Continued from previous page
Pushing in labour
When should the pushing in labour start?
This should be at a stage when the cervix is fully dilated and the head is reasonably down in the pelvis. This is the second stage of labour.
Surely, the earlier pushing is commenced, the shorter the labour?
This is a bad idea. If pushing is commenced before the cervix is fully dilated, it can cause all sorts of problems. The cervix itself is likely to swell up and may be pushed out of the vaginal canal, with serious risk of damage to it, and bleeding. The efforts themselves will not hasten delivery; instead, this will help to exhaust the mother, running the risk of her being unable to push when the appropriate moment arrives. This may mean an instrumental (forceps or ventouse) delivery which may have been otherwise unnecessary.
Why is it then that sometimes the mother feels such strong urges to push when she is supposedly not ready?
This is true. The reason is partly because the birth canal is right next to the rectum and back passage. Pressure from the leading part is inevitably transmitted across to this area and this produces the urge to bear down. Sometimes these urges are extremely strong.
Is there any way of avoiding this premature urge to bear down?
As part of parent-craft classes, which are widely available, expectant mothers are taught breathing exercises, which might help in this regard. Epidural analgesia is, of course, much more effective in preventing premature pushing.
When the right moment comes, what is the right way of pushing?
Again, this is taught in parent-craft classes. It is important to push only when there is a uterine contraction. Pushing at any other time is ineffective and only serves to sap precious energy.
The push should be as hard and as long as possible during the contraction.
As the mother feels a contraction building up, she should take a deep breath, hold it (this is very important) and bear down. It is OK to take snatches of breath very quickly in the middle of a push without relaxing. A good "push" lasts 30 to 40 seconds.
Shouting, screaming or expressing an opinion during a push may be irresistible but does no good. All it does is blunt the effort and in effect prolongs the second stage. It should be resisted.
In between pushing, the mother should try to let go and relax as much as possible - breathing deeply in and out, preparing for the next contraction and effort.
Sometimes, there is a strong feeling of an imminent bowel motion. What should I do?
This is quite common. Again, it is the effect of the pressure of the baby in the birth canal transmitted to the rectum, which is immediately adjacent. Even when the rectum is empty, a strong feeling of an imminent emptying of the bowel may be there. Many women find this hard to cope with because, culturally, opening the bowels is a very private thing. It should really never be a worry because midwives and doctors are used to it and half-expect it to happen anyway. Ideally, a woman should go in labour with an empty rectum but this does not always happen and should never be a cause for worry.
Sometimes, when a woman is seen in the latent phase of labour and is examined vaginally, a loaded rectum may be felt. Since there is still time, a suppository or even an enema may then be administered, to facilitate a bowel movement before the establishment of labour.
Below is a video of an actual birth(courtesy of garrynofear)
Note: There is no sound
Sometimes a midwife uses a catheter to empty the urinary bladder; is this really necessary?
Yes, sometimes this is necessary. A full bladder may impede both contractions and the descent of the baby down the birth canal. In the first stage of labour, normally the woman will be encouraged to pass urine herself from time to time. If an epidural has been used, then she may lose the sensation and therefore a catheter will be left in place to continuously drain the urine.
In the late first stage and in the second stage, it is usually impossible for the woman to pass urine herself. If her bladder is rather full, then a catheter may need to be used for the reasons explained above.