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Childbirth -- directed pushing vs. pushing instinctively


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Dumb question: Does pushing instinctively always work (provided the mother is fully dilated)?

 

All of my babies were delivered with directed pushing. I'd like to try instinctual pushing instead this time -- it seems to me that I wasted so much energy with directed pushing; that there was a point with each one where I couldn't help but push and that those few pushes were what moved the baby.

 

But. I have this fear that I'll ask for instinctual pushing and then the staff will just be standing around forever, twiddling their thumbs so to speak, waiting for me to feel the urge. Is it like that?

 

ETA: I'll be having a natural birth, no epidural. I had three of them without any anesthesia, but each time the nurses/midwife/OB was instructing me to push as soon as I hit 10 cm.

Edited by Pretty in Pink
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Will you have an epidural? If so, then you need direction. If not, then I think you can listen to your body and push when you feel the urge as long as you are fully dilated.

 

ETA: Yes, I think that natural births always work with instinctive pushing after full dilation. It may take a bit longer, but I think it is worth it for the mom to feel in control of the experience, barring some sort of emergency rush to get the baby out.

Edited by texasmama
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No idea, I've always had ppl directing me too...although, I do get an epidural, so initially, I tend to need some direction until it wears off a bit.

 

This time, I'm telling everyone to shut. up. Nothing ticks me off more than the constant chorus of, "Push into your bottom, like you're having a bowel movement..." Nice visual when giving birth. :glare:

 

Considering this is baby #5, I think I know how to push, thanks.

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They directed me when to push with DS... It was nightmarish. With DD, I pushed exactly twice. Once when I felt her crowning, and once more to get her shoulders out. They were telling me there was no way she was ready to come out yet. They had just induced me & sent my husband home to get some sleep two hours before. Before he got to sleep at home, they had called him and told him his daughter had been born.

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The instinct comes when your body is ready. I wouldn't want to push before that. I had two labors with instinctive pushing and it was very different from directed pushing with an epidural. No one was twiddling their thumbs. I was instructed not to push when I had the urge because they weren't ready or they wanted me to push less frequently. So, at least for me, it was the opposite and they wanted me to twiddle my thumbs:tongue_smilie: Oh, and I found instinctive pushing to be far more positive than my experience with an epidural and directed pushing.

Edited by Wehomeschool
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Will you have an epidural? If so, then you need direction. If not, then I think you can listen to your body and push when you feel the urge as long as you are fully dilated.

 

ETA: Yes, I think that natural births always work with instinctive pushing after full dilation. It may take a bit longer, but I think it is worth it for the mom to feel in control of the experience, barring some sort of emergency rush to get the baby out.

 

:iagree::iagree:

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I've had 2 home births. I pushed because my body told me to. I pushed no more than 5 times, don't know how many times, but it was not many before my babies were born. I was only checked twice for dilation on my first and once on my second birth which was long before I was fully dilated. I think the baby starts to push down on its own which causes a little pressure, sort of like you've been holding out to use the bathroom for a long time but on your cervix and that's when you get the urge.

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As a midwife I can tell you that sometimes one way works best, sometimes another. You just have to be tuned into the woman and see what will work best for her at that particular moment. Some women need coaching, even with natural childbirth, because they way they are pushing is wasting their energy and just wearing themselves out without helping the baby out. Some women, even with epidural, just push instinctively and it's just right and they just need me to be quiet! And, you can start or stop the coaching at any time! :001_smile:

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I have hospital births, an epidural, and I'm always hooked up to a contraction monitor. The midwife always tells me when a contraction is coming on and when to push. That being said, with DD#2, I automatically knew when to start pushing despite the epidural. I didn't feel any pain or pressure, but I knew that something was happening and that I felt the urge to push.

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I've tried to explain instinctual pushing to women who have never experienced it by comparing it to having diarrhea. I know that isn't very pleasant. :001_smile: That's how I felt, though. When I had my oldest son the doctor wanted me to stop pushing because he wasn't ready but I could not have stopped if I had wanted to. That's why I compare it to diarrhea.

 

Elise in NC

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When I had MissB, they had turned down my epidural by the pushing time (actually, I think the 1dose wore off mostly), and had me do some directed pushing for about 20 minutes, and she did NOT budge. The nurse said for me to relax, drink some juice, and she'd be back in 15 minutes.

