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.
Specializes in LTC, assisted living, med-surg, psych.
That's funny.........when we first moved up here, we had a stairway like that.
My family STILL talks about the time, just a couple of weeks before I delivered our fourth child, when I got so mad at oldest dd that I slung her forty pounds over my shoulder like a sack of potatoes and hauled her butt UP those stairs at a dead run. Of course, the adrenalin was flowing---she'd said something really bratty---and I was only thirty years old at that time. But it was still a pretty athletic feat for a 280-pound pregnant woman, just the same.........don't think I could pull it off now though.
That's funny.........when we first moved up here, we had a stairway like that.
My family STILL talks about the time, just a couple of weeks before I delivered our fourth child, when I got so mad at oldest dd that I slung her forty pounds over my shoulder like a sack of potatoes and hauled her butt UP those stairs at a dead run. Of course, the adrenalin was flowing---she'd said something really bratty---and I was only thirty years old at that time. But it was still a pretty athletic feat for a 280-pound pregnant woman, just the same.........don't think I could pull it off now though.
We have stairs in this old house - to the second floor where my kids bedrooms were and then down into the basement where the washer and dryer and wood burning furnace are . . . .I swear this is why my husband's grandma lived to 97.
Specializes in LTC, assisted living, med-surg, psych.
We have stairs in this old house - to the second floor where my kids bedrooms were and then down into the basement where the washer and dryer and wood burning furnace are . . . .I swear this is why my husband's grandma lived to 97.
steph
Hey, maybe we will too..........our current house has stairs which dh and I use all the time. We live in the downstairs apartment (bedroom, BR, living room which we call the "man cave", and the laundry room) and we go up and down those stairs several times a day. Guess I'm in a little better shape than I thought!
Actually valsava (breath holding) pushing is harmful to both mother and baby- results in poor cord gases, lower APGAR scores, more fetal distress, and more perineal trauma. More effective "coaching" in second stage would be explaining to mom the mechanics of physiologic pushing and encouraging her when it is performed correctly. Whether mom pushes or not the baby will come out- it is best to avoid exhausting and harmful valsava pushing.
There was a small "n" in the study you've noticed, and usually cord blood gases are only done when there is fetal "embarressment" (the old term for distress). Low Apgar scores represent poor oxygenation in labor, which usually can be rectified by giving mom nasal O2 during the birth, to correct the loss of it when she pushes. That was a valuable result of the study. Other low Apgar scores represent meconium expulsion during labor or even earlier, which causes irritation of fetal lungs, and pulmonary complications.
A laboring mother is sometimes told to push before complete dilation, which prolongs labot greatly as it causes swelling of the cervix, effectively "shutting/narrowing the exit door". I've seen and heard of doctors who allow many more hours of pushing than is safe, even in the 2nd stage, and then finally choosing to do a C/S that should have been performed many hours sooner.
With today's diagnostic capabilities, it is criminal, I think, to eschue them when the size of the baby may cause CPD. The first hint of that, is a huge guy accompanying a tiny woman to your office, childbirth preparation classes, or L&D. When I see such a "Mutt and Jeff" combo, I warn them regarding the need for C/S after 1 1/2 hours of pushing. That doesn't make doctors like me more, but honesty is the best policy.
When my daughter married her average sized husband, and I learned that he had been the 8th live birth of the all over 10 pound babies his mother had, I said it might be likely that a C/S would be necessary, as my daughter weighed 6#13oz at birth (she is adopterd, and when I finally met her "natural" mother, she was quite "narrow in the pelvis". Unfortunately my daughter labored 22 hours in hospital, getting to 4 cm (admitted to hosp. at 2 cm). Her 2 children weighed way over 9 pounds each. When I encouraged her to have a "trial of labor" with her 2nd, she said, "NO WAY"!!
They are both healthy, although her first child, a daughter, had an anatomical congenital anomaly of her left ear (no ear drum, ear canal, or stapes, malius, or that other little bone that vibrates to create sound - I should look it up, to appear less aged, but hopefully you'll bear with me.
My daughter sought her "natural" mother, with my exuberant blessings, when her MS was diagnosed shortly after her 2nd birth, to know more about her health history. That was the positive side of the possibly "double edged sword" discovering her origins could have brought. As has been documented widely, the "unwed mothers" without benefit of oral birth control in the '50s and '60s, often had another baby in similar circumstances, shortly after relinquishing the first baby. My daughter now has a full sister a year younger than she is, who looks and acts just like her. They are thrilled to know each other, and email and talk frequently.
