Coaching style during pushing

[sbic56]

Wondering what you think about the cheerleader style of encouragement during pushing. You know...the counting to ten during every push and the constant instruction some coaches/care providers/nurses get into. I can see that it may be necessary for a few, but in general i think it's just plain annoying and unnecessary, especially when the patient is doing fine w/o it. I prefer calm reassurance and encouragment and keeping the mood/ atmosphere a bit calmer. Same goes for the breathing with ctx...the breathing is a tool, but I think is often overused and overrated. Isn't this supposed to be a natural process? The way some people coach I sometimes I feel like I am at a football game!

[shay]

Originally posted by imenid37

i hate counting. baby story does for l/d what cap'n crunch does for dental health.

Bwahahaha!!! Priceless!! So true, so true. Hee hee. Man, I hate that show.

[fergus51]

I find the more coached pushing is for my patients with epidurals and for the non english speakers. Unfortunately that makes up about 75% of my patients lately, so I have been quite annoying, though not for 10 seconds at a time.

[mother/babyRN, RN]

I am there for them in whatever style I notice they need. For instance, if they have been to class and really want to do the counting, fine...If they need to relax, I gently touch their faces and turn them toward me and calmly tell them to breathe as I am-deep breath in, hold it, exhale and hold...That is square breathing..When they actually do that with you, they can't help but slow their breathing...This is helpful for people who hyperventilate. I think the concurrent touching and focus on you helps them too....When they first get that urge, I mention to just let their bodies do what they would naturally do, and do the check when they feel they can't not push any longer. If there is cervical edema and the baby is low, that can be pretty tough..And, if the baby is posterior, we turn her to the side and teach the coaches how to help them hold their legs up, if needed. I think its best to streamline your style to the personality and/or mood of the pt, or both. Most of our nursing skills shine when we are able, even in this example and occasion, to STILL individualize our care...If she needs to hold on to me, great. I am there...If I need to make her get busy pushing because we are having a problem with the fh and the kid has to come out, gently changes to firm and so on....Nice topic...I think people get so lost on "how" to do things, that they get hyper stimulated.....I also ask them to visualize the baby's head coming down and out as they push. I find this helps a lot...I have had many docs laugh when I do that, but the same group has come around since noticing when the pt really gets into visualization, sometimes the doc doesn't have time to gown up cause the kid comes so fast...Plus, you don't need to speak a foreign language or have an interpreter to assist a pt to push or through labor. Touch and tone says a lot.....

[mother/babyRN, RN]

With epidurals in the absence of fetal distress, we do passive descent, so even if the pt is fully for a long time, as long as the baby tolerates it ( or time constraints as with prolonged rupture of membranes aren't a factor), we wait on pushing until she feels increasing pressure, so she can actually at least "sort" of feel an urge to push..And I NEVER forget to mention that as the baby comes down, different nerves are involved and they may sometimes feel that pressure.

[mark_LD_RN]

Originally posted by shay

Bwahahaha!!! Priceless!! So true, so true. Hee hee. Man, I hate that show.

i hate baby story! but did you see the episode the other day ? first time i ever saw a decent birth on it. it was at a free standing birth center with a midwife. get this, they let patient walk,intermittent fetal monitoring,she was even allowed to eat to toleration. woohoo imagine that, thet had a non traumatic birth on the show for once.

I hate the counting thing myself only do it if patient requests it.

[mother/babyRN, RN]

I follow the pt lead too, and tell them to imagine the head coming out as they push....We do a lot of visualization...

[L&DTami]

Helpful hints all! I follow the pts lead too, after all this is HER birth.

I hate the Docs who insist on pushing when complete, never mind that mom is numb and cannot! I have them wait if they have an epidural until they feel they HAVE to push. Sems like it takes a lot less effort on their part.

Our Doc who delivers the most wait til baby is +2 to push. We never push for 3 hrs with her pts.

[RN2B2005]

My husband and I attended one of those stupid, low-lights-soft-music, touchy-feely birthing classes offered by the hospital.

There is nothing like being in a room full of very pregnant women and very anxious dads, all trying to keep a straight face while pretending to be in labour and thinking of a "happy place". My "happy place" was GETTING THE FRIGGIN' BABY OUT! My thinking was, women have been having babies for thousands of years without Yanni on the CD player and aromatherapy, coaches, and some idiot counting to ten.

I checked into the hospital at 7:45p and delivered my son at 10:20p. I walked around a lot, but that was it. I think I used the grunting technique and did the pursed-lips breathing thing, I don't know what it's called, but itw worked and they didn't teach it in the class.

[ayemmeff]

Originally posted by RN2B2005

I checked into the hospital at 7:45p and delivered my son at 10:20p. I walked around a lot, but that was it. I think I used the grunting technique and did the pursed-lips breathing thing, I don't know what it's called, but itw worked and they didn't teach it in the class.

I had my first son in 14 minutes..........slash and grab for a prolapsed cord.They didn't teach THAT in class either!

Mother/babyRN,if I ever have any more babies would you come and be my nurse????:kiss I'll pay your air fare!