I kicked off this blog carnival with a post titled, 'Six Reasons I *Heart* Qualitative Research.' I had been wanting to write a post about qualitative research for a while, and the topic of the second stage of labor was the perfect opportunity, since there's so much great qualitative research on second stage.

After collecting the posts for this carnival, I have discovered why. Women want to tell their stories about pushing their babies out. With only a couple exceptions, everyone who contributed to this blog carnival wrote about their own personal experiences.

Just like good qualitative research, the stories show what spontaneous, upright pushing looks, feels, and sounds like.

• Kristin at Birthing Beautiful Ideas posted three remarkable videos that show how a pushing urge develops, grows into strong bearing down efforts, and culminates in the baby's birth.
• Sheridan at the Enjoy Birth Blog prepared educational videos showing several women instinctively birthing at home and others using mother-directed pushing in the hospital.
• Well-rounded Mama, who blogs about the maternity care needs and experiences of women of size, shares photos of women of all sizes pushing in upright positions.
• The nurse blogging at At Your Cervix posted her thoughts on upright positions and shares a diagram of images of nearly every position imaginable.
• Macondo Mama describes in detail how her care providers supported her in second stage (proving that care during a spontaneous birth need not mean the care provider or labor companions sit there doing nothing.) They helped her work with her voice, breath, and movements to birth her baby, provided feedback about the baby's descent, and gave support to her partner.
• Tiffany at Birth In Joy shares some of the encouraging words from her labor support team: 'Way to go, you're moving the baby down!' 'I'm not in a hurry, rest if you want.' and so many other phrases of support and caring.
• boheime at Living Peacefully with Children shares the words she herself said while birthing her baby. When her water broke just as she transitioned to second stage, she coped with the intensity by talking tenderly to her baby 'Okay baby, let's go slow. We will do a little bit and then take a little break. Mommy needs to take a break, and then we will go a little more. It won't be long and then I can hold you. Just a little bit and then Mommy needs a break.'
• The midwife blogger at Birth Sense recalls attending a birth of a mother who wanted a more calm and unrushed experience the second time around. 'The room was quiet, except for the soothing music she had chosen, and the soft sound of her breaths. Carolina was bearing down gently with her contractions for several minutes, then made eye contact with me and said, 'The baby's coming.' I couldn't see anything, as she had her hand covering her perineum, but moments later, the baby's head was out. One more push, and the rest of the baby was born into Carolina's waiting hands. She smiled at me, 'That was so much better than being yelled at to push!''
• Desirre at Preparing for Birth collected the comments of two dozen women sharing what it felt like to push and give birth.
• Three bloggers offered analogies. Lori at Choices in Childbirth compares the shifting and wiggling that gets a baby born with the best way to get a stuck wedding ring off. 'I'll grab hold of my wedding band and pull forcefully toward the tip of my finger,' she writes. 'Invariably, it moves a fraction and then gets stuck. The flesh between the band and my knuckle gets all bunched up, my finger starts to turn frighteningly red, and I begin to wonder if the ring will ever come off. On my second try, I tug on the ring while gently jiggling it back and forth. This time it moves right along without any trauma to my finger at all.' Doula,Annie Reeder suggests that the winning combination of upright posture and relaxed pelvic floor that helps get the baby out is something some women may already be familiar with - that is, if they have ever hovered over a public restroom toilet while urinating. The aspiring Lamaze educator at the Birthing Goddess Blog presents a common sense analogy many of us are already familiar with: 'Who would ever think of having a bowel movement while lying down? No one, right? Same goes with a baby being born.'

Contrast these with the stories that document the opposite: our cultural norm of rushed and managed birth, and the emotional and physical toll this approach can take.

