new to l&d...question???

landonsles · Apr 13, 2008

I always tell them (before we start pushing) that they need to take a big breath like they're going under water, to hold it, and then to push like they are "pooping a watermelon." (OK--it depends upon my rapport with my pt as to whether I tell her the watermelon thing or not...some people I do say to push like they're constipated)

Then while she's pushing, each time I remind her to "take a deep breath, chin to chest and push...one...two...good job...four...keep pushing...six", etc, etc

You will find your own preferred wording/scripting/phrasing in time!!

rn4babies63 · Apr 13, 2008

I do the same.....I tell them to fill their lungs with air like they are going to swim the length of a swimming pool under water then bear down, chin to chest, like they are going to poop the baby out! I only count if they can't hold their breath for at least 10 seconds.....gets annoying after a while!

HappyNurse2005, RN · Apr 13, 2008

First of all, don't count to ten!

If htey don't have an epidural, I tell them to push however they feel like they want to. A woman without the epi will feel the urge to push and will know what to do. absolutely NO COUNTING if she has no epidural. I've shushed doctors (politely) who've done this. I will encourage them to change positions if the pushing is taking a while, esp if htey are on their back. Generally, though, they'll do what they want to and be fine. No stirrups, either, if you have no epidural. Oh, and no instruction to hold their breath. Not necessary. It's natural to grunt and groan and yell, and babies come out that way.

If they do have an epidural, I still dont put them in stirrups. Foot pedals, occasionally. I tell them to pull their legs back(this works if they are on their side or back) and curl around the baby like a tube of toothpaste and push into their bottom. NO mention of breath holding, though many do, I dont tell them to. I say to push til they feel like they have to stop, then take a breath and do it again. Instead of counting (which is annoying and redundant ) I say "good job, you're doing great, keep going, you can do it, " etc if it seems like its a mighty long push, i'll say "let it out when you have to and do it again" If they aren't pushing long each push, and this continues after gentle encouragement to push longer each time (which i bring up as a suggestion, not an order "Why dont we try to push longer each time?") I will occasionally ask if they think it would be helpful to them to push if I counted to 10. Also change their pushing position if its been a while.

It is so annoying to have someone (a doctor, another nurse) yelling at the patient "push! Push! push! 1-2-3-4-5-6-7-8-9-10" ugh. like she doesn't know she needs to push.

NurseNora, BSN, RN · Apr 13, 2008

Depends on the situation. A patient without an epidural who is in touch with her labor and her body, I'll often just tell her to listen to her body and do what it tells her to do. Just because someone is 10cm dilated, doesn't mean she has to push. Some people aren't ready to push just because they're complete. Gradually the baby will come down from the uterine efforts and the patient will begin to push spontaneously. I've had primips deliver without ever telling them to push.

In childbirth classes, I've told women to take a deep breath, put the back of their hand against their mouth and exhale against that pressure, so that they can feel the area where the pushing effort needs to be directed. Try it yourself--with an empty bladder.

I don't count for patients to push. I just tell them they're doing well (or not), and let them breath when they need to or if I think it's been too long since their last breath. Studies show that prolonged pushing efforts cause more decelerations than shorter ones.

Many people need to be reminded to exhale before they take their next breath. And most need to be reminded to make the breath quick as the baby moves back up when she quits pushing. I tell them it's like taking 5 steps foreward and 4 steps back. You get there, but slowly. And slowly is the best way because if the baby came down really quickly, there wouldn't be as much time for the tissues to adjust and stretch. Of course if the baby does come down quick, I don't have to give that explanation.

I tend to be quiet and laid back rather than a cheer leader (depending on what my patient needs, I can get out the pom poms when necessary) and will often coach right next to the patient's head and speak very quietly right into her ear. The noisier everyone else is, the quieter I get.

I've done all the other things described above at one time or another too. Like everything else, there is no one way that is right in every situation.

Belinda-wales, RN · Apr 13, 2008

Personally I hate the counting- worst thing ever the whole room counting in unison if you notice it (the counting gets faster)- I use a lot of vision direction- I say imagine their baby in the birth canal- fix itin your mind close your eyes and as you push see in your mind your baby moving though thebirth passage comming out to meet you try it - ts effect are amazing!

OzMW · Apr 13, 2008

Depends on whether they have an epidural. I never count. Gentle encourage with each push. And when they don't have an epidural the best is to leave them push spontaneously, no cheer leading. Just a quiet your doing great every now and then.

OzMW · Apr 13, 2008

I do the same.....I tell them to fill their lungs with air like they are going to swim the length of a swimming pool under water then bear down, chin to chest, like they are going to poop the baby out! I only count if they can't hold their breath for at least 10 seconds.....gets annoying after a while!

Research shows that this is the stuff that exhausts women and causes fetal distress. Encouraging a labouring woman to hold her breath for 10 seconds is potentially detrimental to fetal wellbeing!:redbeathe