Caldeyro-Barcia’s (1979) studies showed what most midwives practice or believe intuitively; that coached pushing and prolonged breath holding by the woman during the pushing stage of labor is dangerous to the baby. He showed that this type of pushing caused placental perfusion issues (not enough blood flowing between baby and placenta) and resulted in fetal hypoxia. Aldrich, et. al (1995) showed that prolonged breath-holding decreased fetal cerebral oxygenation. Thompson’s 1993 study showed that women who had coached pushing for more than an hour, the babies had a lower pH at birth (meaning they were acidotic and likely stressed).
Basically, there is no evidence to support coached pushing but it still exists! Observational studies have shown the following complications that arise from coached pushing; maternal exhaustion, more assisted vaginal births, more episiotomies and tears, more impact on the pelvic floor and instances of urinary incontinence after birth.
Watching a woman’s body push her baby out is an education in these principles. I have observed that she will naturally breathe faster and slower as she needs to; she will grunt and hold her breath for short amounts of times, as she needs to. I would never pretend to understand exactly what is going on in her body to prompt her to do what she is doing. If she is unmedicated and allowed to follow her body’s lead, I think there is little that can go wrong. The most physiological way to push a baby out is with the body’s own cues. Some women will experience the “fetal ejection reflex” which can look like there is next to no “pushing”. It is a physiological expulsion of the baby by the body. When you’ve seen this happen, it is a world of difference between the forced/coached hospital (or home birth!) pushing that can turn women blue in the face.
So, despite what you have heard…there is no good reason (physiologically or otherwise) to think that anyone should tell you WHEN or HOW to push. You will know when it is time. You will do it just right, and with the greatest benefit to you and your baby and with the least amount of trauma.
I am a doula, and I have been to many births, medicated and unmedicated. It is beautiful to see a mother follow her own body’s cues to push out her baby. yes, in a naturally timed way . More often than not, I am attending hospital, medicated births, and these mom’s are being told to hold their breath and push when prompted. How can we navigate around this issue?
[…] Once, I had reaffirmed my initial beliefs that coaching pushing had more to do with the control of women, their bodies, the birthing process, and expediting births for financial reasons for the hospitals… I wanted to find out more about how to justify the benefits of allowing mothers the dignity to follow their own bodies rhythms. I realize not all view birth as I do as a natural rite of passage and transition into motherhood. So I wanted to seek science for those who merely view birth as a biological process that could be potentially painful and uncomfortable. “Research does not support the routine use of directed pushing, and some researchers suggest it is harmful. Holding your breath for a long time naturally decreases the flow of oxygen to your baby. Research suggests that this is stressful and may even be harmful for your baby.”Link As I realize many Western Medical people view birth as an event in which the baby’s health is the number one priority I want to present my argument from that viewpoint. While I personally believe the mothers health, experience, safety, and emotional experience is paramount to her transition from maiden to mother, I realize this more romantic view of the birthing space is not held by the Western medical majority. A lack of oxygen to the baby itself should be enough to stop the practice of coaching pushing itself, but is there more? Yes, in fact a study also has shown babies born to mothers who were “coached” for over an hour were born with a lower pH meaning they were acidic and more stressed. Link […]