Their mother is happy too, but still hasn't told her parents about knowing her first baby. They wouldn't allow her to keep my daughter, as she wasn't likely to marry the father. More's the benefit for us!:redpinkhe
With today's diagnostic capabilities, it is criminal, I think, to eschue them when the size of the baby may cause CPD. The first hint of that, is a huge guy accompanying a tiny woman to your office, childbirth preparation classes, or L&D. When I see such a "Mutt and Jeff" combo, I warn them regarding the need for C/S after 1 1/2 hours of pushing. That doesn't make doctors like me more, but honesty is the best pol
When my daughter married her average sized husband, and I learned that he had been the 8th live birth of the all over 10 pound babies his mother had, I said it might be likely that a C/S would be necessary, as my daughter weighed 6#13oz at birth (she is adopterd, and when I finally met her "natural" mother, she was quite "narrow in the pelvis". Unfortunately my daughter labored 22 hours in hospital, getting to 4 cm (admitted to hosp. at 2 cm). :redpinkhe
A woman's pelvis loosens up before birth (with the help of hormones), and an upright and/or squatting woman can birth a considerably larger baby. A woman in the lithotomy (lying on her back, head of bed elevated) is more than likely not going to push a larger than average baby out, due to the size of outlet that this position creates. Since obstetricians continue to place women in this position for their requirement of 'access', not considering the birthing mother's needs to be in a better position to open her pelvis, it is more likely that women will be given a potentially false diagnosis that their pelvis is too small to birth their baby.
lace women in this position for their requirement of 'access', not considering the birthing mother's needs to be in a better position to open her pelvis, it is more likely that women will be given a potentially false diagnosis that their pelvis is too small to birth their baby.
The pushing information you give to the class - 1 1/2-is this based in any sicence?
Its sounds like she was in tha latent phase what a pitty they did not let her go home get established and return later she MAY have had a different out come.
With today's diagnostic capabilities, it is criminal, I think, to eschue them when the size of the baby may cause CPD. The first hint of that, is a huge guy accompanying a tiny woman to your office, childbirth preparation classes, or L&D. When I see such a "Mutt and Jeff" combo, I warn them regarding the need for C/S after 1 1/2 hours of pushing. That doesn't make doctors like me more, but honesty is the best policy.
plenty of very small ladies can have very big babies. I am 5'2 and my pelvis birthed a 10 1/2 pound baby (and I was only 6 something pounds at birth). HOw discouraging to tell them that after 1.5 hrs of pushing they might need a section, when "normal" pushing, esp with an epidural, can take up to/over 3 hours! Yes, sometimes, the baby "wont fit" but what did WE do to cause it? rupture her early and cause the baby to be asynclitic? have her push on her back with her feet in the air? not change her position frequently after her epidural/while pushing? Dope her up so much she cant feel anything, much less push anything out?
There was a small "n" in the study you've noticed, and usually cord blood gases are only done when there is fetal "embarressment" (the old term for distress). Low Apgar scores represent poor oxygenation in labor, which usually can be rectified by giving mom nasal O2 during the birth, to correct the loss of it when she pushes. That was a valuable result of the study. Other low Apgar scores represent meconium expulsion during labor or even earlier, which causes irritation of fetal lungs, and pulmonary complications.
There are many studies that support the practice of physiological pushing vs valsava pushing so I am not sure which particular study you are referring to. It is a well-established fact that valsava pushing affects outcomes negatively, obviously most often not to the extent that it causes major problems but it does affect baby and mom negatively. In two of the hospitals I know in the area they are making a big push (ha!) to educate the nurses in good evidence-based pushing technique.
The practice of giving oxygen in labor is questionable- due to the fact that if mom's O2 is already 99-100% there is simply no capability for further oxygen to be carried to the fetus. There are conflicting studies on whether it is beneficial or not, so of course we err on the side of using the practice. Best scenario however is always avoiding things like valsava pushing that cause the problems in the first place.
A woman's pelvis loosens up before birth (with the help of hormones), and an upright and/or squatting woman can birth a considerably larger baby. A woman in the lithotomy (lying on her back, head of bed elevated) is more than likely not going to push a larger than average baby out, due to the size of outlet that this position creates. Since obstetricians continue to place women in this position for their requirement of 'access', not considering the birthing mother's needs to be in a better position to open her pelvis, it is more likely that women will be given a potentially false diagnosis that their pelvis is too small to birth their baby.
lace women in this position for their requirement of 'access', not considering the birthing mother's needs to be in a better position to open her pelvis, it is more likely that women will be given a potentially false diagnosis that their pelvis is too small to birth their baby.
The pushing information you give to the class - 1 1/2-is this based in any sicence?
Its sounds like she was in tha latent phase what a pitty they did not let her go home get established and return later she MAY have had a different out come.