• Dionna at Code Name: Mama recently helped her sister have a natural birth and describes her as calm and coping well until the hospital staff forced her into bed to give birth. She writes, 'She was uncomfortable on the bed, and when the nurses forced her to lie down, she began to cry from the pain and pressure - not from the fact that the baby's head was crowning - but because she had felt more comfortable and in control in the position she chose for herself previously.'
• Mamapoekie at Authentic Parenting had an urge to push that stopped her in her tracks as she walked across her room. 'When the contraction subsided,' she writes 'they led me to the birthing bed, positioned me on my back and had my legs in the stirrups before I knew what happened.Everything was kind of a blur, but I remember wondering where everybody came from, because all of a sudden, there were three midwifes, two OB's and my husband miraculously reappeared. I had not the strength to fight the position I was in and my husband was shaking like a leaf in a thunderstorm.'
• Rebecca at Public Health Doula laments the many great labors she has attended that take a turn for the paternalistic, medicalized worse once the woman is 10 centimeters dilated. She writes, '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.'

Women who prepared carefully for birth were not necessarily immune to repression and coercion in second stage.

• Simone Snyder, blogging at ICEA.org, had prepared a birth plan that clearly laid out her wishes for a spontaneous, upright second stage. Instead, she got 'doctor's high pitched, screeching voice-'Push Push Push'-the nurse counting in my face-the confusion and fear as I lay there on my back in the hospital bed'. In her post, she writes, 'There is a point [in my birth video] where you can hear me say 'I don't understand what to do-do I push-what do I do?' All the direction, all the shouting and commotion-I was not encouraged to listen to my own body and therefore I was lost.'
• Karen Angstadt at Intentional Birth went on the hospital tour, heard all the right answers and even saw the squatting bar she hoped to use, only to find out when it was time to push that none of the doctors would agree to use one. In her birth story she recalls that with persistence she was 'allowed' to try a few squats, 'before being told, 'This isn't working', and put on my back for the remainder of the birth.'
• Hilary at Moms Tinfoil Hat had been careful to do her homework, and thought hiring a nurse-midwife would ensure that she could have a natural birth. 'I ended up flat on my back... pushing against a cervical lip for three hours, while being barked at and blamed by my CNM,' she writes. 'I remember begging her to stop, and feeling defeated while I was forced to push, and push, and push, as my mother, husband, and even the labor nurse looked on with dread. I was unprepared for pushing the first time around, and terrified of it the second.'
• Melodie at Breastfeeding Moms Unite planned a home birth and wrote a birth planand still got told what to do. In her birth story, she recalls, 'I remember when transition was finally over. A sudden peace washed over me. A calm in the storm. I was 10 cms. They told me I was ready to push. Except I wasn't. My body wasn't. I didn't feel the urge. My midwife decided that this would then be the perfect time to instruct me 'how' to push.'

On the other hand, several bloggers' stories show that it is possible, healthy, and feels amazingto push a baby out with one's own immense power in all sorts of unexpected circumstances.