When she came back (not quite 20 minutes later), I'd been going w/ my body doing what it wanted, and MissB was almost completely crowned, and she's saying "don't push, we're not ready", and I'm like "huh?!" and pushed, and MissB crowned and was delivered through the shoulders in one long push (about a 15count, w/ 2 breaths, 1 at 5, and another at 10, without releasing the muscles). The doctor was leaning on the bed rail w/ gloved hands and he's "There she is" about 5 seconds later when the rest of her slid out. She landed on the bed (I was on my side, not in the stirrups even though I had an epi), eyes wide open, looking around.

So I got a lot more done w/ going w/ what I was feeling than when they were directing w/ the contraction according to the monitors. And it was a LOT more comfortable to push the way I eventually did it than when they were directing me.

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When I had my oldest son the doctor wanted me to stop pushing because he wasn't ready but I could not have stopped if I had wanted to.

 

:iagree::iagree::iagree:

I didn't have any urge to push with my oldest but with my other two I couldn't have stopped it any more than I could stop a freight train from coming. :lol:

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:iagree::iagree::iagree:

I didn't have any urge to push with my oldest but with my other two I couldn't have stopped it any more than I could stop a freight train from coming. :lol:

 

:iagree::iagree::iagree: They told me when to push with my first (epi) but I could feel it a little and figured it out. With my other two they were natural and no force on earth could have stopped me from pushing. :lol: With one I went from 7cm to her born in 18 minutes, and with the other I had all of two pushes.

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With my only completely natural birth (homebirth), the contraction before the last one was a bear. The next one was just as difficult, but half way through I yelled, "I can't not push!" My midwife got giddy, "Oh, good, the baby is coming!" He was born within a few contractions...about 10 minutes.

 

That's when you should be pushing. You simply can't help it.

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I was directed when to push with my first two (hospital births) and did it instinctively with baby #3 (homebirth). All three were quick labors (3-5 hours) and no epidurals or anything. Pushing seemed a bit more intense and did seem to take longer with my homebirth, but I also noticed a *considerable* difference in pain/healing with #3. I mean that I had NO pain afterwards. I did have a waterbirth, so I don't know if that factors in also, but I believe the instinctive pushing was a major factor in that. I think just the fact that you're working with your body instead of against it makes a big difference.

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Have you talked to your care provider about it? I had an epi with my first and directed pushing that lasted a long time and was not all that productive. My second birth was much easier and pushing only lasted about 15 minutes. There was no stopping it and going with my body worked much more efficiently.

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I strongly, strongly prefer self directed pushing.

 

My first birth was with a CNM in a hospital. SHe was more med-wifey, and when I went over my birthplan with her before labor she laughed at my "breathing the baby down" (I was using Hypnobirthing). I asked for no coached pushing, etc. and she said fine. But when push came to shove, when I hit 10 cm the nurse was holding my leg back, DH my other leg, everyone was counting...it was everything I didn't want. It ended up being fine, as I only pushed for 20 mins. Had a teensy tear that she used two sutures on. But my legs felt sooooo sore afterward, like I had run a marathon. That was actually what hurt the most the next day.

 

With my 2nd, I was in a different state and seeing CNMs at a birth center. I told them I had a great experience with my first birth, but really regretted the whole pushing thing at the end. I had very much the opposite experience. They waited until I felt the urge to push (my water was still intact up until it was time to push). I also wanted to use an alternative position and pushed in sidelying. I gave them the okay to sort of gently guide me if they thought it would help prevent a tear. They reminded me to breathe the baby down (ala Hypnobabies/Hypnobirthing). 2 pushes and she was out, no tearing, and a much easier recovery. No sore legs. No holding them back. It was much more enjoyable.

 

My third was a homebirth with a CNM. I reiterated my stories from the previous two births. She checked me when she arrived (i was at 5-6 cm) and then never checked my cervix again. I got in the pool as things got more intense. My water was still intact again. I started to feel grunty...just a little bit. My water finally broke. Shortly after that it was 2 real pushes w/ one contraction and baby #3 was out. That was the easiest recovery of them all. No tears (he was 9 lbs, the biggest of my 3). I never even needed or wanted to use a peri bottle (while I didn't tear, I still found it helpful after my 2nd child's birth). It was just really a pleasant experience.

 

It was cool to see how my body knew what to do. When I felt grunty, I thought maybe it was time. No one felt the need to check my cervix to be sure, etc. and my body did what it needed to do.

