When is the right time to push?

My neighbor just had a baby and she was told she can start pushing lightly at 8 cm. It was my understanding that one had to wait until 10 or risk tearing the cervix? ( OB is not my specialty ) When is the right time to push? Isn't it dangerous to push at anything other than 10?

Having had four babies naturally with a midwife, that strikes me as a very funny question. You body starts to pusssssssssssshhhhhhh when it's ready.

I think the problem with pushing before 10 is that the full-on, sustained, hard voluntary pushing that women are coached to do can cause the cervix to swell and impede progress. Perhaps the light pushing at 8 is meant to mimic what happens naturally.

My neighbor just had a baby and she was told she can start pushing lightly at 8 cm. It was my understanding that one had to wait until 10 or risk tearing the cervix? ( OB is not my specialty ) When is the right time to push? Isn't it dangerous to push at anything other than 10?

With a mom who doesn't have an epidural, I think it's preferable to wait until she's complete AND has a strong urge to push. Some women get to 10 and kinda chill out for awhile before they do the hard work of pushing. This is really normal. Once she has that strong urge, she can go with it. Pushing before she has the urge makes her do a lot of work she could avoid. (Some women will begin to push around 9 cm - I know I did. No swelling or anything.)

With an epidural, lots of OB nurses will let the body "labor down" the baby, which is to let the uterus do most of the work instead of Mom, given that her sensation of the pushing feeling may be hindered by the drugs. It's worked fabulously for tons of women and also helps to avoid maternal exhaustion.

The idea that once you reach 10 cm, you HAVE to begin pushing is sort of silly, as long as you're dealing with a normal labor. I think it's nice to have a woman follow her instincts in this area regarding pushing and position.

Alison

With an epidural, lots of OB nurses will let the body "labor down" the baby, which is to let the uterus do most of the work instead of Mom, given that her sensation of the pushing feeling may be hindered by the drugs. It's worked fabulously for tons of women and also helps to avoid maternal exhaustion.

The idea that once you reach 10 cm, you HAVE to begin pushing is sort of silly, as long as you're dealing with a normal labor. I think it's nice to have a woman follow her instincts in this area regarding pushing and position.

Alison

This is really nice that you say that. I've found that a lot of OB nurses are really ignorant when it comes to the laboring down technique and waiting to push. I did some research on it after having my baby. I was just chilling out, had my epidural and the nurse comes and tells me I'm 10 cm and it's time to push. Everyone in the room including my mom and motherinlaw starts YELLING at me PUSH PUSH PUSH. I am Exausted, and the nurse tells me I *have* to push in 3's (3 counts of 10 during each contraction) and I am holding my breath and pushing as hard as I can and seeing stars***, begging them to let me push at least "in twos" (everybody laughed when I said that). After a few minutes of pushing, doctor gives me an episiotomy and my mom and mil tell me it was because I didn't push fast/hard enough, even though I was giving it my best (kind of hard to do when you're about to pass out from lack of oxygen). Anyway, after the episiotomy the baby slides right out (only 6lb15oz after all). I have this reallly painful episiotomy that does not heal well and is really painful for about 8 weeks and the only thought I have to console myself with is ITS MY FAULT because I didn't push him out fast enough. The whole thing was over in tops 10 minutes. I feel that if I had been allowed to labor down, and if they had let me push more spontaneously instead of making me push to a count a of 10, that I would not have needed the episiotomy. I think the doctor just wanted to get back home to his nice warm bed. I ended up feeling "rushed" through my birth experience and traumatized by everyone in my face yelling and counting AT ME and then getting cut for no good reason. I would love to have a midwife next time I deliver, in fact, I would rather have an unassisted homebirth than get treated like a piece of meat that needs to get delivered and moved in and out as fast as possible.

With an epidural I let the woman's uterus "labor down" the baby if she has no sensation or desire to push. This cuts down on her "pushing time" considerably, particulary for first-time moms. Whereas a woman may have to push in excess of 3 hours if made to push as she reaches 10, allowing her to labor down can mean she only need push 30 minutes or less!

If no epidural, the woman will tell you when she is ready. (grin). Wait til she says so, even if she is "complete" before asking her to push.

If her cervix is not completely dilated, I have her pant through the contractions (a cervical rim). If there is a "lip" I let her push a bit to "reduce it". IF it's not friable/reducible, then I help her breathe through the contractions until such time the cervix does move. But most women will "grunt" a little anyhow. Nature has an amazing way of taking care of these things in the absence of anesthesia, particularly.

