Pushing with a primip

[mandyjk77]

Just wanted to see how you push with a primip, I usually labor down until +3 station and the pt is feeling tons of pressure, but if they're not feeling pressure or they're not pushing effectively, what are some techniques you initiate? I like knee chest if they are willing to get on their hands and knees, I also will sit on the bed with them and while they're pushing, guide them by pushing down towards their rectum so they can feel where to push. Does anyone have any techniques that they swear by? Just trying to get more creative with my pushing & coaching. Thanks!

[klone, MSN, RN]

Push/pull method - grab a blanket and tie a knot in both ends. The mother holds one end and you hold the other. During UCs, while she's pushing, play tug-of-war with the rope.

Having a mirror also helps, so she can see her perineum as she's pushing and be able to visualize what are effective pushes.

[justapatient87]

I'm just a lurker (started lurking when I was pregnant with my son last year to prepare for a hospital birth) and just want to say that the mirror totally freaked me out. I watched tons of childbirth videos...my mom is a nurse and my dad and brother are paramedics...blood and ick doesn't gross me out or anything...I just thought I was going to watch myself...explode...and it scared me. I was unable to form the words to ask my nurse to move the mirror, so I just closed my eyes.

I chose to birth without medication, and one thing that DID help was my CNM telling me that the "silent" pushes were more effective, and then I would let out my scream/grunt/"oh gosh, oh gosh, oh gosh" at the end of the contraction. Anyone putting their finger somewhere to "show" me where to push hurt like heck and just ticked me off.

[klone, MSN, RN]

We always ask moms for permission before bringing in a mirror. We present it to them as a suggestion for helping to push more effectively, but she's free to decline.

[justapatient87]

Oh, I asked for the mirror...and then after a few pushes, I wanted it to go away.

[benegesserit]

I'm just a lurker (started lurking when I was pregnant with my son last year to prepare for a hospital birth) and just want to say that the mirror totally freaked me out. I watched tons of childbirth videos...my mom is a nurse and my dad and brother are paramedics...blood and ick doesn't gross me out or anything...I just thought I was going to watch myself...explode...and it scared me. I was unable to form the words to ask my nurse to move the mirror, so I just closed my eyes.

Same here. I got into nursing through being a doula, so I've seen plenty of births. I have absolutely no desire whatsoever to have a mirror down there during pushing, and I suspect that having one would be negative feedback for me and make me hold back more.

If the baby is far enough down, encouraging the mom to reach down and touch the head can help. But again, some people are going to be freaked out by that, so it's something to suggest, but not force.

[estrellaCR, BSN, RN]

it would also help what position you have her push in. Sitting up or hands and knees works a lot better than lithotomy. These positions work with gravity while lithotomy (laying on back) is against gravity and takes longer to push baby out. Walking around before pushing also helps bring the baby down.

[klone, MSN, RN]

Oh, in early stages of 2nd stage (assuming she doesn't have a block), pushing on the toilet also helps. It seems more instinctive for many moms to know what to do.

[DalekRN]

I did NOT want a mirror but someone brought one anyway (don't know if they knew or not). For me it was SO helpful, even unmedicated I was having a hard time knowing how effective my pushes were. As soon as I saw his head starting to come out with each push, I had seen enough and didn't look anymore. It was enough gratification to see something happening and got me through to the end.