour, let alone every 4 hours - beware those words, "and then we'll assess you".

    I'm not saying that there is never a time to do a VE (as long as the mother has consented - and has the right to withold her consent, otherwise it's not an unbounded choice!), but research shows that many maternity units & obstetric policies are not allowing long enough for primip labours, and many primip labours unfold over a much longer period of time than many obstetric staff are trained to believe - according to this study.

    New study shows normal labour takes more time than OBs are allowing for

    So there's a good case for waiting longer and reducing or avoiding VEs, and instead - waiting and observing for external signs of progress such as:

    • Location of FHT (foetal heart tones) with pinard or fetoscope; good for gauging descent. FHT early deceleration pattern will indicate resistance onto pelvic floor and therefore descent.

    • 6cm = contraction pattern shifts, flushing over cheekbones.

    • 8cm = hot/cold/trembly/irritable/nauseous. Contractions seem to not give her a break.

    • Near full = increased pressure, vomits, breathing more ragged, ‘catch’ in breath, deeper, guttural moaning. FHT’s midline and low. Sacrum seems flat and full. Her energy will be acutely aware during contractions but she will retreat just as intensely between them. More show, spotting of fresh blood. Feels like pooing, membranes release

    • Purple line that creeps up like a mercury thermometer from anus to top of bum crease. When it reaches the top, the woman is fully (increase in intrapelvic pressure affects veins in the sacrum).

    • Vomiting and ROM (release of membranes) at the same time = 7 cm stretch

    • Look at bottom of foot with the toes pointing up. The spot above the heel and in the center will tighten and release as the uterus contracts IF she is at least 5 cm.

    • Fully = passing stool involuntarily, pouting of anus, instinctive bearing down begins at the beginning of the contraction and not at the height of it.

    • The contracting uterus swells upwards as it pulls in the dilating cervix. Before a woman begins to dilate and is about at term, you can get about 5 fingerbreadths of measurement between the fundus and the tip of the breastbone (xyphoid). As she dilates, this measurement decreases at about 2 cms per fingerbreadth. I.e., 1 1/2 fingerbreadths between these two points would be equal to 7-8 cms. dilation. It's an old trick I learned several years ago. This really works but, like vaginal exams, it takes practice. Unlike vaginal exams, it's not out of the scope of practice as a doula to do this type of exam because it's not done internally and not "really" considered a clinical test.

    • Abdominal signs: thin line or crease above/parallel to Symphysis Pubis. As baby descends and cervix opens, the line/crease becomes wider from side to side. Near transition = ? across. All the way across indicates that pushing is most likely imminent (bulk of baby’s shoulders closer to SP?)

    • When she "pushes" spontaneously, does it begin at the very beginning of the sensation or is it just at the peak? If it is just at the peak, it is an indication that there is still some dilating to do. The woman will usually enter a deep trance state at this time. She is accessing her most rudimentary brain stem where the ancient knowledge of giving birth is stored. She must have quiet and dark to get to this essential place in the brain. She usually will close her eyes and should not be told to open them.

    • Does she "push" (that is, instinctively grunt and bear down) with each sensation or with every other one? If some sensations don't have a pushing urge, there is still some dilating to do. Keep the room dark and quiet as above.

    • Are you continuing to see "show"? Red show is a sign that the cervix is still dilating. Once dilation is complete the "show of blood" usually ceases while the head molding takes place. Don’t mistake another gush of blood which may be vaginal wall tears at the point that the head distends the perineum.

    • Watch her rectum. The rectum will tell you a good deal about where the baby's forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the mother must be in hands and knees or sidelying position.

    External & Observed signs of dilation, descent and progress
    Last edited by Julie Doula; January 26th, 2012 at 04:15 PM.

  3. #21

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    I had no VEs this time- and the baby still came out!

    My first labour was augmented/induced with syntocinon, multiple VEs, over 2 hours of coached pushing - because i was 10cm, and i never felt the urge to push. The environment was so wrong that i don't think i was able to listen to my body, and resulted in ventouse, episiotomy...

    My 2nd labour was at home, i felt supported during my pregnancy, i was mobile during labour, i didn't feel i had to push, more just support my body & baby as baby entered the world. I was standing with one leg on the couch, and then entered the birth pool and was kneeling when my baby was born. My professional support people (student midwife & then midwife) didn't need VEs to know that bub was on its way.

  4. #22

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    Was this just a few weeks ago, HotI? I see on your sig your DS was born Jan 2012? Congratulations! It sounds just wonderful. Is there a link to your birth story? (If you have written it yet - it took me like 9 months to get mine written!)

  5. #23

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    only 5 days ago! no birth story yet but i will write it.

  6. #24

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    Wow, congratulations HotI! Babymoon blessings to you, enjoy those milky snuggles and baby-gazing *bliss*

  7. #25

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    I was the same as most of these girls. I never made a decision to push. My body just pushed as it wanted to. The pushing contractions were spontaneous and erratic because I probably had an anterior lip. My MW did a very basic VE when I was in a forward leaning position and suggested that I float on my back for awhile, just so that the lip wasn't crushed between the babies head and my sp. when I did float on my back the contractions intensified but actually decreased the lower abdo pain I was experiencing. But it was amazing the way my body just curled up and pushed on its own. I really was a bystander to my body at that point.

  8. #26

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    I too only pushed when my body pushed. The midwife would be saying push, but I just ignored it and only pushed when my body was. I actually wonder if my body would have pushed DD out on it's own if I hadn't have helped it, it was pushing pretty strongly lol


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