 

Pushing with #2 and #3 was more of a not pushing until I couldn't not push, kwim? Grunty little stuff going on, but when I felt gripped to really, really bear down, it was like 2 pushes each time and they were out. Much less tiring that way, and I can only compare it to the 20 min pushing phase with my first (which felt way more tiring, even though I got off easy for a first timer)

 

Pushing til blue in the face (holding breath, etc.) is really a dated concept IMO and at the very least, there's no way I would do that. There was a study a while back linking that to some not so great outcomes. I don't think it is great for your pelvic floor, not great for baby's oxygen levels, and I just think generally unnecessary for an unmedicated labor.

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Mother-directed pushing in the position of her choosing is almost always more effective and less likely to cause perineal trauma.

 

I personally do not get a strong urge to push until my babies move through my pelvis and low into the birth canal. Before that point I just keep relaxing and let my uterus do the job of pushing. My longest pushing time without an epidural was 15 min. My shortest time was 1 min. (no tearing). My mw hangs back and supports me in doing my thing. :)

 

Explain beforehand that you want to push your way. If they want to be in the room, you want them to stay quiet and out of the way unless there's an issue that needs to be addressed. :)

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I had a completely natural birth (the midwife wouldn't even touch me) and I knew exactly when to push. It's a lot like having a BM - no one has to coach you through it, you just do it! I didn't have anyone checking my dilation or the baby's position; I labored normally and once I changed to a certain position, my body started pushing involuntarily. It was incredibly empowering.

 

Directed pushing drives me mad. Unless the mom is so numb she has no urge at all, her body will know what to do. And actually, with my first birth, I had an epidural and my contractions pretty much pushed my baby out while I was taking a "break."

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I was directed when to push with my first two (hospital births) and did it instinctively with baby #3 (homebirth). All three were quick labors (3-5 hours) and no epidurals or anything. Pushing seemed a bit more intense and did seem to take longer with my homebirth, but I also noticed a *considerable* difference in pain/healing with #3. I mean that I had NO pain afterwards. I did have a waterbirth, so I don't know if that factors in also, but I believe the instinctive pushing was a major factor in that. I think just the fact that you're working with your body instead of against it makes a big difference.

:iagree:

 

Not only did I have no pain afterwards, I didn't even have swelling down below. I mean - I pushed out a 7 1/2 lb. baby in two pushes, and my body didn't even show signs of birth. A couple of hours after the birth I took a shower, got dressed, ate breakfast ... never had a touch of soreness. I also had a waterbirth.

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I have had three inductions with epidural and never heard of "directed pushing." Do people still have epidurals that block so much? None of mine were like that. The epidural took away the pain of contractions (loved them!) but I always knew when I was fully dilated because I would start to feel a massive pressure and an absolutely irresistible urge to push. I just told the midwife when I felt a contraction coming on and she and DH would then cheer me on until the baby crowned. It never took long, in any case.

 

The one thing is that with #1, I didn't hear her tell me to stop pushing for a moment when the baby crowned and I tore a bit. DH said that the baby just came FLYING out! WIth #2 and #3, I tried to be a bit more careful at that moment and didn't tear at all, with either one.

Edited by JennyD
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OOOOO This is a huge thing with me. I had 3 undirected and then my last was directed. I hated the directed pushing. It took me a while afterward to realize that that was why I hated my fourth delivery so much. The undirected for me was much more efficient.

 

Anne

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I like the idea of open glottis pushing (versus the hold your breath and push for 10 seconds kind of pushing) but unfortunately, I can't see if it works better with my patients for the most part because we have a 97+% epidural rate and they don't have the urge to push. I almost always have the women who don't have an epidural push as they listen to their bodies (and most of the time, you can't stop them!!!:001_smile:).

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My first two were without epidurals and my last one was with one. I never started pushing until I felt the urge. Even with that though it took me 2-4 hours of pushing with each one. My pelvic bone is built such a way that I have a hard time getting them past one part. With my first I had no idea what I was doing so that was part of the problem, my second was my biggest baby and shortest time pushing. Once I got him past that bone he was here. My third I had an epidural and the first contraction after I was at a 10 and felt the urge to push. I held off for about 10 minutes but I needed to. So it took me 3 1/2 hours to push her. I did my best pushing with her because I was more relaxed but her positioning made it harder on me (I broke my tail bone and she was only 6 lbs 14 oz).

 

I think it really depends on how your body is made. I have never really had directed pushing other than once I start they count with me to help me keep pushing. I started though when I felt the urge. Also with my last we tried every position imaginable because she was so stuck.

 

With all of my babies though once we got the shoulders past that bone in my body, they came out in 2 pushes. In fact with my first they tried to stop me from pushing and almost did not catch her.