• even with an epidural. Paige at The Baby Dust Diaries had complications that necessitated an epidural and confinement to bed. When the nurse began counting and coaching, she simply told her to stop. In her post, Paige shares the breathing technique she used to birth her baby gently.
• even lying flat. Kiki at The Birth Junkie shows that it is the freedom to experiment with positions in second stage - not a certain position per se - that makes the difference. In her first birth, she knew instinctively to stay off her back, a knowledge that was confirmed when she tried it briefly. In her second birth, something deep down told her to try pushing on her back again, and this time it was just the thing to get her baby to come under the pubic bone . He was born with the next contraction.
• even in the midst of grief. Molly Remer at Talk Birth, recalling her own three births, shares the story of birthing her third son too early for him to survive. (She was experiencing a second trimester miscarriage.) She writes, 'I found myself kneeling on the floor in child's pose. This position felt safe and protective to me, but I finally coached myself into awareness that the baby wasn't going to come out with me crouched on the floor in that manner. I told myself that just like with any other birth, gravity would help. So, I pushed myself up into a kneeling position and my water broke right away.' Her baby was born moments later.
• even when birthing twins. With the deck stacked against her (twins, one baby breech, an epidural, and stuck on her back) the mother of four blogging at Cream of Mommy Soup gave into the urge. She writes: 'For a million reasons, I was impressed with my body. But pushing was the most surprising part of the whole adventure. I could not believe that my body had done that for me - had given birth to two children, in fairly rapid succession - without any assistance from my brain. It was awesomely primal, that experience.'
• even when the baby is 11+ pounds. Three (count'em - THREE) of our bloggers shared stories of pushing out 11+ lb. babies. In 'How My Wife Had an 11+ lb. Baby At Home and Didn't Die,' the nurse blogging at Man Nurse Diaries invites a guest post from said superhero wife, who uses gravity to birth her baby quickly when the umbilical cord begins to get squeezed during pushing. Born not breathing, their daughter resuscitates herself via an intact umbilical cord after birth, never needing the oxygen the midwives had handy. Things were a little less dramatic for our other two 11 pounders. Lauren at Hobo Mama reports having a really good time pushing out her baby, despite it being the culmination of a 42 hour home birth turned hospital transfer. As she pushed, Lauren overheard her midwife and nurse praising her pushing efforts. She writes, 'Even in the distraction of pushing out an 11-pound, 13-ounce, baby, that exchange brought a smile to my face!' Finally, Jill at The Unnecesarean tried a bunch of positions until she found the sweet spot. In a post that started the 'Captain Morgan maneuver' meme, Jill writes, 'I put one leg on the edge of the tub and felt the baby spin out. It was freaking glorious feeling. I wouldn't trade those twenty or thirty ridonkulous transition contractions for anything in the world if it meant that I would have had been unable to feel that.'

But we know that these stories are not the norm, at least in U.S. hospitals, where more than half of women with vaginal births give birth on their backs and 4 out of 5 are told how and when to push, according to the 2006 Listening to Mothers II Survey. Not surprisingly, many of the stories women shared were of births that took place at home, where women can more easily follow their own instincts to birth their babies, and are usually attended by midwives and labor companions who encourage and support those instincts.

• Amy at 263-and-dna felt the urge to push before her midwife even arrived, then settled into the urge once she got there. She writes, 'I started to push almost immediately - b/c we were READY. I didn't need coaching or encouragment. I knew what to do and when to do it.'
• Carol at Aliisa's Letter has attended many births at home, learning something new from each one. She writes, 'I saw the benefits of a variety of pushing positions: sitting (curled around the uterus), kneeling, hands/knees, squatting and side-lying. Each labor pattern and birth was unique and unfolded with its own revelation.'

The stories bloggers shared for this carnival are phenomenal and important. They call into question our cultural norms of what is safe, healthy, and appropriate care. Just as Robin at The Birth Activist learned in her childbirth class to reject the dominant cultural image of laboring woman as stranded beetle and Michelle at The Parent Vortex likewise began to question cultural ideals of men telling women how to give birth after reading Janet Balaskas' book, Active Birth, perhaps the posts in this carnival will be the spark the next woman needs to question unhealthy, unsafe obstetric routines.

To me, the posts in this collection suggest that what happens during the second stage of labor and how well the women is cared for may be the most important factor in how she sees herself and interprets her experience after giving birth. Not surprisingly, the care and support that helped women feel triumphant and strong are also supported by evidence of optimal safety. But reading through these posts, I'm also struck at how difficult it is to foresee the roadblocks to safe and healthy second stage care, and give women the tools to navigate around them. Having made her choice to have a hospital birth with a group of doctors she likes, pregnant blogger Jenn from Baby Makin' Machine is sick of people telling her how to have her baby. Jenn has discovered what almost every mom has discovered before her: everyone wants to tell you what to do and how to do it, whether or not you ask for their advice, and it doesn't stop once the baby is born. The best way to find a path through it all and parent with confidence? Follow your instincts, be patient with yourself, be assertive when something seems unsafe or uncomfortable (even if everyone else seems to be going along with it), and fall back on common sense. It's good advice for second stage and for parenting.

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