Monday, February 28, 2011

I still hate directed pushing

Navelgazing Midwife has a great post up about doula-ing the birth of a woman with epilepsy. I think it's a very educational post for doulas, touching on aspects of working with women with chronic medical conditions, women who are not opposed to intervention, and women with very interesting ways of coping with their contractions!

My attention was caught by another illustration of one of my pet peeves, directed pushing:

Now it was time to push. Now that the stage was set for everyone else. Never mind she’d been pushing for a few minutes already. And the head had come down fantastically without any coaching whatsoever. No, now she needed direction and education. Really? Let the cheerleading begin.

When I talked to my client afterwards, she said she was only focused on the doctor, her husband and me, so she was protected from the chaotic yelling at her to push. The woman had a ten minute second stage. And it took three minutes for the baby to be born from the time we first saw her head. Yet, every nurse there, as well as the doctor kept trying to tell her how to push. I’m serious.

“Take a deep breath. Let it out. Take a deep breath. And push, counting to ten.”

Are you kidding me? The woman coughs and a quarter of the head gooshes out!

“No, not like that. You’re wasting your energy.”

I couldn’t believe the surreality of the situation; it was so absurd I really could barely accept they were instructing her this way. I kept whispering to her, “You’re doing great. Exactly like that. Yes… you’re doing great.” She told me that’s all she heard. Thank goodness the cacophony of shrieking nurses remained in the background of this mama’s perception.

I wrote about this in my post on how much I hate directed pushing:

Everything goes great until pushing and then BAM, all of a sudden we're back to the worst of the medicalized model. The second a woman is judged to be "complete", everyone in the room suddenly gets license to, quite frankly, be a total jerk to her. Before she has pushed even once, there is the presumption that she is going to push "wrong". She is never even given a chance to try pushing in different positions or for a few contractions to get the hang of it. Instead, the nurse spells out the position she should assume (chin to chest, pulling back on her thighs, on her back? but of course!), support people are given her legs to hold, and she gets the 3-pushes-per-contraction speech. Then from the first push she is loudly coached, counted off, and urged on MORE MORE MORE KEEP GOING PUSH HARDER HARDER HARDER and that's about when I start grinding my teeth.

In comparison, what happened at the homebirth I attended this month?

As the mom hit transition, she started to make sounds that the midwives and I recognized as "pushiness". The midwife just talked quietly to the mom about how she was moving through transition, acknowledged this was a very intense time, and reassured her. Once mom finished transition and instinctively began to push (there was one cervical check not long before she hit 10 centimeters to check progress, but there was no check to ritually declare her complete) the midwife again quietly spoke to her and encouraged her to let the baby push down with contractions, and let her body be the guide about when she should begin to actively push. That's exactly what she did, pushing in short bursts at first, and then longer as she felt increasing pressure. She started on her side in bed, then got up on her hands and knees. The midwives watched her and would let her know when they saw a very effective push, giving her nothing but gentle praise and encouragement. As the baby began to crown, the midwife again quietly told her to listen carefully as the head emerged, because the midwife might tell her to slow down or breathe through a contraction (although baby came barreling out so quickly I'm not sure the midwife got a chance to get a word in edgewise!)

End result: a good-sized baby born to a first-time mom in almost exactly an hour of pushing. This result achieved with no need for yelling, cheerleading, counting, special magical pushing positions, or other forms of, as NGM so aptly puts it, this "odd ritual".

Just say no to the pushing police!


Kristen said...

AMEN! This is one of my least favorite aspects of hospital birth (among other things). I think it's near miraculous when a woman is able to ignore all of the chaos around her and just push as she damn well pleases, according to her body's own instincts and urges.

I look back now at my own birth, where my extraordinary OB "let" me push in the tub and pulled the nurse aside to explain the benefits of mother-directed pushing (and to note how "beautiful" it was!)...and I realize how very, very lucky I was. And this shouldn't be a matter of luck. It should be a routine matter.

*ranting off*

Enjoy Birth said...

ME TOO! I agree often in hospital births I attend as a doula, it is sweet and peaceful and all is well, until pushing. I try to whisper encouraging, calm things in moms ear, but it feels so chaotic and loud with the counting, etc.

I remind the staff mom is doing mother directed pushing. Sometimes that works, but most often it doesn't.