Pushing Positions

  1. How long do you let a patient push in one position?

    For those of you who don't have them change positions, if they don't make much progress after 2 hours in one position.. do you suggest they try another position or just get the doctor to assess for a c-section?

    I am posting this because I am trying to figure out why at the last birth I was at that ended in a c-section, the nurse only let her push in semi-sitting with legs in stirrups and never suggested squatting or an upright position (even after 2 hours).

    Thanks!
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  2. 22 Comments

  3. by   shay
    Man, my fingers hurt from typing........:chuckle

    I usually encourage a pt. to change positions if she's not making any progress in one position. I try pushing that way for about 30 min. if it's the first position we've used and she's a first time mom. If a pt. isn't making progress, I've been known to do everything but dangle them from the light fixtures to try to get the baby out...:chuckle (kidding about the light fixtures, you know).

    Anyhoo, I can tell you that when I was a young/inexperienced labor and delivery nurse I didn't change positions with my pts. AT ALL. I know, I know.......you can all give me 40 lashes right now, I deserve it.

    I don't know why that nurse wouldn't let your pt. change positions. I honestly can't say without having been there. Maybe she was like I was, inexperienced and just didn't know any better or was afraid to try something new.

    I remember vividly the first time I was encouraged to try some different positions. I was that inexperienced nurse, and they had paired me with a traveler nurse for the day to show her around the unit. She had many years' experience, and showed me some great techniques.

    As for when they decide to do a c-section, it depends on the doc. That's all I can say. I've seen a c-section called after 1 hour, and I've seen it not called until 4 hours.
  4. by   canoehead
    Change positions every 30 min until you see perineal bulging, and don't call the doc til you see a little head, cause that darn lithotomy position stinks to push in.

    Actually our docs will deliver in most any position, except if they wind up upsidedown (hands and knees) it gets a little confusing landmark wise I guess.
  5. by   JEA616
    I changed most of my patients positions every 20 minutes, unless they were making obvious quick progress. 2 hours in 1 position! Yikes, talk about a recipe for a c/s. I agree with the above, don't call the doctor until you are ready for delivery. Try any position that the patient will agree to including squatting,and standing. Let gravity work for the patient.
  6. by   sbic56
    I keep that patient moving while pushing, just as was done all through labor. Lithotomy not working? Try squatting, or turn her around, kneeling, facing the head of the bed to push. Could be just what the baby needs to facilitate turning out of the malpresentation he has gotten himself into. Gravity is definitely our friend in this case.
  7. by   mark_LD_RN
    i use multiple positions and never let a patient push in one position for an hour i usually change every 20-30 min unless pt making good progress in current postion. I really like knee chest for OP presentations. never be afraid to try something new. have avoided many c/s by using creative pushing
  8. by   bagladyrn
    Have had pts. push in every possible position, including standing at the bedside doing deep knee bends/squats with each contraction. Pt. stood with her hands on my shoulders, so I did squats with her (oh the sounds from my knees!) while the midwife sat on the floor.
  9. by   at your cervix
    I agree with everyone else, change position q20-30 min. However, if pt has an epidrual it is sometimes hard to do anything really creative (hands and knees, squatting etc) But, I do try side to side etc. And I agree, the "stranded beetle" (lithotomy) is the worst position for pushing unless baby is very low and it only takes a couple of pushes. Also, I don't know about others but i am a huge fan of laboring down (esp primips). If a pt has an epidrual and baby is high or they are a primip, i often let them sit at complete for an hour!!! If no epirual, I never push a pt until she feels like pushing, it just wears her out!!! I think it best to let the body do as much work naturally as it can. (besides, call me terrible, but I HATE pushing primips!!)
  10. by   Natalieboo
    God, I just WISH that nurse I worked with would read this damn thread. I mean, I know I can't say for sure, but I it just keeps bugging me that the outcome could have been totally different if she had just listened to me.. I subtly hinted twice "should we have her get in a squatting position". I know not to interfere with medical staff.. but jeez.. I just want to go back in time now!!
  11. by   shay
    It may very well have changed the outcome Tiffany. Unfortunately for your patient, we'll never know.
  12. by   SmilingBluEyes
    I flip em....if they have epidurals, it is encumbent on nursing to do this....i warn them, they will feel like "FLAPJACKS" when i am done. we go from side to side and in mc roberts again every 20 min or so, or more often if baby starts looking cruddy or in OP pos. just what i do, anyhow.
  13. by   obtnt
    Unless we are making remarkable progress (visable) I change pt position q 20 min or so, depending on fht's. I know this is my soapbox, but here again, we are stuck in the "we've always done it this way" attitude. Some dr's are adamant that THEIR pts push like he/she order!! Also, the epidural (I know, it is great for pain relief, ok?) is responsible for alot of this "failure to progress crap). I recently read where the mom's who were allowed to wait to push, waiting on the sensation not the clock, were pushing much less and had less fetal distress. THINK about it, waiting to push until the head decends and/or the mom "FEELS" the urge!! It's amazing!! We have intervened to the point we are responsible for a plethera of bad experiences. The docs want to get on with it and go golf, the unit needs the bed, whatever, we rush the labor process too much. The mom needs to let gravity work for them, be assertive with their dr and tell them they want to avoid the 3 hr pushing and be patient (pun not intended). Even with an epidural, most of us have birthing beds which allow creative pushing. Also, if more of us would refer our fellow nurses to this site, they MIGHT learn something new. It's just not fair to wear out these women, pushing the second the cervix is "10". It might be a good idea to do a unit study comparing pt's who push at complete, and those who were allowed to wait on their urge to push and/or waiting for the head to decend with contractions for at least 30 min after complete. Let me know what ya think!
  14. by   mark_LD_RN
    obtnt i like your post and totally agree with you. I constantly move my patients and dont usually push them unless they have the urge

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