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We do three pushes counting to ten each contraction. I usually have her start on her back to get the hang of it, then try side pushing or sometimes the squatting bar if her legs aren't too numb (which is rarely at my place)
I rarely count unless the pt seems to do better that way. If they're too frozen to push or change positions I wait and if they have urge we do three pushes or four of 8-12 seconds approximately--whatever is working. I tend to use instructions like "that's it, give it a little more and keep holding it!" and keep my voice low if that's working. The frenetic, loud voiced "1-2-3-4...." that you can hear from across the unit makes me nuts!! The odd patient needs it but most people respond better if you explain that the baby needs to rock back and forth and the rationale behind holding the pushes for a long time.
For one thing, where I work we practice laboring down as much as possible until the baby is almost crowning. Rarely do we push for hours (although, I would say 95% of our patients have an epidural). I talk to the patient about pushing before she begins and let her know I'd be happy to count for her if she'd like. But usually at that point they can feel how and where to push.
Labor down if we can, until they are about +3. Then (because about 98% of our patients have epidurals) they get put up in stirrups and we do 3 pushes to the count of 10 with each contraction. If they are doing amazingly well then I skip the counting and just encourage.
If you have a patient without an epidural, you don't have to do or say anything, other than encourage her! She (her body) will know exactly what to do and what position she needs to do it in (which is almost NEVER on her back!). Unfortunately, we've forgotten that women were designed to give birth without being told "how". Of course, epidurals completely cancel all that...
I work night shift, and we LOVE laboring down. We don't do any convincing to the MD's because they are not here and our patients will oddly enough stay about 9.5cm until they are +1 or +2 Of course, we take a risk of delivering the babies ourselves, but that's much better than pushing with a patient for 3 hours lol
How do I convince my unit to allow more laboring down? Where can i find the latest evidence base article?
I don't know about research or articles, but what you can do (and what I have heard of some nurses doing if you have a doctor who is strangely opposed) is just check them and mysteriously find them to have an anterior lip.
We like to allow patients to labor down as well. I rarely count to 10 with a patient unless they really want that or seem to do better with it if they aren't making the progress needed or holding their pushes long enough. Depending on the situation, I try to educate them on pushing before it begins and then say encouraging words like, "good job..bear down, down..or push harder, etc". Most of the patients have epidurals and they get put up in stirrups when they are close to delivering after some practice pushing (again depending on the situation, patient etc) and then we do 3 pushes with each contraction.
I love it when I can tell a patient to "just listen to your body and do what it tells youu." They start out with short little grunts (the equivalent of a pt with an epidural laboring down) and as the baby gets lower and they feel more pressure the pushes become longer and stronger, but not usually as long or forceful as the count to ten and push harder...harder...HARDER. When it works, it makes for a beautiful natural birth. But a lot of American women aren't really in touch with their bodies--they're in their heads wanting to control things and "do it right". These women do better with coaching. I don't count, I praise, when my breath gets a little short, I tell them to take another breath. Many women need to be reminded to exhale before taking another breath. You cannot praise a laboring woman too much, she deserves as much as you can give her and more. "Good job, that's right.fantastic. keep going, I can see that the baby's moving lower (if it is). Push, lower, lower, you're pushing in your face/chest, push in your bottom like you're trying to pee (somtimes more effective than poop). That's it, can you feel the difference, you really moved the baby that time, do it again just like that.Lots of feed back. I can see the electrode wire moving, some hair with my fingers in your vagina, without my fingers in your vagina, the baby's head.Take the Intermediate Fetal Monitoring course thru AWHONN, management of the second stage of labor is discussed. AWHONN publishes a booklet on second stage of labor with lots of references.It's not very expensive and you'll have all the evidence you need to convince reasonable docs. For the unreasonable ones, you may find that a lot of your patients develop that persistent anterior lip,