Sensitive Midwifery - Issue 43 - July2019

Push- started Sensitive Midwifery Magazine asks, is this how birth is supposed to be? T he most common form of pushing in labour is directed pushing. Women are instructed to start pushing as soon as they are fully dilated and hold their breath when a contraction begins, pushing as hard as possible while the midwife sets a particular rhythm. After a quick breath, they do it again, aiming for at least three pushes per contraction. However, this approach is outdated and potentially harmful to women, infants, and natural birth itself. Dangers of directed pushing Directed pushing started in an attempt to speed up the second stage of labour, because a prolonged second stage was deemed dangerous. Studies have since found that directed pushing does not shorten labour; instead, it: • Increases chances of perineal tears, episiotomies, post-birth urinary problems, and forceps or vacuum- assisted birth • Decreases oxygen for Mother and Baby due to breath holding • Limits blood flow to the placenta • Fatigues women because pushing starts before Baby is low enough • Disregards women’s instincts and sabotages a gentle birth Because a woman who feels rushed, and directed against her instincts, often panics and tenses up, labour progresses less well. Spontaneous pushing Once fully dilated, women wait until they feel the urge to push; resting and relying on contractions to keep Baby moving down the birth canal. Instead of midwives timing pushes, women push whenever and however they like, based on their bodies’ natural urges. They are also encouraged to keep breathing while pushing. Spontaneous pushing enables better labour progress, despite a potentially slower process. Mom and Baby recover between contractions. Midwives can work with moms’ bodies by: • Helping women change into upright positions while pushing • Advising women to push using their abdominal muscles and pelvic floor instead of their upper bodies • Reassuring women that it is normal for Baby’s head to crown and then disappear again • Encouraging women to breathe during contractions and not hold their breath for longer than six seconds at a time • Letting women feel Baby’s head or see it using a mirror if they need some encouragement Continued on page 17 Birth 16 eSensitive Midwifery Magazine Issue 43