How long do you push?

SmilingBluEyes · Feb 17, 2005

as long as mom and baby can tolerate it....

which can exceed 3 hours.

I do allow them to rest when they are tired, if they feel need to. As long as baby and mom are fine there is no hurry.

JaneyW · Feb 17, 2005

Out of curiosity, wondering how long your docs/midwives allow your moms to push before they cut, bearing no complications, reassuring fetal heart tones? Ours will rarely allow our moms (first time) to push much longer than 2-3 hours. I wanted to see what everyone else does. :)

I work the night shift, so I think this kind of thing is more under my control as a nurse than it might be during the day. We are definitely in the 'labor down' club at my hospital. If the patient is comfortable and in control, I don't even start pushing them until they are +2 or +3. Then, if it doesn't appear to be going well after 30 minute or so I will change their position (side or squat or knees chest) and let them labor down some more. I tend to do this instead of continuous pushing.

Sometimes no amount of pushing is going to do it. That's when you get the FLK babies with the gumby heads. I even circulated on one c/s where I had to go under the drape and push the baby's head from that end to dislodge it. That kid's brows were like a neanderthal's!

SmilingBluEyes · Feb 17, 2005

dont forget about "laboring down" esp in women with epidurals.....

let them labor that baby down til the head is VERY low, and you will cut down on pushing time and energy expended by mom to push.

also in moms w/o labor epidurals, let them push as they feel the need to....most of the time, you won't have to TELL them to; let them do it on THEIR timetable in the manner that feels best to them.

babyktchr, BSN, RN · Feb 17, 2005

I wish I wish I wish more docs would understand the whole labor down thing. Especially the epiduralized women. Sheesh.......it is so frustrating and such hard work on everyone...

ayndim · Feb 17, 2005

Wow that seems so short. I pushed 5 1/2 hours with my first. But then I had a CNM.

Jayla · Feb 17, 2005

Could someone explain what "labor down" means? I'm a new grad, and not working in L&D, but curious. I work with pregnant moms, and I'm not familiar with this term. Thanks!!

SmilingBluEyes · Feb 17, 2005

"laboring down" refers to allowing a woman's uterus to contract and push the baby down to a low station by itself, without the woman actively pushing. It is useful in the labor patient with an epidural and no urge to push. If we let it, the uterus will push the baby low and allow us to let mom rest, thus cutting down pushing time by as much as two hours or more.....

I never have moms who are complete push unless there is an urge to, or the baby needs to come out soon. (signs of distres---and even here, you can help the baby by allowing a few contractions w/o active pushing, giving the baby a "break").

Of course, working nights is great this way, cause the doctors don't hang around telling us to have a woman begin pushing just cause she is completely dilated. It's a LONG way from zero to plus 4/5 station, ya know! Conserve her energy!!!! so....

I let women 'labor down" until they either feel an urge to push, or their babies are VERY low station, close to crowning. It really does work and moms will thank you for it.

USA987, MSN, RN, NP · Feb 18, 2005

The length usually depends on the doc...and as others have said, mom's energy and baby's tolerance. The longest I've seen someone push is 3 1/2 hrs.

I am also a firm believer in laboring down. Seems like most of our younger docs agree with laboring down. Some of the "older" guys want you to push the moment they are complete. I must admit...with some of them I've lied and said that the pt. is 9 cms just to buy them some time!!! :rolleyes:

daisybaby, LPN · Feb 18, 2005

I let my primip labor down today. She pushed for 15 minutes & had a beautiful delivery. Because all the docs know how much I let my pt.'s labor down, when I call them for delivery, they know I mean it. Works out fabulously for everyone.

SmilingBluEyes · Feb 18, 2005

Beautiful work, Daisy.

Dawn27 · Feb 18, 2005

This is a real tricky topic, I am very much in favour of having as little intervention as possible. I think as long as there is definite progression it's ok to continue, but 3 hours is a long time to have a woman actively pushing.

However there has been some research about the effect of prolonged pushing and postnatal urinary incontinence due to damage to pelvic floor muscles( I'll see if I can post the reference) and for this reason I would be wary of a very prolonged second stage.