Laboring down

nursejohio, ASN, RN · Feb 7, 2007

I love letting primips (and occasional multips) labor down! Nothing worse than pushing for 3 hours for a 6# baby. I explain that to the moms, and help them breathe through the ctx until they get the hang of it. I tell them that they can do slight 'grunty' pushes if it feels better, but there will come a point she feels like she absolutely can't NOT push, and that's when we'll get serious about having a baby. Of course, if the epidural isn't working so great, that gotta push feeling comes earlier and we end up pushing longer because mom simply can't wait...

nurse79 · Feb 7, 2007

ok thats what i usually try and do also phriedomrn, of course depending on how well the epidural is working! i just feel like when i ask the pt if they can pant blow, or grunt a little to help out they still end up pushing. do you stay with ur pts the entire time they are complete???

SmilingBluEyes · Feb 7, 2007

labor down!!!!!!!!!!!!! labor til the baby is way down there or the dr comes in and whine about it.

nursejohio, ASN, RN · Feb 7, 2007

Most of them are still pushing a lil bit, but I have noticed much less swelling/bruising in the ones who don't do the full out pushes for hours. I'm in the room the whole time, except for quick runs for warm blankets and more washclothes. I hate docs who want to push as soon as mom hits 10cm, it's so much harder for mom (and the nureses). By the time she needs all her energy for crowning and shoulders, shes exhausted!

starrcan · Feb 8, 2007

We have 1 doc that ALWAYS wants to starts pushing the second we hit 10 cm....and sometimes a bit earlier. Might I add that he also has the highest c-section rate. I would always prefer that moms labor down.

JaneyW · Feb 8, 2007

I don't see the problem with the pt doing 'gentle pushing' and grunting pushing. This will help with her laboring down efforts--why tell her to stop? I will put the moms in a high fowlers and tell them to push a little if they feel the urge. Had a 1st baby pretty much birth itself the other day with that scenario. Why tell them to blow? Of course, I now work at a teaching hospital where the docs are there--I can see where this might get more tricky when you have to call them in from home.

SmilingBluEyes · Feb 8, 2007

If there is an urge to push, I say let them. But in absence of an urge (as in epidural anesthesia), laboring down makes much more sense to me. But many OBs dont' like us to do that. 9-5 obstetrics at play here.

KellNY, RN · Feb 8, 2007

Janey, you could have just described my birth! My son (a 9 pounder!) came out so easily when my CNM "let" me do small grunty pushes--which felt SO good, so good--for about 40 min. I was a primip and literally gave only one or 2 real pushes, just to get the shoulders out. It was a beautiful, peaceful birth and I am so thankful I didn't have people counting to 10 in my face while I held my breath. Any breath holding I did was completely an involuntary reflex, lasting for a very short period of time.

So, yeah, I'm a big fan of laboring down. But if mom feels the urge to oush and is 9-10cm, then let her give small pushes.

txspadequeenRN, BSN, RN · Feb 8, 2007

i wish i could labor down , labor up , labor sideways..anything to reduce this abdominal girth.....

ragingmomster, BSN, MSN, RN · Feb 10, 2007

One patient earlier this week refused to labor down. She had a pretty good epidural through her labor but when she got to completely dilated she was feeling pressure.

We tried to explain and tried to get her to quit giving big pushes and slow herself down to the "grunting" push method, she stopped for about 20 minutes then went back to full force.

Two hours later we were going for a c/s due to failure to descend. The baby was WAY acynclitic and had to be pushed back up by and RN under the drape in the OR because he was wedged in.

Now of course this pt feels like she failed and will likely not try to VBAC next time because she worked so hard this time for nothing. :sniff:

eden · Feb 10, 2007

Labouring down as long a baby is fine is the best thing they can do. When I explain to my patients that waiting for that urge will in fact make less work for them in the end, most labour down nicely. I've only had one insist on continuing to push full force and it turned into a 6 hr second stage.:chair: