WASHINGTON (Reuters) - Pregnant women coached through their first delivery do not fare much better than those who just do what feels natural, according to a study released on Friday.
Researchers at the University of Texas Southwestern found that women who were told to push 10 minutes for every contraction gave birth 13 minutes faster than those who were not given specific instructions.
But they said the difference has little impact on the overall birth, which experts say can take up to 14 hours on average.
I call that old "counting to 10 and pushing thing" , purple pushing. It's not always so great, OR effective and the baby WILL peter out if this is done for too long. But just TRY and tell our docs that. Sigh......
It isn't our docs . . . .it is some of our nurses.
oh! when the ob did show up to deliver my baby, i do remember him saying that the pain a woman endures is comparable to a man passing kidney stones.
i took my foot out of the stirrup and kicked his shoulder so hard that he rolled backwards in his stool. still don't regret it.
OMG!!!:roll
BTW, How does HE know what labor is like?
Really, I don't think anyone can generalize about birth, even those who have been through it. I have seen women go through what I would call very difficult labors say that it wasn't that bad at all. And I've seen women acting like they had their leg cut off after experiencing a few contractions. Pain is so subjective.
I couldn't agree more with SBE, what works for one woman will not work for another necessarily. I have had moms who needed coaching and moms who don't.
I'm just wondering what the study was trying to prove. As a doula, I have many clients tell me that they don't want "coaching" during 2nd stage, that they want to push when they feel the need (laboring down), just not as soon as the cervix is complete. I believe that it does tend to lengthen the 2nd stage, but outcomes and maternal satisfaction seem to be very good, especially those with epidurals.
I just don't take too much stock in some of these studies. Sometimes researchers have ways of making the study results agree with their point. I'm not talking about just L&D, but all sorts of fields. This is just my opinion though.
Specializes in Case Mgmt; Mat/Child, Critical Care.
I haven't read each and every post, but just want to add my .02. As far as I'm concerned, if this so-called "study" says coaching women during childbirth makes no difference, I say "phooey"! As a prepared childbirth instructor, I can give you the results of my own "study"....being prepared for and having adquate support during labor most certainly does help and "make a difference" for laboring women. I think the key is being prepared...regardless if a woman ends up opting for a medicated birth or not....it's her experience of labor up until that point. I can't tell you how many women have thanked me and told me that they "couldn't have done it w/out my assistance...."coaching" if you will.
Now there are those that are completely out of control, have no desire to deal w/any pain level and want an epidural from the minute they find out they're pregnant, LOL, and w/those, only a small amount of good is seen w/coaching those women....., if any at all. So, yeah, it can not be an across the board statement that prepared childbirth does not make a difference.
OK I'm one of those... a labor "coach" and while I don't force my moms to do anything that doesn't feel natural to them, I haven' yet had a mom (or dad or gramma for that matter) say that coaching was anything but helpful. Most of them in fact have an overwhelming feeling that they "couldn't have done it without". This is of course not true, but my point being, from the frontline, I think coaching does help moms, and everyone else for that matter. Of course I'm partial ;o)
My husband & I (Flight/ED nurse respectively) attended the childbirth classes last fall. He has personally delivered 6 "helicopter babies" in his career and I have caught 3. (Notice I said caught, not delivered! :) )
Anyway..I am so glad we went to the classes. We both felt better knowing what to expect from the patient-side of the equation.
My Pit was started at 0830, doc broke my water at 1300, and Erika was born at 1525. No other drugs, just a supportive husband and out-of-this-world nurse! It was 4 months ago and I still hug her when I see her in the halls.
So "PHOOEY" on this study...One study does not a rule make!
Note that the article is about coaching during second stage. It is not addressing labor support (which we often call "coaching") at all. There are plenty of studies about the utility of quality labor support.
I think it depends on the person. Some people like "structure" and for them "coaching" in second stage may be a good thing. I certainly didn't want it. I came in fully at 36 weeks w/ baby #1 and had to be encouraged not to push. I pushed about three times for #2 and 1 long one for #3. For some pt's w/ an epidural, guiding them for pushing is helpful. This doesn't mean count to 10 and hold your breath until you lose consciousness. It means try holding your legs up, try it w/ us holding your legs, try a different position, etc. Some people who have a posterior baby also seem to benefit from some coaching because they have that urge to push and it is not effective unless you reposition them, etc. and they can use a little guidance. Many women are doing just fine going w/ what their body does and this often also includes many who have an epidural, but not all. There are also some who have this scared response when a contraction and need to push occurs so they want reassurance or support each time and that's okay too. We are all very different in small ways so you have to feel out your pt. and also the support people (hopefully not too many) she has w/ her. Many support people are super. Some are good hand holders, but that's it and some want to run the show. Too many variables here to study this one very accurately. This is situation of where nursing is more art than science IMHO.
PLEASE, PLEASE, SAY IT ISN'T TRUE! A University study done without parameters, is not a study, it's a series of observations.
There's just as many differences among "coaches" as there are, any individuals sealing with high stress.
First problem I saw with considering the article in Reuters reliable, is the mention of pushing 10 minutes with each contraction in the 2nd stage of labor (I hope). 2nd stage contractions may last 2 minutes when they're strongest, and pushing without a contraction is a useless waste of time and precious energy. Counting to 10 is taught in class, only for the laboring woman to get a handle on how long she's been pushing, not a command! She pushes however long she can, DURING A CONTRACTION - WHEN IT'S DONE, SHE STOPS AND RESTS! (has a sip of water, an ice chip, her face refreshed with a WRUNG OUT wet facecloth).
Also the training and amount of time practicing with the patient before labor, is a critical variable. I always told my classes that they were wasting their time coming to class, as far as utilizing the techniques is concerned, if they don't practice ALL the techniques daily, IN SEQUENCE used for labor. It's only the conditioning accomplished by that, which allows recall in labor. It's kind of like a fire drill. Unless it's reviewed frequently, who knows what to do, where to go, etc.
I've met a lot of people who said what has been written on this thread, but none of them were my students (who completed the series of classes), who I made sure practiced TOGETHER, and encouraged to call me so I could review a technique over the 'phone if they forgot something, so it could be practiced correctly.
When it's a Labor Nurse coaching the patient, who she's never seen before, and has no idea what techniques were taught her, often I've seen them teach that patient something other than what was taught, practiced, and CONDITIONED.
It's important, if the partner needs a break and there's no friend or family who's seen what they were taught to do, that the Labor Nurse (if there's time) watch them, realize the rhythm of their work, and understudy that, rather than start from educational "scratch".
The key to coaching, is that so long as the mom-to-be is doing something other than writhing and screaming, that's fine; however, if they're not "in control" - writhing and screaming, BETWEEN CONTRACTIONS, remind them of the technique, and when the contraction starts, breathe with her, and lead her through it.
So, there's coaching, and then there's an educated, trusted partner coaching..............
So basically, directed pushing has no benefit (other than the 13 whole minutes).
Coaching/support during labor such as by a doula or midwife has been shown improve maternal and fetal outcomes in many ways- reducing operative and cesarean deliveries, improving breastfeeding rates, and decreasing postpartum depression to name a few ( http://www.blackwell-synergy.com/doi/abs/10.1177/0884217502239209).
LuvMyGamecocks
184 Posts
oh! when the ob did show up to deliver my baby, i do remember him saying that the pain a woman endures is comparable to a man passing kidney stones.
i took my foot out of the stirrup and kicked his shoulder so hard that he rolled backwards in his stool. still don't regret it.
OMG!!!:roll
BTW, How does HE know what labor is like?