Childbirth -- directed pushing vs. pushing instinctively

[jubilation]

Instinctive pushing didn't work for me w/ my first, despite no epidural and moving about freely. I think I was fully dilated for 2 hours before I finally asked the midwife if some women just never get the urge to push, and she said yes. So then I started making myself push, just to see what would happen, and pretty soon the uncontrollable urge took over.

 

With my 2nd, I actually did find myself pushing at the height of contractions without being able to control it, as soon as I was fully dilated. Still took me 45 minutes of pushing just like the first time, though. :glare:

[goldberry]

It's not like they can "force" you to push, right? :P

 

To me that was the coolest thing about giving birth. I know this is not everyone's experience, but it was the first time I think in my whole life I felt confident in my body knowing what it was supposed to do. I felt this tremendous empowerment and I wasn't going to let anyone take that away from me, doctor, nurse, whoever. I didn't feel any need to be cooperative, or helpful, or anything except what I needed to do right at that moment.

[smilesonly]

subbing to pass along info....

[*lifeoftheparty*]

I had a natural childbirth too. I used the midwife program at the Army hospital, but all the midwives were away ay a midwife convention when I went into labor. :glare:

 

This really nice nurse stuck by me.... they TRIED to direct the pushing, but I was like, "Look, I have no control over this, my body is expelling this baby and there is nothing I can do to stop it, so just roll with it!"

 

The nurse put that bar above my bed, wrapped a sheet around it for me to hold and told me whenever I felt the urge to push, just pull up on the sheet, like "climbing the rope", which is an exercise we did in the Army.... it's a sit up/crunch, but you pretend you are pulling yourself up on a rope, with your hands, while you come up. Clear as mud???

 

I felt so much better after that and it worked great, like I was working WITH my body :) The pushing part of my labor went on for about..... an hour? It wasn't that bad.

 

They asked if medical students could watch b/c they had never seen natural childbirth..... I was like, "Whatever."

[*lifeoftheparty*]

To me that was the coolest thing about giving birth. I know this is not everyone's experience, but it was the first time I think in my whole life I felt confident in my body knowing what it was supposed to do. I felt this tremendous empowerment and I wasn't going to let anyone take that away from me, doctor, nurse, whoever. I didn't feel any need to be cooperative, or helpful, or anything except what I needed to do right at that moment.

 

:iagree:

 

I was like, just stand back and let me do this. ;)

[Alenee]

It's funny to me because I never really thought about it until this thread.

 

First baby, directed pushing because I had an epidural (lying on my back) .

 

Second baby, no pain meds, directed pushing (lying on my back) .

 

Third baby, on my knees facing the back of the bed. I had the urge to push before anyone checked me. Dr., Nurse, and dh weren't even paying attention. I just began pushing instinctively. It was really cool! :D AND she was 11 lbs. 4 oz. Had she not been so big, I'm certain that the instinctive pushing would've had her out in 2-3 pushes. It was much easier to work on pushing while on my knees.

[KidsHappen]

I had six unmedicated births. One was at a military hospital where they directed me to start pushing when I reached ten but all it managed to do was irritate me and I don't think it made any difference in time at all. All of my pushing stages went very quickly. With the rest I just didn't allow them to check until I felt like pushing. In one case, I was at nine with a lip of the cervix caught up and the midwife transfered me. Seems that just changing positions to drive to the hospital made all the difference because that baby was being born when I got there. I did need some help with the last one because she was transverse and had had broken waters close on to 24 hours so we were really working to get her out of there. Otherwise, I say that if the mother is not medicated just let her body tell her what to do.

[twoxcell]

I have never heard these terms before today. With all four of my births I was told when I felt the urge to go ahead and push. There wasn't really any direction until the very end when baby was very close to crowning, but even then it was really up to me. More like gentle coaching than directed. I pushed all the way through transition with my last three. Not a forceful sort of pushing but there was no way I could have really stopped it.

[Amy in NH]

you will KNOW when to push~your body will do instinctively do it.

 

Your body will do it without you. :D

[Pretty in Pink]

Wow, thanks for all of the responses in this thread! I'm going in for an appointment tomorrow -- my supposed due date -- so I will discuss this with my practitioner then.

[myfatherslily]

They asked if medical students could watch b/c they had never seen natural childbirth..... I was like, "Whatever."

