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a PUSHED birth

Posted by on Apr. 22, 2011 at 8:50 PM
  • 8 Replies

What’s a ‘Pushed Birth’?

A pushed birth is one that is induced, sped up, and/or heavily medicated for no good reason, and all too often concludes with surgery, invasive instruments, an episiotomy, or a bad vaginal tear — outcomes you don’t want. Decades of research show that the healthiest birth for you and your baby — and that means your partner, your family, and your community — is a normal, vaginal birth with minimal intervention and maximum support.

If you’re like most American women, though, labor support is not what you’re going to get. Look at the numbers: 4 in 10 women today are induced. 1 in 3 give birth by major surgery, the cesarean section. 1 in 3 vaginal birthers get an episiotomy — surgical scissors cutting your vagina. And most women will put their pelvic floors at risk by lying in a bed throughout labor and pushing the baby out while while flat on their back.

Why? Because most L&D wards aren’t following best practices. They’re strapping 95% of women in for labor with continuous electronic fetal monitoring. It sounds great, but it’s actually a practice that goes against the research evidence. Time and time again, studies have shown that the machine is no better at monitoring your baby than a human being with a stethoscope, meanwhile it increases the likelihood of surgery and other unwanted outcomes because it limits your ability to move, find comfort, and help labor progress.

Labor and Delivery wards also put you on the clock, and more than half of you will be given the synthetic hormone Pitocin to speed things up. You’ll probably also have your water bag artificially broken. Once that happens, you’re on deadline: most OBs won’t allow you to labor more than 12 hours after your water has been broken. If you’re not pushing out that baby, you’re going to be pushed into the OR for a cesarean.

Or maybe you’re being told to induce labor because…your baby “looks big” on the ultrasound, or the fluid “looks low,” or it’s past your due date, or your doctor is going on vacation and you want her to deliver your baby, or you’re tired of being pregnant and, well, why not? There are compelling reasons to wait. An induced labor is not a normal, “physiological” labor. It’s more painful, it requires that you stay in bed hooked up to various tubes and machines, and it ups your chance of a C-section by two to three times. Furthermore, none of these reasons is medically valid.

Even if you’re able to go into labor on your own and progress fast enough, you’re probably going to push lying in a bed, and you’ll be told when to push, how long to push, and how hard to push. It’s a hold-your-breath-bear-down-and-count-to-ten kind of thing, and research has shown this practice to be damaging to your pelvic region and more likely to result in tearing as the baby emerges. Hello painful recovery, painful sex, and incontinence.

It sounds pretty grim, but it doesn’t have to be this way.


by on Apr. 22, 2011 at 8:50 PM
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by on Apr. 22, 2011 at 8:51 PM



Can I Avoid It?

In the United States, there’s a gap between what’s called “evidence-based” maternity care and normal maternity care. According to a 2006 survey, a mere 2% of women had an optimal birth experience. Instead, most women experience a host of routine medical interventions. Research shows that what a woman needs most in labor is support. Childbirth is a process that normally starts and progresses all on its own — the cervix begins to open, the uterus begins to contract, the baby begins to descend, and each of these accelerate until you can’t help but push the baby out. The body does this all by itself. Evidence-based care is essentially when the labor process is watched, supported, and protected with the least medical interference necessary.

So, in order to get optimal care, you need a provider who will provide support. Someone who will…

  • wait for labor to begin on its own and progress on its own
  • allow you to move freely during labor and help you find comfort
  • provide what’s called “intermittent” human monitoring of the baby, rather than continuous machine monitoring, so you can stay mobile.
  • protect your perineum while you’re pushing — by helping you into good positions, putting counterpressure on your bottom while you push, and most importantly not telling you how to push.
  • catch the baby from whatever position you feel best pushing: standing, squatting, hands-and-knees, kneeling, sitting (you get the picture).
  • give you the baby immediately so you can be skin-to-skin and initiate breastfeeding.

Who are these providers, you ask? Unfortunately, they’re not usually obstetricians or L&D nurses. Even midwives working in hospitals may not be able to offer intermittent monitoring and other evidence-based practices. Unfortunately, you need to do your research and be vigilant. Even if a provider has progressive ideas, hospitals are increasingly restrictive in how they manage labor (in fact, the medical term is “active management”).

Some nurse-midwifery practices (which typically work within traditional hospital maternity wards) have a great track record. Look for a low cesarean rate (below 10%). Midwives practicing outside the hospital maternity ward, in birth centers and at home births, have been shown in studies to have the most success in supporting normal, physiological birth.

Home birth — it’s not just for hippies. Two large studies following healthy women who chose to give birth outside the hospital with a trained midwife show that 95% had normal, vaginal births, meanwhile their babies did just as well as those who were born in the hospital.

If that’s not an option, there are still ways to reduce your risk of being pushed:

  • get a doula
  • labor at home with her until labor is really cooking
  • prior to your due date, have your doc or midwife write on a prescription pad “intermittent monitoring, no IV, and OK to eat and drink.” Jackie Levine, a NY doula, calls this an “Rx for a Normal Birth.”
  • during labor, have access to a shower or preferably a bathtub
  • stay mobile and avoid immobilizing anesthesia
  • avoid Pitocin, multiple vaginal exams, and artificial rupture of the bag of waters.
  • negotiate upright, active positions for pushing and delivery
  • refuse an episiotomy
by on Apr. 22, 2011 at 9:21 PM


by on Apr. 22, 2011 at 9:28 PM
Posted on CafeMom Mobile
by on Apr. 22, 2011 at 10:41 PM

Bump! This time i'll have no vaginal exams.. and a doula to help me keep moving. I turned into a giant lump during my transition last time.

by on Apr. 23, 2011 at 12:54 AM


by on Apr. 23, 2011 at 2:49 AM


by on Apr. 23, 2011 at 12:43 PM

I love, LOVE the "Rx for Normal Birth" idea.  Even though we'll be planning a UC homebirth, I still plan to see my OB and plan out my natural hospital birth, only "oopsing" a homebirth instead.  That way, though, if we happen to transfer, unlikely as that should be, she'll already know my plan :)  But, Dr M has been great in 3 pregnancies so far at supporting decisions IF you voice them.

by on Apr. 24, 2011 at 8:37 PM

I know this might sound odd coming from me but is it possible to refuse even EFM's at the hospital? Even with the intermitent EFM's those are my down fall everytime. I wonder if once I notice that things are progressing and getting more intense if I can just tell them "no sorry I'm not doing a EFM this hr" and just hold to that until baby is born?

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