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DIRECTED PUSHING - BREATH HOLDING
What: Women are instructed to take a deep breath in and hold it for 10 counts, then push throughout the contraction – regardless of her natural urge to do so. Often, women are put in a semi-recumbent position, with legs up and chin tucked in a C-position.
Why: Directed pushing during childbirth became the standard half a century ago when women were heavily medicated during labor and birth. It’s still a common practice in labor rooms, but evidence shows that this technique should be avoided. Instead, women should be encouraged to follow their bodies, pushing only when they feel an urge.
Lower your risk: Ask your labor support team to follow your lead when it comes to pushing. Change positions often during this stage. Remember, there is often a “rest and be thankful” stage between urges. Try moaning or exhaling while you push. Ninety percent of the work is done by your uterus. You can focus on relaxing your perineum and pushing with your body cues. Visualize your baby rotating and descending.
If you have an epidural, remember that your pushing can be impeded by the numbness. Talk with your support team about the practice of “laboring down.” This means allowing the uterus to move the baby down without your active pushing, until the baby is low enough in the pelvis and triggers the receptors that will give you the urge to push. Patiently allowing time for the baby to descend naturally reduces the chance of requiring an instrument delivery (see “Instruments to Know,” right) or a cesarean.
What: A surgical cut to the perinium and the muscle beneath it, between the vagina and the anus, during the pushing stage.
Why: If there is fetal distress, an episiotomy may shorten the pushing stage by 5 to 15 minutes so the baby can be born faster. It is often required if the baby needs to be assisted, rotated with forceps or a vacuum extractor, or if her shoulders aren’t able to rotate and pass through the pelvis. Episiotomy should not be done routinely; it is largely unnecessary and carries risks to the mother, such as pain, infection and blood loss.
Lower your risk: Recent studies have shown that the routine use of episiotomy does not benefit the mother or newborn. Also, not only does it increase postpartum pain but it weakens the pelvic floor, contributing to long-term problems. Make it known before labor begins that you’d like to avoid having an episiotomy unless absolutely necessary.
During late pregnancy, continue Kegel exercises to strengthen and elasticize your pelvic floor. This will decrease your need for an episiotomy and lessen the chance of tearing naturally. Choose labor positions, like squatting, that help speed the process. Try not to hold your breath for extended periods. And follow your body’s cues, pushing when you feel the urge. Warm compresses or oil on your perineum may help ease pain.
What: Major surgery that allows the baby to be removed via incisions into the abdomen and uterus.
Why: When there is an urgent threat to the life of the mother or the baby, a cesarean can be a life-saving intervention. Examples include a mother hemorrhaging or a baby not getting enough oxygen. But most cesareans are not emergencies. Some non-emergency reasons are prolonged labor (“failure to progress”), a baby in a breech or transverse position, and changes in the baby’s heart rate.
Lower your risk: Cesarean rates in the United States have reached an all-time high of almost 32 percent, and the World Health Organization is urging health-care providers to decrease that number. Lower your risk by choosing a health-care provider and place of birth with a low cesarean rate. Skilled, continuous labor support is also vital. Research has shown that the presence of a doula can lower the chance of having a cesarean. Finally, be actively involved in all decision making before and during labor, and ask if each medical intervention or pain-relief option increases the risk of cesarean birth.
Some hospitals or health-care providers will not allow a woman to have a vaginal birth after she has had a cesarean (VBAC). But the American Academy of Family Physicians has a policy to expand VBACs, so research your options.
Giving Birth with Confidence, the online community created by Lamaze International, provides articles and tips written for and by real women (and men) on a variety of topics related to pregnancy, birth, breastfeeding and parenting. Their goal is to help women achieve healthy pregnancies and safe, satisfying births by offering a meeting ground to obtain information and support from other women, Lamaze-Certified Childbirth Educators and knowledgeable experts.