[Selke]

Good morning everyone. I have another question for your collective wisdom.

How do you all hold a woman's legs while she's pushing? I hear/observe different things and wonder what you all do.

I was told once to hold a woman's legs and push back (if she's not holding them herself) from behind the thigh, by the knee, and to not push back on the foot.

Other nurses/midwives will push back on the feet as far back as they can (I'm not speaking in terms of a McRoberts Maneuver for shoulder dystocia, just ordinary pushing). I've been told by some to push straight back on the feet, knees bent sort of at 90 degrees (can't explain this, sorry). Others will splay out a woman's feet pretty far, legs not straight but more like 120 degrees, and held way out from her body, and push back that way (sorry, can't explain this either!) --

I like having a woman bring her feet together, bring her arms together in front of her and grab her ankles, if she's able to do this. This opens up the pelvis quite a bit.

What do you all do? Do you have resources that address this? Thanks!

[RNnL&D]

I generally support the foot, either with my hand, or my hip. I think of myself as a portable footrest. I encourage Mom to hold behind her thighs, in front of her thighs, knees, whatever is most comfortable. And I never have anybody push with the head of the bed lowered. It's just too close to the lithotomy position for my comfort. They are generally in semi fowler's, if lying in bed. Although I have had women push with the squat bar, on hands and knees, on the floor next to the bed, standing at the sink, on the toilet....... whatever works is my motto.

Here's a good description of positions for pushing and advantages to each.

http://babies.sutterhealth.org/labor..._labr-pos.html

Here is another good article that talks about pushing styles in different cultures and asks the question is semi sitting really that different than lithotomy position.

http://www.ican-online.org/resources...wp_pushing.pdf

[elizabells]

During my LD clinicals (standard not-a-nurse-yet disclaimer here) we had everyone in lithotomy - I know. Evil. Crazy heavy epidurals, too. So mom rested feet on footrests in between pushes. As to holding the legs, we had one hand behind the knee, the foot in the crook of the other elbow, and her shin resting against our chests, with both hip and knee at 90 degrees. We didn't push back on her foot, just provided resistance to keep the joints at those angles.

[Selke]

It's hard for me to explain this ... I have recently seen people hold a woman's legs not only very far apart, but hold her feet way up in the air, with the knees straightened, like a 120 degree angle, then have her push. I've never seen this before and can't find any pictures in my labor support and position changing books. Maybe nobody else has done this, it's just done at this one hospital I'm now working at? I'll have to ask someone there next time I see them do it why they do that and what the advantage is. (I'm talking about pts with epidurals who can't get up and squat, &c.)

[elizabells]

Okay, so I'm a HUGE nerd, because I just got down and tried the position you describe... I think maybe the abs engage more? Like, the lower abs, and also pelvic floor muscles? It...creates more tension than the 90/90 position. Kind of hard to describe.

[Selke]

Originally Posted by elizabells

Okay, so I'm a HUGE nerd, because I just got down and tried the position you describe... I think maybe the abs engage more? Like, the lower abs, and also pelvic floor muscles? It...creates more tension than the 90/90 position. Kind of hard to describe.

You're cracking me up. I think we're all nerds here. Birth geeks, whatever. Who else asks questions like this? (having fun with smilies now)

I'm working this weekend so I'll try to ask somebody about it.

BTW, you probably do know quite a bit about pushing, as there's not a whole lot of positions, esp. if most of your pts have epidurals and can't get out of bed or squat or kneel or hands and knees or stand while pushing. If you have a lot of labor pts in your clinicals you can learn a lot in a short time. I'd love to get the bucks to go to one of Penny Simkins' or Polly Perez's workshops one day. Reading books is one thing, it helps me to see demonstrations and do it.

signed, another nerd

[elizabells]

Hah! I really am a birth dork - if my screwed up back and joints would allow it, I'd work L&D. My clinicals made me SO MAD though, because it's all heavy epidurals and MANDATED lithotomy. Like, no choice. You give birth there, you're on your back. Lots of episiotomies, just awful for a girl from Berkeley.

[Selke]

Originally Posted by elizabells

Hah! I really am a birth dork - if my screwed up back and joints would allow it, I'd work L&D. My clinicals made me SO MAD though, because it's all heavy epidurals and MANDATED lithotomy. Like, no choice. You give birth there, you're on your back. Lots of episiotomies, just awful for a girl from Berkeley.

You have a screwed up back and joints at 25? You're too young for that ... But I think other areas of nursing are even harder on your body than L&D.

I agree about the huge numbers of epidurals and lithotomy; it's sad. But, the women want and expect the epidurals. The larger question is, how can US women be changed so they have faith in their ability to deal with birth without it? They can tell the anesthesiologist to leave the room but instead they all offer to marry him for taking away their pain!

I hear you about Berkeley -- I lived and worked there for a few years until very recently. The SFBA is a phenomenal place, and working in OB was special -- I worked with the most amazing RNs, MDs, & midwives. RNs are respected there like no other place I've lived. I would laugh at the RNs who would complain about our hospital -- they have no idea how OB is like or how nurses are treated everyplace else in the country.

[RNnL&D]

Originally Posted by elizabells

Hah! I really am a birth dork - if my screwed up back and joints would allow it, I'd work L&D. My clinicals made me SO MAD though, because it's all heavy epidurals and MANDATED lithotomy. Like, no choice. You give birth there, you're on your back. Lots of episiotomies, just awful for a girl from Berkeley.

That sucks. I'm lucky enough to work in a facility with many low intervention births. Our epidural rate is 35-40%. And this is in an inner city hospital.

[elizabells]

Originally Posted by RNnL&D

That sucks. I'm lucky enough to work in a facility with many low intervention births. Our epidural rate is 35-40%. And this is in an inner city hospital.

Wanna be freaked out? That was our C/SECTION RATE. Our epidural rate? Ninety-frickin-five percent. Now, the C/S rate is partially explained by the large number of high-risk antepartum patients. But still.

And in re my back and joints: yeah, that's what I keep saying. But years of ballet and gymnastics and cheerleading disagree with us. And possibly something rheumatic, that's being looked into right now. So I work in the NICU. If I can lift a patient with one hand, and spend quite a lot of the day sitting down, I can get by on NSAIDs instead of a narc, which is better for everyone.