The newer "birthing tables" were designed to allow pushing and birth in the squatting position, or "all 4s" and on the side, with the table elevated for "access" if necessary. However the comfort level and resistance to change most OB staffs exhibit (nurses and MDs) has kept the incidence of anything but lithotomy very low.
It takes midwives, nurses such as you, to try everything. The figure of
1 1/2 hours for pushing AFTER complete dilation has been achieved hasn't been researched adequately, but is a commonly used parameter. Charting for the 2nd stage is less than scientific. Usually once pushing begins, it is assumed that the patient's use of it is appropriate. A lot of thge time, it isn't, which adds to the long stage 2 reports. I've even seen 12 hours!
Usdually I'm soothed by the adage that "we do the best we can at the time, given the circumstances". I was in CA the first time my daughter gave birth (2 weeks before her EDC, and a day before my scheduled flight). As I sat in L&D talking to her nurse in VA, it was frustrating to know there hadn't been enough practising done, especially in the squat position, which she found degrading.
She is my daughter, not me. Separation is important long before our children/students experience labor. I'd done my best to see that she had a "good" OB, that she went to classes, and knowing she has "true grit", I'd thought she'd do what was best for her. Having attended alanon meetings, I knew that I was "powerless" to change her proclivities. Practising is the key to following through on what is taught at childbirth classes, and I knew that was not her strong suit. Her daughter is now 15 years old, and seems to have a similar deficit, not doing homework, taking the easier way out and I marvel at my daughter's self control in not trying to change her.
The key there, is support and approval of what she does do right, leading her to success through knowing her strengths. In other words, accepting her exactly as she is. :heartbeat
With today's diagnostic capabilities, it is criminal, I think, to eschue them when the size of the baby may cause CPD. The first hint of that, is a huge guy accompanying a tiny woman to your office, childbirth preparation classes, or L&D. When I see such a "Mutt and Jeff" combo, I warn them regarding the need for C/S after 1 1/2 hours of pushing. That doesn't make doctors like me more, but honesty is the best policy.
plenty of very small ladies can have very big babies. I am 5'2 and my pelvis birthed a 10 1/2 pound baby (and I was only 6 something pounds at birth). HOw discouraging to tell them that after 1.5 hrs of pushing they might need a section, when "normal" pushing, esp with an epidural, can take up to/over 3 hours! Yes, sometimes, the baby "wont fit" but what did WE do to cause it? rupture her early and cause the baby to be asynclitic? have her push on her back with her feet in the air? not change her position frequently after her epidural/while pushing? Dope her up so much she cant feel anything, much less push anything out?
All of the above!~ Self flagellation isn't as good a learning tool as objective acceptance (in time and examination) of what happened, with the desire to learn more and improve circumstances using modern technology.
The newer "birthing tables" were designed to allow pushing and birth in the squatting position, or "all 4s" and on the side, with the table elevated for "access" if necessary. However the comfort level and resistance to change most OB staffs exhibit (nurses and MDs) has kept the incidence of anything but lithotomy very low.
It takes midwives, nurses such as you, to try everything. The figure of
1 1/2 hours for pushing AFTER complete dilation has been achieved hasn't been researched adequately, but is a commonly used parameter. Charting for the 2nd stage is less than scientific. Usually once pushing begins, it is assumed that the patient's use of it is appropriate. A lot of thge time, it isn't, which adds to the long stage 2 reports. I've even seen 12 hours!]quote
Designed tables rubish - nothing to do with the woman and labour all to do with the care giver- Evidence showes that mobile women labor faster. It is wrong for you to tell familes that attend your classes that after pushing for 1 1/2 to expect a LSCS- completly wrong its not evidence backed information. But you should be telling them about is the latent phase - so when they turn up for a labour check and 2cms and are not in established labor they are confident to go home untill labour is established - this information is supported by evidence. Also about tranistion and everything that brings.
Of course, the adrenalin was flowing---she'd said something really bratty---and I was only thirty years old at that time. But it was still a pretty athletic feat for a 280-pound pregnant woman, just the same.........don't think I could pull it off now though.
Liar liar pants on fire . . . . .
VivaLasViejas, ASN, RN
22 Articles; 9,996 Posts
That's funny.........when we first moved up here, we had a stairway like that.
My family STILL talks about the time, just a couple of weeks before I delivered our fourth child, when I got so mad at oldest dd that I slung her forty pounds over my shoulder like a sack of potatoes and hauled her butt UP those stairs at a dead run.
Of course, the adrenalin was flowing---she'd said something really bratty---and I was only thirty years old at that time. But it was still a pretty athletic feat for a 280-pound pregnant woman, just the same.........don't think I could pull it off now though.