Directed pushing

[LauraLou]

I have a question about helping pts push. My preceptor has the pt hold her breath and push for a count of 10 x 3 per contraction, while we hold her legs. This is how I learned in nursing school and is the way I have always seen it done.

The internship class I am taking says not to do any of that. The legs should be down, have her breathe while pushing and don't count, let her push however long/little she wants during a contraction. (This class is not held at my hospital but is a consortium of several hospitals which hold a joint class.)

I can understand the not holding your breath while pushing, that makes sense to me. But I don't see how having the pt's legs down and not coaching her to push would work. Is it really more effective than the traditional way?

I want to use the most update practices but I would really need to see a nurse help a pt push the new way before I would be comfortable trying it myself. All the nurses on my unit push the old way. I have been using the count to 10 x 3 method because I am not sure how to use the new method and there is no one to show me.

What are your thoughts how to help a pt push and what method do you use? Thank you for your help!

[bookwormom]

I hope you won't mind a question from a non- OB nurse. With my third baby, when I was pushing (in the traditional method as discussed above), one of the nurses was simultaneously pushing hard on my abdomen. It was an unmedicated labor and a sizable baby -- 9 lb 2 oz. It seemed unusual for the nurse to push on my abdomen. Is this a common practice ? I don't recall reading about it.

Thanks.

[SmilingBluEyes]

NEVER should a nurse/dr use push on your abdomen when you are pushing--------

If there is a shoulder dystocia, a nurse may push on your PUBIC BONE to aid in the delivery of the newborn....but this is again for a difficult delivery, where a baby is getting "stuck" at the outlet. And again, pressure is exerted on the pubic bone, not the abdomen.

[riern]

I hope you won't mind a question from a non- OB nurse. With my third baby, when I was pushing (in the traditional method as discussed above), one of the nurses was simultaneously pushing hard on my abdomen. It was an unmedicated labor and a sizable baby -- 9 lb 2 oz. It seemed unusual for the nurse to push on my abdomen. Is this a common practice ? I don't recall reading about it.

Thanks.

The old fundal pressure. As SmilingBlueEyes said this should not be done. However, when I started in OB many years ago we did this frequently. Even had a little stool we used to stand on especially for difficult deliveries. This isn't something that I've done in years but am familiar with.

Hope that helps....

[DOUBLE DEE]

Laboring women are all different. Just when you think you have it figured out someone throws you for a loop. Pushing needs to be indivual. As a coach and as a women's advocate your owe it to her to figure what pushing works the best for her and use it (as long as the fetus is tolerating the pushing).

[Spidey's mom, ADN, BSN, RN]

Laboring women are all different. Just when you think you have it figured out someone throws you for a loop. Pushing needs to be indivual. As a coach and as a women's advocate your owe it to her to figure what pushing works the best for her and use it (as long as the fetus is tolerating the pushing).

Before I read anything about this subject, something seemed wrong with the one-size fits all method of pushing and counting to 10. I rarely do that anymore unless someone really needs to be directed.

I take my cue from the woman. Some are very focused. Some need help. And then there are the ones in the middle.

steph

[Mrs.S]

I'm with SmilingBlueEyes! Nothing beats laboring down. It's better for mom and baby.

:)

This seems to be sort of controversial at my hospital. I've been doing L&D there for about 8 months, and I've heard that the doctors will get pissed if you don't have mom start pushing right away. that's why so many nurses, like a previous poster said here, will "fudge" dilation & call them 9cm in order to let the woman's body do the work. recently one of our OB's had her first baby there, and some of the nurses were discussing what a lovely delivery she had...."Dr. So-and-so let her labor down, so she really didn't have to push for very long..." I sort of got a kick out of that, like it's a special privilege.

[lafrn97]

I will often ask the pt if she wants me to direct her with her pushing or just work with what her body is doing. Most primips will ask to be guided.

[tinyscrafts]

check the chapter on second stage in The Guide to Effective Care in Pregnancy and Childbirth, based on the cochrane reviews.. free at.. http://www.maternitywise.org

[SmilingBluEyes]

very interesting resource. Thank you, tinyscrafts.