Do you count?

They assumed it at my hospital, and therefore I had more pain than was necessary when they turned the epidural down.

I understand that people use their own experiences to make generalizations about situations. I'm sorry that the nurses at your delivery made assumptions about your ability to push. I was merely pointing out that I don't assume anything and I am sure many other L&D nurses do not either, but rather, listen to their pts and their needs. You said "I hear everybody saying...." I just think that was a misinterpretation.

For instance, my pt last night, told me, "I feel like a have to take a crap". I did not assume because she had an epidural that she was unable to feel that or when she needed to push.

I also don't discourage them from making noise--as this helps keep the glottis open.

This is how open glottis pushing has worked for my pts. I encourage them to grunt or moan lowly while pushing if that helps them. It's hard to hold your breath and grunt. :) For my pts that have little feeling due to an epidural,who may be more quiet than my unmedicated Moms, I encourage them to blow their air out slowly through pursed lips like they are blowing up a ballon. It seems to work great for me. Some pts still hold their breath while pushing just because that is what feels right to them. And that is fine, I just try to remind them to catch their breath before they turn purple.

I understand that people use their own experiences to make generalizations about situations. I'm sorry that the nurses at your delivery made assumptions about your ability to push. I was merely pointing out that I don't assume anything and I am sure many other L&D nurses do not either, but rather, listen to their pts and their needs. You said "I hear everybody saying...." I just think that was a misinterpretation.

For instance, my pt last night, told me, "I feel like a have to take a crap". I did not assume because she had an epidural that she was unable to feel that or when she needed to push.

I understood what you were saying. I just wish all nurses were like that and would really listen to their patients. Some of mine did and some didn't. That's all I was bringing up.....everyone is different.

I should have said "I hear some people saying......"

Now I will stop sharing my personal experiences and let you guys discuss your experiences at work with the pushing issues.

Do you think it's alright to ask the woman? Sometimes I didn't know what I wanted in the middle of labor. Other times, like when I was laboring quietly with my 8th at home, my two midwives chatted in whispered tones about a display booth they were going to do for some event or other. They weren't being loud or trying to be rude, but I didn't have the heart to tell them I really wished they would be quiet. It was my own fault for being so passive.

But that was in transition. Maybe it's different in the pushing stage.

You should OBSERVE the woman, watch how she is coping and then offer your help if it appears she is having difficulty staying "with it" , or concentrated or can't make progress. Or if she ASKS for your help . It's ok to ask, but first observe to see how she is doing. Good luck!

I am a pre-nursing student and l&d is a particular interest of mine. Maybe because I have had 3 little ones. Anyway, I watch these shows on the discovery channel and I hear the nurses counting. To me it is just plain annoying. And when I was delivering I think I would have told off anyone who did. Well with #1 my hubby did try to count but the CNM told him I knew when to push and for how long before I got the chance. So do you count when your moms are pushing? If so do any of your moms ask you not to? If you don't do any drs/cnm's want you to?

Just curious.

Thanks

Aloha,

Patients will let you know what they need. They sometimes need hearing the count to focus on, knowing that there is an end in sight as they expend

that much energy and trying to get three good pushes from each contraction usually. But I usually ask as my moms get into transition before they ready themselves to push what their preferences are. There are even times where the whole family or whoever's present all count together which changes the dynamics of the room. But the bottom line is what the patient wants, she usually gets. That's what we're there for anyway.

Much Aloha,

Tammy

I let the woman do what she wants to, and put my finger gently on the head and tell her when I feel the baby moving downward. Most women get the idea of what is going to work for them and what it feels like to push effectively. I had an unuasual labor recently where the baby came out with short little "squirt" pushes...never would have thought they would be effective, except I felt that head coming down, so figured we'd go with what mom wanted, and it worked.

I pretty much go with the flow. If the patient is not pushing well, I might suggest counting, but I rarely count myself. I have the dad or the labor coach do it. Gives them something to do, and they are usually more receptive to it. Plus, if the mom doesn't like it, she may not want to tell me, but usually has NO PROBLEM telling her partner to shut up! And, I think that for the most part, open-glottis pushing works great. I just think it is very hard to explain to someone in labor how to do this. If they are doing it on there own, great. Like I said, I just go with the flow:)

Friday, what worked for me with a new mom unable to push effectively at first was a mirror. I showed her the head peeking out when she pushed well....it was all she needed to give her the "oomph" to finish the job, and effectively. She, being a primip with a strong epidural, pushed her baby out in 40 minutes this way, without me counting once. It depends on the mom. The visual was all this lady needed to get the job done.