pushing c pts - tips and techniques

[ischialspines]

let's share things that work for second stage with our mamas!

-LABOR DOWN if mama has an epidural, especially if she's a prime :) Make sure to get her in a good position (L Sims is my favorite most of the time) while laboring down, to promote OA babies.

-McRobert's. Sometimes this is the best way to get a baby out, especially if it can't seem to round the pubic bone.

-Hands and knees! this is good for labor but I push in it often. If mama is switching positions a bunch it can be quite tangling, though. I use hands and knees c epidurals all of the time. They tend to kind of kneel with pushes.

-forward-leaning squat- McRobert's but with gravity. I always feel nervous about this on a hospital be because it seems unstable, but sometimes it's just what is needed. Epid mamas usually can do it, but I feel nervous about their hip joints. The squat bar, in my opinion, and on our beds, is useless for squatting.

-squat bar tug-o-war - this is what the squat bar is useful for :). works well with primes especially, wouldn't ever hold the towel/sheet without the squat bar. I've heard of enough flying nurses because of that mistake :)

I tend to not be very agressive or hands-on with the perineum during pushing if it's going easily. But I've had some lately where that's what I've been doing, downward pressure and "massage" of the perineum.

counter-pressure/warm compresses/cold compresses on the orifice/vulva, especially if there's already 'rrhoids or swelling.

I like to focus on position, fetal position before we get to pushing.

Pelvic press to open the outlet. Pubic lift only if I'm desperate.

I've had a few primes recently that have pushed for 3+ hours using every trick that I can think of, that I just couldn't get to round the pubic bone. They were all primes and all had epids but had pretty good muscle control, all of them have ended up with successful vac assist deliveries. Any tips on rounding the corner?? or things to do in that situation?