 

I'm so pitiful, I'm sure I'd say, "Heck, yeah, let 'em see how this is really done!" I think I'm a little overly proud of my births :blush5:

 

OP, I put this on my birth plan, "No directed pushing, unless extra coaching (epidural, etc) or urgency is needed." I felt that made my first choice clear, while showing that I understand how sometimes that's not the best choice. I probably could have used more direction for my first baby.

Would it be a bad thing if they were standing around just waiting for you to feel the urge? :) You'll do fine!!

[Celia]

For my natural birth with ds2, I didn't feel the need to push. Had I not been directed to, the little monster might still be in there.

[Coffeetime]

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. ;)

 

Lol, I pushed for 3 hours... and believe me, it felt like a week! :tongue_smilie:

 

I was so exhausted, I couldn't even change position because I couldn't hold myself up, the baby was huge and posterior... I will forever be grateful to my doctor for letting me keep going because I know a lot of docs would have gone straight to a c-section in that situation.

 

I don't know, I had always heard "you'll KNOW when to push, don't worry!" and it just has never happened for me. Medicated OR unmedicated. I guess everyone is different. I think it's best not to make too many "solid" plans about how you want to push etc and just keep your options open. :001_smile:

[HS Mom in NC]

Homebirth midwives rarely direct pushing unless it's necessary to avoid tearing (they don't do episiotomies.) My pushing was not directed and my body. knew when to push.

 

The urge to push may not come immediately after dilation. I was at a friend's home delivery and she got to 10 and didn't fell the urge. Thank God she had a sensible midwife who told her to relax and take a nap. About 45 minutes later the urge came.

 

I saw a great video of a free-standing birth center birth where some man's wife was delivering her second child there. He only had hospital birthing experience. He asked the midwife if he wanted him to count to 10 for her. She rolled her eyes and said, "Oh, good heavens! We don't do that here."

[RainbowSprinkles]

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.

 

 

I just did this. :) You will definitely know when to push if you're doing it naturally. You can't miss the pressure you'll feel.

 

When I had to push, I was told to wait because the midwife was late, lol. But then it felt like just one big push and her head was out, then she gave some direction from there just to get her out safely.

[fairfarmhand]

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."

 

 

My sil just birthed a baby in the front seat of her car in the hospital parking lot. She held back as long as she could. Thank God for the oncology nurse, who was going off duty, that just kind of stuck her head in to "see what was going on and if there was anything I could do" (Sil's mom and my bro. were both off looking for help, and sil was left in car w/2 yr old.) Oncology nurse pretty much caught the baby as soon as she peeked in.

 

Your body can do this. It knows what to do.

 

I found that w/my births, even slightly medicated, I don't think I listened at all to what everyone was telling me. I was in a world of my own...perhaps that was the meds or not.

[Cabertmom]

Oh man, if someone told me when to push while I was in labor, I think I'd be ready to strangle him. To say the least, it would not help with the peace and concentration that is so important to giving birth. However, as someone else noted, if you have an epidural, I think you would have to be directed as to when to push.

 

I had the first two at a hospital with the door opening and closing and a nurse-in-training chatting with my husband about poetry. I had epidurals with them, though that was not my plan originally. I also got in trouble with the staff for falling asleep with my newborn son in my bed, LOL.

 

All of this led me to having the last three with midwives and no epidurals in a quiet dark room. Obviously I'm biased, but I'd say if you have decided to go without the epidural, then your body should know when to push without anyone interfering. In fact, normally it's really hard not to push at the right time. If you push during a contraction and then only, you save your strength, and it's most effective. You probably already know this.

 

However, with my youngest son, the contractions completely came to a standstill after I was completely dilated, so I "directed" my own pushing and had him standing up because he was his heart was slowing a bit so it was important to hurry things along. I'm pretty sure that they would have done an emergency C-section if I had been in a hospital. Glad I wasn't. ;)

[Cabertmom]

Wow, thanks for all of the responses in this thread! I'm going in for an appointment tomorrow -- my supposed due date -- so I will discuss this with my practitioner then.

 

Just my two bits--don't let them force you into being induced unless it's what you want or there's a really good reason for it, like not enough amniotic fluid. Not every baby is born within 10 days of his due date, and their estimates of weight are not very accurate at all, so if they tell you the baby is going to weigh 12 pounds, it ain't necessarily so.

 

Mine have been 10 days, 15 days, 19 days, and a record whopping 29 days late. My mom was the same way with the 4 of us. All of them were born healthy in spite of being technically overdue, but the one who was induced under pressure from the OB at 15 days had a ventricular septal defect. I don't know that that's related at all, but since VSD is normal until shortly before birth, one has to wonder if perhaps he would have benefited by waiting to be born until he was ready.