Edited by bbsweetpea
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Huh. My last baby was my only completely natural birth. I was completely dialated and when she finally moved down into position, I couldn't have followed directions to save my life. There was a locomotive coming out, and there wasn't any question of when I needed to push. Might be just how my body works, though.

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With my first baby, I pushed for two hours and never really knew what people meant by "the urge to push." The midwife asked "Do you feel like you want to push?" and I said "Sure, okay, whatever." I pushed on my contractions because I knew that was what I was supposed to do.

 

My baby got hung up because her hand was alongside her face, and for more than an hour everyone in the room kept telling me "I see her, she's right there," but I couldn't push her out. Finally my midwife threatened me with pitocin ("You may need some pitocin." "I don't WANT pitocin." "Well, then PUSH THE BABY OUT.") and I managed to summon up the extra strength to push her out.

 

My second baby, suddenly I felt an unbearable feeling in my entire body and I knew that I was going to die if I couldn't push. I somehow managed to hold back until the midwife came in and confirmed that he was crowning. Two contractions later, there he was in the tub with me. :D

 

Two labors, both unmedicated, completely different pushing experiences.

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I have had three inductions with epidural and never heard of "directed pushing." Do people still have epidurals that block so much?

 

My 1st delivery I didn't feel any urge to push. I had to watch the monitor and listen for the OB to tell me when to push. It took an hour and my dr. finally had to use the vacuum. I wound up with a 3rd degree tear :glare:

 

My 2nd delivery I again had an epidural but definitely felt the urge to push. I didn't actually recognize what it was- I thought I had to go #2 in the worst way. :lol:

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ETA: Yes, I think that natural births always work with instinctive pushing after full dilation. It may take a bit longer, but I think it is worth it for the mom to feel in control of the experience, barring some sort of emergency rush to get the baby out.

 

In my unmedicated birth I never had an "urge" to push. So no, it does not always work.

 

You can always wait until you're dilated to 10 and then make the decision based on how you feel at the time. It's not like they can "force" you to push, right? :P

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I have no experience of giving birth with an epidural, but I have given birth naturally (without any meds/epidural/pitocin) 4 times. All I can say is if you go natural, there is no way that you cannot push and there is absolutely no twiddling of thumbs! The urge to push is incredibly overwhelming and instinctual. Best of luck to you!

Edited by solascriptura
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As a midwife I can tell you that sometimes one way works best, sometimes another. You just have to be tuned into the woman and see what will work best for her at that particular moment. Some women need coaching, even with natural childbirth, because they way they are pushing is wasting their energy and just wearing themselves out without helping the baby out. Some women, even with epidural, just push instinctively and it's just right and they just need me to be quiet! And, you can start or stop the coaching at any time! :001_smile:

 

That was me. I had an epi., but I still felt the urge to push with my last child. It took two, and he was born without any help or coaching.

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Do people still have epidurals that block so much? None of mine were like that. The epidural took away the pain of contractions (loved them!) but I always knew when I was fully dilated because I would start to feel a massive pressure and an absolutely irresistible urge to push.

 

I've had two epidural babies (my first two) and two natural (my last two). With the epidurals, I felt nothing and was not aware I was having a contraction. The doc had to watch the monitor and tell me when to push. With my two natural births, I couldn't stop from pushing. It was an irresistable urge. I screamed my head off and pushed like crazy.

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In my unmedicated birth I never had an "urge" to push. So no, it does not always work.

 

You can always wait until you're dilated to 10 and then make the decision based on how you feel at the time. It's not like they can "force" you to push, right? :P

 

But you would not have lain there for the next week waiting for the urge, right? At some point, you would have either had the urge or your uterus would have expelled the baby. ;)

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In unmedicated births, not every woman gets a strong urge to push. Sometimes it is a positioning thing. Getting up and moving around can help the baby move in subtle ways and make things happen. Most women, however, do get a strong urge to push and don't need instruction. Pushing before the urge comes is usually a waste of time and energy. That time would be better spent resting and replenishing. One thing to keep in mind ... they can't tell you to push at 10 cm if they are not doing vaginal exams. (Some doctor - can't remember who - said "If the cervix was supposed to be measured, it would be on the outside.") If they insist on an exam before pushing, keep delaying them until you feel an urge. There are some women who do get a premature urge to push before she is fully dilated. Sometimes that can be mitigated by position changes as well.

