Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin & Janet Walley & April Bolding & Ann Keppler & Janelle Durham

Author:Penny Simkin & Janet Walley & April Bolding & Ann Keppler & Janelle Durham [Simkin, Penny]
Language: eng
Format: epub
Publisher: Meadowbrook
Published: 2010-08-30T21:00:00+00:00

Directed pushing

Directed pushing is used if you can’t feel your contractions and delayed pushing isn’t an option or if spontaneous pushing isn’t effective. Your caregiver will tell you when, how long, and how hard to push. (See page 233 for more information on directed pushing.)

Prolonged pushing

Prolonged pushing differs from directed pushing in the length of time you’re expected to hold your breath and bear down (ten seconds or more, instead of five to seven seconds).

Not long ago, standard practice in maternity care required that women push for as long and as hard as they could, in order to push out the baby as quickly as possible. Many maternity caregivers are still more comfortable advocating prolonged pushing than spontaneous bearing down. Research shows, however, that prolonged, forceful pushing usually isn’t necessary and may sometimes cause problems that are less likely to occur with spontaneous bearing down, including exhaustion of the mother, overstretching of pelvic ligaments and muscles, possible perineal tears, later urinary incontinence (leaking of urine), concerns with the baby’s heart rate, and failure of the baby to rotate or descend.11

Prolonged pushing, especially in the supine position (on your back), can also decrease the oxygen available to your baby and may cause your blood pressure to drop, both of which can increase the need for a faster delivery with an episiotomy. The second stage may last slightly longer with spontaneous or directed pushing than with prolonged pushing, but babies usually remain in good condition throughout the process.12

Prolonged pushing is best reserved for women with inadequate progress in the second stage, even after trying different positions, or for women whose babies are already in distress and may require interventions (such as a forceps delivery, vacuum extraction, or cesarean birth) unless they’re pushed out quickly. Well before your due date, discuss prolonged pushing with your caregiver. Include your preferences regarding the practice in your birth plan and discuss them with the staff when you arrive at the hospital or birth center. See pages 232–234 for more discussion on the various pushing techniques.

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