Question about noisy/open-glottis pushing

[seemerun]

Why is this one hard to come around on? There are so many things that we have come around on. In my facility we have ended all elective inductions prior to 39 weeks, no longer no the pit to distress and many other things as well. I am new in Labor and Delivery but it's kind of weird - every class, every article all state that that it is OK and better for baby to allow mom to make noise during pushing. Yet every time and I mean EVERY TIME this never happens. And it's everybody - nurses, doctors and nurse-midwives. It's hold your breath, count to ten, 3-4 times with every contraction.

In truth I do see more effective pushing this way - but I am guessing this is not so much an issue of how quickly you can push baby out but an issue of how well oxygenated baby remains through the process.

Is this just my facility or does everybody run into this? How can I help make change?

[SoldierNurse22, BSN, RN]

I'm not an L&D nurse, but I've read into this very issue quite a bit. Ina May Gaskin, a leading midwife who is based out of TN, wrote an interesting book that addresses this issue and how open-glottis pushing is ultimately more natural and assists in the birthing process. I think a lot of the hesitation to do this in hospitals is fear of being judged/societal norms that discourage the expression of pain in certain cultures (I floated to L&D once and a nurse once compared women who open-glottis push to barnyard animals) and because you're not at home--you're in a hospital.

[klone, MSN, RN]

I think another thing to consider is that while open glottis pushing is natural for women who feel the *urge* to push, many women who are epiduralized do not feel that urge, so they need to be coached on how to push.

Also, there is a difference between open glottis pushing and screaming, which some women do. Screaming tends to be not a very effective technique at pushing out a baby. :)

I remember when I had my last baby (in the OB unit where I worked), when I took my first push, my friend who was my OB nurse, started counting. I remember screaming "DON'T COUNT!" at her. :)

[seemerun]

Absolutely true about epidurals. Which is why I like laboring down until hopefully getting some sensation back.

I am supportive ofnatural birth if thats what the patient wants but that's not what I am getting at with this post. Everything I am hearing since starting in L&D talks about this being scientifically better for baby as well. i.e. less vagal response during pushing and better overall tolerance of the second stage. I am just finding that no matter how many times I hear it - it isn't matching up with what I'm seeing in practice.

[babyktchr, BSN, RN]

When doing something for so long one way, its hard to change lanes. Look how long its taking for standardized nomenclature to catch on. Open glottis pushing is effective when done properly. It has to be taught with good reinforcement. Screaming is not the way to get a baby out. I find most that want to open glottis push want to just scream and yell. I would much rather prefer you to vomit. At least there would be pressure down there to move the baby. Start with one thing...get rid of counting. It's my personal pet peeve, but it is a safe harbor for some. Let mom push with urge and listen to her body.

[DalekRN]

I screamed during the pushing with my non epidural birth but it wasn't during the contractions, it was right after- I remember feeling like I needed to blow off steam after the work. I needed better coaching I think.

[nrsang97, BSN, RN]

I made some noise pushing. Not a lot when I had my son, but there was some noise. I do remember telling my mother in law to stop rubbing my feet or she would be killed. I don't know why she kept doing it.

[gemininurse71]

The thing about open glottis pushing is that it almost always takes longer. Since 80-90% of the patients we see (at my hospital) are epiduralized, this could mean more time pushing, and moms get exhausted. The younger (and poorer educated) the patient, the harder it will be to teach the perfect balance of noise vs. muscle use, but at least most women can learn to hold their breath and bear down. I absolutely agree that open-glottis pushing in natural labor is great, since they can feel what is going on and their urge to push is not dampened. It could even decrease tears and pelvic floor damage and I think it is most likely better for baby. But before most of us will be convinced, I guess research needs to be done comparing the benefits of open glottis pushing versus the extra time it will take to get baby out.

[TexasCourgette]

I think it mainly comes from how uncomfortable it is for the OB/midwife/nurses to hear someone making that kind of noise (and truthfully, I see this most with OBs, at least at my hospital). It's not a societal norm we have, and so people are asked to stop and coached to do the quiet, closed-glottis thing. Even in cases where open-glottis pushing takes longer (and I do think it tends to), I think it's how uncomfortable it makes the care providers, rather than the time, that drives a lot of (over) coached pushing.

Personally, I think if you, as a care-provider, have a problem with how someone looks in natural labor, then it's *your* problem, and the onus is not on the patient to conform to something you like better. If there's a mom who is screaming during a push, or not pushing effectively, I'll often tell them to try "grunting against the pressure", or making the same low-pitch sounds I encourage them to use during labor. In my experience, it works well, particularly with moms who are going sans-epidural, or have some feeling. If a mom is just totally numb (can't feel her contractions, has never had a baby, needs lots of coaching for pushing), I'll labor her down if I can (per OB), and include open-glottis in my coaching. Sometimes the OB will come in for delivery and tell them to be quieter (in so many words), but by that point, the baby's almost out. Open-glottis pushing isn't something that's caught on much in my hospital, but I use it in my practice, and so do 2 of my co-workers.