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Instinctual pushing (not "purple pushing") out of lithotomy is correlated with lower prolapse and tear rates. I am so glad I was able to push when and how I needed to with my last 2 children. It made ALL the difference. With my last, I didn't really have an urge to push until she fully engaged and was about to crown. I felt it suddenly. It was cool but terrifying. Even then I didn't have a strong urge to push, but she was born a few minutes later in the caul. :D

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I had one epidural and directed pushing and one waterbirth with instinctual pushing. The second (waterbirth) was 1,000 times better. My waterbirth was in a hospital, not at home; the midwife and nurse encouraged me to do what my body wanted to do. It was incredibly freeing and the warm water really helped me move my body as I needed to.

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Pushing doesn't have to start at 10 cm. It is absolutely fine and often preferable to let the uterus move the baby down without mom exerting effort. Most women do eventually get an urge to push or an automatic pushing reflex. This is, of course, only a good option if mom doesn't have an urge to push and baby is doing fine. Some women get a break between full dilation and pushing. Rather than telling a woman to go ahead and push just because she's 10 cm, it can be more helpful take advantage of the break. "Rest and be thankful." :)

 

Mother-directed pushing works when no time constraints are given for when or how to push. A few women never get the urge to push. The uterus pushes the baby out. :)

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I had 3 no pain-medication births (one with pitocin due to a stalled labor) and with all three I had an instinctive urge to push and nothing could have stopped it. I remember with one of them the nurses asked me to stop and there was no way I could stop.

 

My problem was that for all 3 labors I ended up pushing for more than 3 hours each. It was exhausting and why I ended up on Pit for my first one.

 

I wished that I could have ended up with a short pushing phase but it wasn't meant to be.

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Don't allow vaginal exams. Then they won't know when you are at 10, and you don't have that issue. Or at least don't have one until you are feeling pushy. Trust me, you won't be able to help but push. It didn't feel like an overwhelming urge for me, exactly...I just started doing small grunty pushes without even knowing I was doing them at first. It hurt less to push, so that is what I did. Trust me, it isn't like the baby is going to stay in there forever if no one tells you when to push.

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I've tried to explain instinctual pushing to women who have never experienced it by comparing it to having diarrhea. I know that isn't very pleasant. :001_smile: That's how I felt, though. When I had my oldest son the doctor wanted me to stop pushing because he wasn't ready but I could not have stopped if I had wanted to. That's why I compare it to diarrhea.

 

Elise in NC

 

My friend says it is like vomiting out of your va*ina. Same kind of thing, where you don't have a choice.

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Pushing doesn't have to start at 10 cm. It is absolutely fine and often preferable to let the uterus move the baby down without mom exerting effort. Most women do eventually get an urge to push or an automatic pushing reflex. This is, of course, only a good option if mom doesn't have an urge to push and baby is doing fine. Some women get a break between full dilation and pushing. Rather than telling a woman to go ahead and push just because she's 10 cm, it can be more helpful take advantage of the break. "Rest and be thankful." :)

 

 

 

I already responded, but I wanted to agree w/ this. I was 10 cm when I arrived at the birth center w/ my 2nd, but my membranes were still intact. I simply didn't feel pushy. At all. So I hung out for an hour before I had any desire to even attempt to push. My water broke while I was pushing and 2 pushes later DD was out. But there was an hour where I waddled around the birth center trying to entertain myself, chatting w/ my parents who were there to care for my older child, talking w/ the midwives and dh, because DD was doing just fine (via doppler check) and I had zero urge to push. They never rushed me or made me feel like I had to start because I was 10 cm. And with my third birth, the midwife only checked me when she arrived (and I was a 5 or 6) and then after that I never got checked again. Totally knew when it was time. Like Ktgrok I had the little tiny grunty thing going on and thought...hmmm...must be getting close. And then my water broke in the pool, and a few mins later, it was like a train and there was no stopping it. Two big pushes and he was out. It happened so fast midwife didn't get a chance to don her gloves in time. Apparently I said "he's coming" about 2 seconds before he came flying out ;)

Edited by Momof3littles
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At the previous check a few minutes prior, I was only at 8. Then next thing you know, I yell, "I'm pushing!" I had absolutely no choice. Nurse yelling stop, wait, because she thought I wasn't at 10 yet, then checked and confirmed oh yeah, you are at 10, so go ahead. :glare:

 

I didn't have a choice, my body just pushed. If anyone had tried to explain it to me, I wouldn't have understood until it happened.

 

No epidural though.

 

ETA, short pushing period delivered baby...maybe 15 minutes? She was my first (and only!)

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