No more purple pushing.

 

Today's labor post is going to be about what I call, "purple pushing."  You know, the nurse tells the laboring woman, "Oh!  What do you know?  You're fully dilated and it's time to push.  Now hold your breath, count to 10 and push as hard as you can!"

This is what we've all seen in movies, right?  And for those of us who is given birth, chances are this is what your nurse or doctor instructed you to do.  However, the evidence now tells us this practice could be detrimental to baby and should be avoided.

According to AWHONN (the association of women's health, obstetrical and neonatal nurses), *"the practice of counting to 10 and encouraging breath-holding while pushing should be abandoned."  This so called "closed-glottis pushing" actually decreases the mother's oxygen saturation and in turn decreases oxygenation to the baby.  The baby's heart rate may start having decelerations due to the lack of oxygen caused by the mother holding her breath.  Looking back to my first delivery, this may have been the reason the nurses kept throwing oxygen on me, turning me on my side and possibly the reason my baby came out quite blue. 

So what can a mother do?  I suggest the method of "breathing baby down."  You can still push, just breath!  Don't cut off oxygen to your baby.  Your body will actually push the baby out regardless of what you decide to do.  Women who labor naturally often experience involuntary pushing where the body bears down on it's own.  For these involuntary pushes the woman may hold her breath naturally for 6 seconds max, bear down, and then breath normally.  This is much better for the baby.  And for moms who get epidurals, the evidence shows (according to AWHONN) that coached pushing doesn't even significantly shorten the 2nd stage (pushing stage) of labor!  Can you believe that?  All that work for nothing?

There is something called "passive fetal descent" which is better for a baby.  The body will push the baby down on it's own, and you won't have to do a thing until the end when you actually feel the urge to bear down. 

The evidence says to wait for that bearing down sensation, regardless of dilation.  So if you're like me and don't like anyone shouting in your face, "PUSH! 1-2-3..." this is great news!  Your body knows what to do.  It's great to have your nurses and support person coach you, but there's no need to turn purple!

*Simpson, Kathleen and Creehan, Patricia: Perinatal Nursing, 3rd Edition.  Philidephia.  AWHONN, 2008