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To Push or Not To Push

by Lisa Morgan (follow)
A writer who also reads waaaay too much.
Babies (4)      Childbirth (3)      Healthcare (2)     
Women as experts in their own bodies.

Just before the fetal ejection reflex began
Homebirth attended by the woman's mother and a midwife

Women who birth with a doctor or midwife in attendance are likely to experience directed pushing where they are told when and how to push. In addition, there are also women who are told to stop pushing because of a cervical lip, or not being dilated enough, or in the case of a baby emerging, to check for an umbilical cord.

With these expectations on pushing, it stands to reason the concept of pushing a baby out is viewed by the majority to be within a birthing woman’s control as per instruction from her care provider. Movies and TV shows also reinforce this belief with childbirth scenes of controlled breathing and pushing, and women working hard to expel the babies from their bodies.

The argument for being told to push follows the idea that once fully dilated it is time to push. Seeing as women can't possibly know their own dilation without being told, then they will be told to push when it is time. This is common in medical births where epidurals are used because intervention can alter how a woman experiences birth and prolong the second stage.

There is research showing directed pushing has negative outcomes on oxygenation to the baby and trauma/injury to the mother. Fetal distress and maternal distress are also adverse consequences of such pushing.

Stopping an imminent birth in its tracks to check for an umbilical cord is based on the idea babies will not be able to be birthed if the cord is around their neck and impeding the birth process. Most cords are not that short, and if they are, the baby is still able to be birthed without needing to fiddle with the cord. There is information here on the nuchal cord and newborn somersault, and a diagram of what somersault manoeuvre looks like.

As for being told to stop pushing because of a cervical lip or not being dilated enough, it also follows that women’s bodies are defective, and women can’t possibly know what they need to do. This is also common in medical births where birth is monitored with internal examinations.

Curiously enough when it comes to physiological childbirth, not every woman is fully dilated before experiencing the spontaneous bodily urge to bear down. Most of the time this urge quickly becomes a relentless and forceful bearing down in a completely involuntary manner. Regardless of dilation or cervical lips, babies are born like this despite the care provider stating it is not time to push yet!

Just before the fetal ejection reflex began

When birth happens on such physiological and spontaneous terms, it can happen pretty fast because of this intense expelling action. Niles Newton named this action the Fetal Ejection Reflex (a term made popular by Michel Odent) and it is now known widely as the Maternal-Fetal Ejection Reflex to include the mother’s physiology in the process.

Not every women will experience this intense maternal-fetal ejection reflex.There are various reasons for this like vaginal exams, bright lights, or other disruptions to the labouring woman - all of which inhibit the physiological process of birth. Women who are drugged or have disturbed births will usually experience a delay in this, or not experience it at all and need to consciously work at pushing their baby out.

Birth is a force of nature as much as a tropical cyclone is, and to expect a woman to arrest the spontaneous and intense bearing down that her body is doing involuntarily, seems to be an unrealistic expectation. I think women are indeed the experts when it comes to pushing as one midwife suggested. What do you think?

Further Reading:
Womb Ecology - information on the physiological process of childbirth
Pushing: Leave it to the experts - a must read article written by a midwife
Normal Childbirth: Evidence & Debate by Soo Downe - early pushing urges are discussed in this book

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Completely agree that a womans body knows what to do. I was measured at 5cm dilation and quickly after that push my baby out in a few minutes (at home). I remember thinking: I am only 5 cm! The urge was too strong to do anything about it but I always wondered. Did my body dilate that quickly? Or Was there an error in measuring? Its not very natural, is it?
I advise women to listen to their body. Helianthe Mucha Mama www.muchamama.nl
by info
Yeah I think your body probably did dilate that quickly! In "Normal Childbirth: Evidence & Debate" by Soo Downe - there are quite a few accounts of this quick dilation. When the body and baby is lined up, there just is no stopping it hey!
I had thIs with my second child. I started bearing down, about 2hrs into labor. When the nurse checked my cervix she said I was only at 6
But I couldn't stop the urge to bear down. She checked again and said I was at 9 when the contractions hit. This was followed by them telling me not to push because the dr was not there yet. It was impossible to fight? My body would contract and bear down on its own. I could literally feel her moved down my body as I fought the contractions and she came out almost entirely on her own.
Imagine how quickly and effortlessly it could have happened if you weren't fighting the contractions and the urge!
My own undisturbed birth ended with the maternal foetal ejection reflex without and pushing from me at all. Told at www.therabbitinthemoon.blogspot.com
I read your birth story, loved it :)
I hate this piece simply because it makes me vividly remember the awful hospital birth I had to endure. Everything I wanted to do was ignored, I was forced to do what I expllicitly said I didn't want to do. I was told not to push when my body already was, I wasn't allowed to sit up for it (I was literally pinned down and drugged) I was made to push when I didn't need to and 'harder because the pushes are ineffective'. Agh! Such crap! Thank the Lord I had an awesome homebirth 2nd time with zero help from anyone besides my husbands arm:)
I am sorry you had an experience like that with your first. I am a strong believer in women's right to have autonomy in birth and it is a shame this can't be supported by hospitals as a matter of practice. You didn't mention whether you experienced the fetal ejection reflex at your homebirth - how did that go for you?
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