Thursday, February 4, 2010

Being Pushy

I have a few moments before I run off to see the play my daughter's boyfriend is in. It is fun to have extra "family" members to support.

I have seen a lot of difficulties in birth when women are asked to push before they are good and ready. I have real challenges with the whole pushing circus. The "on your back" thing is a whole other story, fodder for many a rambling blog. I'm talking here about the insane HURRY there seems to be in getting the baby out. There are many reasons this happens. Not to dis doctors as a profession.. I don't want to give the impression I am against birth in a medical setting..I'm not...just to be clear I'm speaking of individuals, not a collective..but I had a nurse tell me once that a baby most certainly WOULD be born by 7:00 because the woman's doctor loved hockey and fully intended to make the game he was planning to go to. Luckily, this was not the mothers' first baby, so she delivered quickly and easily, so all were happy. But had she not, to what lengths would have gone to get the kid out in order to make his game?

I saw a doctor once suggest applying the ventuse to the baby's head to vaccuum him out, because he was clearly bored (the doctor, not the baby). He was wandering in and out of the room, yawning and looking restless. After the lady had been pushing for an hour, he told us he was very concerned the woman was too exhausted to push, and that the ventuse would be needed. The woman was not exhausted. She claimed she was just fine. He ventured further to say he wanted to spare her from becoming exhausted, and would apply the ventuse so she could have energy for her baby. I wanted to call him on his shit, I most certainly did. But I am a doula, I cannot call "foul play" if I suspect it, because I'm not a clinician, and could be wrong, potentially resulting in a dangerous situation. Also, I have diplomatic relations to keep, and I don't like to make a mom and dad stressed out by conflict. So I gently and with a smile asked him if it was unsafe for her to continue pushing the baby out. He hemmed and hawed and tried some verbal gymnastics, so I tried again, same tone, same smile, "Is it unsafe for this lady to keep pushing?" Finally, because he could not give any good reason why the baby should be suctioned out of this woman with a fancy toilet plunger (which looks SO painful to the poor baby, and risks intercranial haemorrhage..not something to be used lightly), he sighed and said, "No, it's not unsafe." This lady pushed her baby out about 20 minutes later.

I'm thinking maybe the whole second stage pushing dealie should be re-evaluated. When a woman has an epidural, hospitals seem to be smarter about it than when it is a natural birth. They realize that though the woman is 10cm, the baby might need to move down a little more. They have Mom hang out until the baby does so, and her need to push is really urgent and uncontrollable, regardless of the epidural (though it occasionally happens a mom on epidural doesn't feel this sensation, it's not the norm...the pushing urge will usually override the medication, and if it doesn't, the staff will usually turn the medication down so she can feel it, knowing the mother and baby will work better together with sensation). They allow this, because the woman is comfortable on the epidural, and doesn't make much noise about waiting awhile for the baby to naturally come down.

To me, pushing with an epidural looks like really hard work a lot of the time. When the baby reaches the vaginal opening, the sensation of pain and burning often hits the woman fast and hard (epidural usually doesn't freeze up to the vaginal opening). Up til then, she's usually been reasonably relieved of pain, and now, without the benefits of a build up of nice endorphins a woman has when she is birthing with no epidural, the pain seems more brutal, rather than less, as one would think. But everyone is different. Anaesthesia is a funny thing and affects everyone differently. I never personally found "crowning" to be a big deal at all...not compared to dilation. But like I said, everyone is different.

Now for those who are pushing unmedicated, what I don't like at all is women being told it's time to start pushing before they feel like it. Just because a woman is 10cm doesn't mean she's ready to push. The baby may need more time to come down before hitting all the right areas and triggering the fetal ejection reflex (thank you, Michel Odent, for that wonderful phrase). What's wrong with not pushing? In home births I've seen several women hardly actively or intentionally bear down at all. They just breathe or yell or whatever they need to do, and their body seems to just do it on its own. When a woman is unmedicated, I think the urge of the staff to have her start pushing right away is because those in attendance are uncomfortable with her expressions of these powerful sensations. They tell her, "just push..it will relieve the pain!" This is motivated by compassion, and while I appreciate that, it's not always the best advice.

The moral of this story is that if Baby's doing fine, there's no hurry. I did not feel much of an urge to push with my first baby. While, because she was born star gazing, I felt a lot of pressure in the bum bum, it wasn't that overwhelming, desperate, uncontrollable need to GET IT OUT, resulting in great bellowings and animal noise making. It took awhile. I think had I not been encouraged to push the whole 3 hours of my second stage, given the urge was not at all strong, I may possibly have not ended up with such a swollen perineum (though with no tear, thank God), or a feeling that my guts would fall out of me for a couple weeks after birth. Who knows?

My advice to women is to follow their bodies, follow their babies. Sometimes that uncontrollable bearing down is present before full dilation, and I echo Gloria Lemay in that I have never seen a woman destroy her cervix when the need to push is bigger than anything else in the room. Though she will, mark my words, be told by nurses that she WILL swell and rip her cervix for being "naughty" and pushing before she's "fully", even though when the fetal ejecting begins, she cannot consciously stop it, even if someone were holding a gun to her head. If you have to barf, you may feel nauseated for awhile, and can sort of will yourself not to up to a point. You can breathe through those mounting waves of nausea and think happy thoughts. But for most people, when the body begins heaving because the stomach simply cannot hang onto its contents anymore, it is a relex, not something they can control. How dumb is it to tell someone, "don't puke" when they're at the point of no return?

Who says you always have to be 10cm before second stage starts? The cervix usually just slips over the baby's head in that case as the uterus pushes that baby on down. We're not lemons because we don't follow a rule, and most certainly should not be threatened by the destruction of our own bodies for "daring" to veer outside the norm. And conversely, just because you're at the magical 10cm, doesn't mean you automatically need to start directed pushing. In fact, unless you like to and it feels right for you, as some people really find it helpful, why take much direction about pushing at all? After all, if you were out in the woods and you went into labour, and given everything was normal, you would get that baby out. Imagine that, without one yell of "PUSH" or counting to ten 3 times per contraction, or having your eyes bug out of your purple face from the effort of straining and holding your breath for so unnaturally long. Now that's a whole 'nother topic.