The Push Paradox
When it comes to pushing during labor, more isn’t better.
Coached pushing may indeed shorten labor; one study found that the second stage of labor is, on average, 13 minutes shorter for women who follow the old-school approach. “But shorter is not intrinsically better,” says Romano, who manages Lamaze
International’s informative Science & Sensibility blog (scienceandsensibility.org). “Shorter is only better if it protects the baby’s health, reduces the mother’s suffering or prevents the use of other interventions like vacuum-assisted delivery or Cesarean surgery. Coached pushing does not help with any of these.”
With spontaneous pushing, a woman pushes when she feels the natural, normal urge to do so. “No one has to tell you to do it,” says David Paad, a certified nurse-midwife at Special Beginnings Birth and Women’s Center in Arnold, Md. “You feel the urge to push. The baby’s head is pressing on similar nerves that cause you to have bowel movements.” Women who push spontaneously tend to do it for five to six seconds at a time, five to six times per contraction, and their pushes are often accompanied by groaning or grunting.
Choosing to push without coaching is not the same as pushing without support. During spontaneous pushing, a birth attendant can still offer feedback, encouragement and guidance—but without the rigidity of counting or directives. “These should be done in a way that includes and supports the mother rather than overriding her instincts,” Romano says.
If you’d rather avoid coached pushing, think about it well before you arrive in the delivery room. “Find someone who is familiar with uncoached pushing—a doula, a midwife, a childbirth educator—and discuss it with them,” Paad suggests. Once you’ve educated yourself, raise the issue with your obstetrician, if you’re using one. Although some are slaves to medical tradition, others are willing to consider fresh evidence and go along with the belief that during labor and delivery, women’s bodies are usually their best coaches.
When you need a coach’s count
Coached pushing can be helpful when you’ve had an epidural. Because anesthetic numbs the nerves that are normally activated by the pressure of the baby’s head, you may not fully feel the natural urge to push. The external prompts from a coach can be a good replacement for these urges.
More labor options! For seven ways to give birth, go to fitpregnancy.com/haveityourway.