Three delivery dilemmas explored
1) Should you wait to push? If asked whether they’d like to prolong labor, few pregnant women would say yes. But in some circumstances, waiting to push may be a wise thing to do. Women who receive epidurals may have less complicated deliveries if they delay pushing until after the cervix is completely dilated to 10 centimeters, research indicates. Here’s why: Waiting a few hours before pushing allows the continuing contractions to help propel the baby into the pelvis.
This technique, called “passive fetal descent” or “laboring down,” can prolong labor by three hours or more. But a Canadian study of 1,862 first-time mothers who’d had epidurals showed it also reduced by half the number of expected difficult deliveries (those requiring forceps, vacuum extraction or a Cesarean section) when babies were in unfavorable positions, says study leader William D. Fraser, M.D., M.Sc., chairman of the obstetrics and gynecology department at the University of Montreal. Such babies are head down but facing to one side (transverse) or toward the mother’s abdomen instead of her back (posterior).
However, a small study (this one of 202 women, also first-time mothers who’d had epidurals) found no significant benefits for women who waited to push. In fact, C-section rates were identical, and the women who waited to push required slightly more forceps deliveries. “Our study was relatively small and not [set up] to show a difference in C-section rates,” says study author Beth A. Plunkett, M.D., a high-risk-obstetrics fellow at the Northwestern University Feinberg School of Medicine in Chicago. “But there was no difference between the two groups in how satisfied the women were with their deliveries.”
Until more research is conducted, there is no way to know whether waiting to push will benefit all or even most women. But Fraser says that at least in certain instances, it probably will help. “A woman whose baby is in a transverse or posterior position is most likely to benefit from delayed pushing,” he says.
2) Can breech babies be turned?
Ellen Bagnato was 36 weeks pregnant with a baby in a transverse breech (crosswise) position when she panicked and began culling the Internet for natural ways to turn her baby in utero. The Atlanta mom-to-be says she was terrified of undergoing a C-section or an external version—a sometimes-painful procedure in which an obstetrician attempts to physically turn the baby. “I was about to start doing handstands in a swimming pool when one of the other techniques I read about worked,” Bagnato says. “I propped an ironing board against my couch and lay on the board with my head at the floor for 15 minutes twice a day.” After she did this for a week, her baby turned head down and was later delivered vaginally.