 

I read not long ago that the baby sends a chemical signal to the mother's pituitary gland that says he's ready to go, and that sends the mother into labor. Isn't that awesome?

 

Jumping down off my big soapbox now, LOL.

[twoforjoy]

I'm terrible at pushing.

 

With my first I pushed for 4 hours. He had a 16" head, though.

 

With my second, I only pushed for about 25 minutes, but it was all directed and it was awful.

 

With my third, I pushed for 6 minutes. However, it was six minutes full of me saying, "I can't do this. I'm seriously going to die. I hate this part. No, really, I'm seriously going to die. Can't one of you people just pull him out? I'm not going to do this. He is never going to come out. This is the last time I'm doing this, and this time I mean it!" I think, though, that really most of my very negative feelings about pushing come from my first birth. After you push for four hours, maybe that's what happens. ;)

 

My last push with him, though, the CNM who was attending suggested that, instead of one giant push, I try doing a series of little pushes. That actually felt much better and he came out much more easily.

 

If I do ever give birth again, I would love to be able to give birth standing/squatting. I think that position would work much better for me.

Edited October 6, 2011 by twoforjoy

[Renee in NC]

I don't know, to be honest. I just push - who really thinks about it? I know that once I get to 10cm I can push with the contractions, so I do.

 

With the last one, I didn't push at all until he was almost crowning, but that was because I kept refusing to put my legs in stirrups at the hospital. I laid on one side until I thought he had moved down too far, then I put my legs in the stupid stirrups and he was delivered in 2 pushes.:tongue_smilie: Idiots. I had delivered more babies than the intern and student put together!:lol:

[mommymilkies]

Just my two bits--don't let them force you into being induced unless it's what you want or there's a really good reason for it, like not enough amniotic fluid. Not every baby is born within 10 days of his due date, and their estimates of weight are not very accurate at all, so if they tell you the baby is going to weigh 12 pounds, it ain't necessarily so.

 

:iagree: My ds has neurological and digestive issues from his induction. They said he'd be big. Turns out the u/s was wrong and my edd was off by a month. He was premature and has undergone many hurdles. I would read Pushed or Born in the USA by Marsden Wagner so that you are fully prepared and educated.

[Forget-Me-Not]

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

 

It's my understanding that sometimes women fully dilate to 10 and then go into a rest period before the urge to push the baby out starts. Just something I've read. I didn't experience the urge with my unmedicated birth either, so she came out with directed pushing. I've often wondered what would have happened if I'd just waited around for a while :D

 

:iagree: I would read Pushed or Born in the USA by Marsden Wagner so that you are fully prepared and educated.

 

Pushed is actually by Jennifer Block, but yeah EXCELLENT book.

[gardenmom5]

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 -- .

I've had five kids. I could never push as well unless I felt the urge to push - however, that urge varied according to what pain meds I had. I had three with epidurals (that can destroy the urge, besides the effects of pitocin) and two with nothing but demarol. (and to think my doc told me not push- yeah right! I think he was trying to clear baby's mouth or something)

 

go ahead and tell your doc you want to do instinctive - after all, if you fail to make progress, you can always do directed.

[gardenmom5]

It's my understanding that sometimes women fully dilate to 10 and then go into a rest period before the urge to push the baby out starts. .

 

yes, it's the body's way of giving time to recover from transition before delivery. Before my first, I recall being SO skeptical that you could fall asleep between contractions during transition. (gee, whadda ya know?). once full dilation occurs, I'd always wake up.

 

that 'rest phase" varies with women. I know one woman that would dilate to six, then boom, she was there and feeling the urge to push. (and to think her doc didn't believe her. she warned him.) yes, she was at 10 and fully effaced.

[Dustybug]

I've had an epidural all three times and with my first I was directed and it took nearly TWO HOURS for my daughter to be born. With my other two, even with the epi, I could feel the pressure and knew when to push, so did so instinctively and they practically slid out for home plate. :D Seriously, my DS was born in 3 pushes and my last DD was born in about 4.

[6packofun]

Ditto this. Delivery went so much better and was less exhausting when I pretty much ignored any direction by an outside party. LOL

[Spock]

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.

 

I always wanted to push before I was sufficiently dilated, and had to try hard to wait until I was allowed, so I have no idea. All 4 of mine were natural childbirth.