"Premature" urge to pushThread
May 12, 2010 12:53 PM
I've been hearing contradictory stories lately about the idea of the "premature" urge to push during childbirth, and I'm hoping that you can point me to some actual evidence on the topic. I've heard lots of anecdotal stories, but I'd love to see research.
We've all heard that pushing on a cervix that's not dilated to 10 cm is a Really Bad Thing and can cause the cervix to tear or to swell so badly that the baby can't emerge, necessitating a C-section. But is that evidence-based? I've been talking to a lot of women who started feeling pushy before 10 cm, often at about 7 or 8. Those who pushed as their body directed seemed to have good outcomes, with no swelling or tearing. Those who were directed by their midwife or OB to not push, and who resisted the pushing urge or had the cervical lip pushed back, went through a lot of pain and often had swelling. For many of them, being told not to push was the first intervention in the classic snowball, and some wound up with epidurals or even C-sections.
I've also read a couple of articles written by a midwife that suggest, based on their own experiences, that if a woman pushes as her body directs, even if she's not fully dilated she should be okay.
http://www.midwiferytoday.com/articles/pushing.asp: "It has become the paranoia of North American midwifery that someone will push on an undilated cervix. Relax, this is not a big deal."
http://www.midwiferytoday.com/articles/RuleOf10.asp: "Could professionals be mistaken about when women can begin bearing down during labor, because they forgot one simple part of the equation—that of observing non-medicated women in labor in their natural habitats?"
It almost seems like telling women to resist the pushing urge before 10 cm dilation, or manually pushing back the cervical lip, is one of the few interventions that most midwives accept, even though it might not actually be evidence based, and may be a relic of 1960s-era births.
May 16, 2010 02:49 AM
I agree. Here is yet another quotation from Evidence-Based Care for Normal Labour and Birth: A Guide for Midwives by Denis Walsh on the same theme as you are finding:
For a topic [early pushing] where there is such engrained custom and practice, one would expect there to be a substantial research base. Not only has it not been researched, but . . . little has been written about it. . . . Early bearing down has spawned practices based at best on worst-case-scenario thinking and at worst on myth.
In my past, admittedly limited, experience as a doula in cases where a client had an urge to push before full dilation, women who were not fully dilated but were feeling "pushy" did not bear down vigorously when left to their own devices because, duh, it hurt. They mostly grunted a bit or gave little, short pushes that were not much more than catches in their breathing. And if you think about it, somehow as a species we managed to birth our babies when we didn't have people doing repeated vaginal exams and telling us what we could or couldn't do in response to our internal urges. I think if a woman with a premature urge to push has been upright, it makes sense to recommend side-lying or all fours to get gravity out of the picture and help relieve the downward pressure that may be triggering a premature urge. Beyond that, I, like the sources you and I have quoted, am not aware of any evidence that telling a woman to resist the urge has any benefits, and it sure can make her frantically distressed.
May 16, 2010 08:41 PM
Thanks, great reply!
May 21, 2010 04:03 AM
You're welcome. Glad to be of service, and thank you for the compliment.
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