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Repeat customer: question for easier/shorter pushing this time.

Last post 01-09-2010 7:03 AM by Brlnbabies. 13 replies.
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  • 11-30-2009 3:19 PM

    Repeat customer: question for easier/shorter pushing this time.

    I have a repeat doula client that is due next Sunday.  I attended her first birth and she did an amazing job all throughout labor.  She did, however, have to push for 4 hours.  It was in the hospital and she did get to try the squat bar for some time and also kneeling but nothing moved  the baby until the doc touched the vacuum to her head, then she popped right out even without the vacuum being used.  So, I am wondering what could have been the deal.  She said her grandma has what she called a "stovepipe pelvis".  I *think* she means her tail bone curls up so the baby has to move up and over it?  Not sure, really, but we are thinking it might be hereditary as her grandma pushed a long time as well. 

    So, my question is this:  what are some positions, movements or anything that can help her when it comes time to push the baby out?

     

    Vicki - wife to Chris, mom to eleven, doula and midwifery student.
    Filed under: , ,
  • 11-30-2009 8:19 PM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    "Stovepipe" to me implies that it's a straight tube, not a curve.  Think stovepipe hat; no curve--Abraham Lincoln.  Every labor is different and she could push for 20 min this time or another 4 hours.  You never know.

    As far as positioning goes, maybe you could try asymetric positions or hands and knees.  These are more conducive to opening the pelvis.  You might also try the hip squeeze or using a rebozo. ??

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 12-01-2009 5:43 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    I think the single most effective way to improve the pushing phase of labor is waiting until you have an uncontrollable urge to push.  Not just that feeling of pressure in the pelvis.  That absolute pushing in the abdomen and uterus that happens.  Not just because you are 10 cm. which is the sign that pushing must commence when you have a baby in the hospital.  My thought, though, is that even if this woman changes nothing, her second baby will come MUCH more quickly.  Joyce  P.S.  So many women blame their own bodies when labor doesn't go the way they planned.  It's rare that it is the woman's body. 

  • 12-01-2009 10:40 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    I've had a couple of doula clients that were having difficulty with baby coming underneath the pubic bone. In most births, stage 2 should be done in upright positions (squatting, hands/knees, standing, etc.). In two cases where this was a problem due to head size or pelvic shape, the midwife had the mom change to pushing on her back until baby was able to get underneath the pubic bone. I was surprised since I'd always been trained that the back is not the position to be pushing in...but it did indeed work when this was the issue. Cat-cow is another technique to try.

    Let us know how this birth goes...will be thinking of you both!

    Dianne

    Dianne~Doula, mother of 4 and Grammie to 2
    www.douladianne.blogspot.com
  • 12-01-2009 11:38 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Repeat customer: question for easier/shorter pushing this time.

    I agree with Joyce, this mama may change nothing at all about the pushing part of her second birth and pushing out her baby will be MUCH faster.  I always encourgae mama to wait for the uncontrollable urge, let that feeling build and build until you cannot not push and mark true pushing from that point.

    Once in a while to help a baby get around the pubic bone I get the message that McRoberts would help and sure enough it helps bring that head around the bone quickly.  Doesn't make sense to go on the back, but it can work.

    Just had a repeat mama who pushed 4 hours as a primip and second baby was 10 minutes of true pushing.  She was probably fully dilated (no ve's just going by emotional and physical markers) for an hour or more but we waited for the uncontrollable urge before marking pushing.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 12-02-2009 6:25 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

     Didn't you say, also, that this was her first baby?  We forget sometimes that first babies take a WHILE to be born.  Her body never had to open like that before!  It's good that it was slow.  Imagine if you tried to do a split for the first time and someone insisted you had to get your legs in the 180-degree position within the first hour (maybe 2) of stretching or they would "need" to intervene.  It's the same kind of stretching: muscle tissue, ligaments, tendons, which are all designed to open but have not yet had to actually DO it.  We just have to keep teaching women that slow is not the same as bad!  Man, is that lesson ever an uphill battle!

    Blessings,
    Aron

    "I AM NOT CRAZY - it's just that my situation seems to require a crazy person."
  • 12-02-2009 9:23 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Repeat customer: question for easier/shorter pushing this time.

    I love what Aron just said!

    Gonna use that,,,,

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 12-02-2009 10:07 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    Oh I have seen a first time home birth take many hours once the mom was complete and everything was just fine.  BUT, this mom was in the hospital and the clock was being watched.  She didn't have the urge to push once complete and yet they had her push anyway.  I am sure that contributed to the length of time.  I guess what bothers me is that they wanted to use the vacuum once four hours came up.  He didn't even attach the thing and the baby was moved enough to come out with that push.  The doc was even surprised that he didn't have to use it.  The look on his face was priceless, like "Oh, THAT was the problem."  But he didn't tell us what the deal was.  I have since wondered what it was with him fiddling with the head to put that thing on that "loosened" things up so baby could come.....   

     

    Vicki - wife to Chris, mom to eleven, doula and midwifery student.
  • 12-04-2009 4:09 PM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

     It's possibly baby was slightly asyclintic.  It's not uncommon especially when pushing begins before the urge does (often babies go on lining themselves up well for birth for a bit before they descend low enough that that full-on pushing urge comes), and generally they try to attach the vaccum to the crown (where it will stick best) so possibly he re-aligned the head slightly in his attempt to attach and so baby came down right away.  I would guess waiting for the uncontrollable urge will make the biggest difference.

    Can you ask him what happened?

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 12-06-2009 10:32 PM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    agreeing with joyce, and yep what worstfriend said. he probably manipulated the head a bit. also, they need to push around in there a fair bit to make sure the ventouse is attatched only to the baby's head and there's no bits of mama's vag tissue stuck in it (no need to give a visual of what happens if there is!), so doing that could very likely have been enough, especially after 4 hours of the baby's head moulding slowly.

    Jesus was born unassisted!
  • 01-03-2010 9:51 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

     I agree with JoyCNM

    Wait for the uncontrollable urge to push.

    By the way how did things go?





  • 01-08-2010 7:27 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    Things went very well!  She only pushed for about half an hour.  She did wait for the urge to push.  She is a very determined mama and wouldn't even let them strap the belts on her.  She made the nurse hold the heart monitor on the baby.  The nurse complained a little, but she did it.  I wish all mom's could be so determined to get what they want!

    Vicki - wife to Chris, mom to eleven, doula and midwifery student.
  • 01-08-2010 9:58 PM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    that's a great update... good for her for sticking to her guns and doing it her way this time!

  • 01-09-2010 7:03 AM In reply to

    Re: Repeat customer: question for easier/shorter pushing this time.

    Thanks for the update! Yay!

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
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