I’ve officially entered back into the adventures of being an on-call Edmonton doula, after taking a hiatus from attending births following my own pregnancy… and boy did I miss this! In the coming months I’ll be pushed out of my comfort zone and attending primarily home births (most of my previous clients have delivered in hospitals). While there are some things I quite like about attending hospital births (yes, a doula in Edmonton who likes hospital births… who would have thought!), one thing I definitely will not miss is the coached pushing phase. Many of you will be familiar with this method of stage 2 management, and this is one I’ve seen many-a-time. This type of management is characterized by health care providers essentially telling you what to do and when to do it when it comes time to push your baby out. And while this can sometimes be necessary and actually crucial to birth a baby, like in the case of an epidural on board for example, women who are unmedicated should never be told when they can or can not push (in my opinion).
Let me start off by giving those of you who have never experienced unmedicated birth a bit of back story. When a woman labours with natural surges of oxytocin and endorphins, a certain rhythm just sort of happens to the labour. There are times when contraction strengths and lengths shift to the next phase and then the next, until finally the birth person is ready and starting to push. Us Edmonton doulas can often visibly see when these shifts happens due to the birth person’s body language. Some classic signs of shifts into a further labour stage are low moans, inability to communicate and towards the very end, uncontrollable grunts and bearing down. These sensations are our body’s way of communicating that our baby has made it’s way through most of the pelvis and is ready to come earth-side, and these little pushes that we begin to involuntarily make actually help the tissues to stretch at a good pace to avoid tearing. Watching a birth person experience stage 2 of labour this way is incredible to see – it often doesn’t even look like they are pushing at all, and I guess technically they aren’t (it’s their body doing the work for them).
Now if a women is heavily medicated often this urge is blocked or less noticeable, in which case it may be best for nurses to monitor the tocodynamometer to see when your contractions are coming and when (and for how long) you should be pushing. Coached pushing is meant for these cases and important, so I definitely don’t want or mean to de-value the place that medical advances hold in certain circumstance. However, how can anyone tell you how big your baby is going to be, exactly what position their head is in during all stages of labour, therefore determining how long or strong a birth person can push, other than that particular person? The answer is, no one can. The female body is absolutely incredible and is expertly designed so that when it comes time to labour and birth a baby, an intricate concoction of hormones give us the signals to know what position we need to be in and what we need to do to get baby from in to out. Another fascinating component of labour are the cardinal movements (I really think this needs to be my next blog topic, kind of obsessed with these). Baby instinctively will move down and through the pelvis in just the way that they will fit through these crevices and passageways, and causing no or minimal damage along the way. Allowing baby the freedom to do this without exerting voluntary force is important and necessary for a safe birth.
So the problem begins when medications and instruments are used to block and interfere with these natural systems. In some cases these medications and instruments are life-saving or very important to the health of mom and baby. But many more times than us doulas in Edmonton would like, these resources are used at a time when they are not truly needed, thus removing the natural sensation labour gives the birth person to know how to bring baby out. Even more problematic is when a women has not had any of these medications or instruments used on her and is still being coached or told to push/not push. In our most natural state, our body knows when pushing is needed, and this is not the same for every women and can not be predicted. One woman might be fully dilated and feel that she needs to wait for an hour before that urge has kicked in, and another might just barely reach full dilation and be ready to get that baby through the finish line. Birth is unpredictable, and this is one of the things that makes it such an impactful and meaningful experience – we can truly see the variety of human form from childbirth. So let’s embrace these differences and leave a woman who’s experiencing a natural labour to push on her own terms!
What was your pushing stage like? Did it go smoothly or would you have wanted something different? Share your “pushing” stories below, I love to hear them all!