This is really nice that you say that. I've found that a lot of OB nurses are really ignorant when it comes to the laboring down technique and waiting to push. I did some research on it after having my baby. I was just chilling out, had my epidural and the nurse comes and tells me I'm 10 cm and it's time to push. Everyone in the room including my mom and motherinlaw starts YELLING at me PUSH PUSH PUSH. I am Exausted, and the nurse tells me I *have* to push in 3's (3 counts of 10 during each contraction) and I am holding my breath and pushing as hard as I can and seeing stars***, begging them to let me push at least "in twos" (everybody laughed when I said that). After a few minutes of pushing, doctor gives me an episiotomy and my mom and mil tell me it was because I didn't push fast/hard enough, even though I was giving it my best (kind of hard to do when you're about to pass out from lack of oxygen). Anyway, after the episiotomy the baby slides right out (only 6lb15oz after all). I have this reallly painful episiotomy that does not heal well and is really painful for about 8 weeks and the only thought I have to console myself with is ITS MY FAULT because I didn't push him out fast enough. The whole thing was over in tops 10 minutes. I feel that if I had been allowed to labor down, and if they had let me push more spontaneously instead of making me push to a count a of 10, that I would not have needed the episiotomy. I think the doctor just wanted to get back home to his nice warm bed. I ended up feeling "rushed" through my birth experience and traumatized by everyone in my face yelling and counting AT ME and then getting cut for no good reason. I would love to have a midwife next time I deliver, in fact, I would rather have an unassisted homebirth than get treated like a piece of meat that needs to get delivered and moved in and out as fast as possible.

So are you saying it is ok to push at 8? Or just breathe through them?

I am curious for several reasons, someday I would love to try and be a L&D nurse and because of my own experience. I was at 9cm for over 6 hours and would have loved to push but told I had to wait to 10. So Everytime I had a contraction I had to tighten my muscles AGAINST the contraction, which of course made the contraction that much worse. ( for a gross analogy - Worse than having a bad case of diarhea with no bathroom for miles. ) I was so relieved when they told me I could push. I still wound up pushing for

2 1/2 hours.

Nurse Pamela, there are no hard and fast rules in OB. That is the only hard and fast rule you'll find.

A multip with a really strong urge to push and a really elastic cervix may be able to start pushing at 8 cm. She may well not be able to not push!

A primip will probably not accomplish anything except cervical trauma and exhaustion if she starts pushing at 8 cm.

In your case, I'd be that the baby was in a posterior position (facing your front rather than your back). This position seems to cause an early urge to push and can slow the progress of labor, both dilation and descent. Pushing before you were complete would not have helped, although from your description, some sedation or an epidural may have helped you relax and speeded up dilation. Or not, everyone's different. Getting on your hands and knees may have helped. We could devote a whole thread to ways of delaing with posterior positions.

Just because someone is 10 cm dilated, with or without an epidural, does not mean she is ready to push. The uterus will almost always move the baby down to where the woman begins to get the urge to push on her own. I like it when I can tell a woman to just listen to her body and do what it tells her to do so that she may ease gradually into pushing. I almost never count for patients unless the doctor is there and that is his instruction. Really long pushes decrease maternal cardiac output and so stress the baby too much.

We do not offer epidurals at our hospital, although we may occasionally have the odd one. I usually find that a woman instictively knows when it's time to push, and pushing before that usually is unproductive. I do not let my patients push before 10 cm. but look for comfort measures to help decrease the urge-position changes, empting bladder etc. I have seen a cervix become quite swollen from pushing too early. It usually isn't that long to wait.

That makes more sense to me, thank you. The one thing I learned is there is no one thing. If only the babies would read the books. :-) I don't know what postion the baby was in when I was 9, I just remember a lot of pain and the nurse not letting me push. So when I found out my neighbor could push at 8 needless to say it brought back a lot of ill feelings. Thank you for the explanation - it helps.

THis may be a dumb question. What happens when the cervix becomes traumatized and/or swollen? Can they just sew it back up like they do everything else after the baby??? I'm guessing risk for hemmoraging is greater as well as emerg. c-section????

It's not always the nurses choice to have the pt. labor down. It's not that they are ignorant to the technique often times it's the OB. When you don't work @ a teaching hospital it's easier to let your pt labor down b/c you don't have a doc breathing down your neck. So @ home I let all my pts labor down. I can't do that where I am now. Even if you suggest such a thing to some OBs they prefer to have their pts push immediately.

This is really nice that you say that. I've found that a lot of OB nurses are really ignorant when it comes to the laboring down technique and waiting to push. I did some research on it after having my baby. I was just chilling out, had my epidural and the nurse comes and tells me I'm 10 cm and it's time to push. Everyone in the room including my mom and motherinlaw starts YELLING at me PUSH PUSH PUSH. I am Exausted, and the nurse tells me I *have* to push in 3's (3 counts of 10 during each contraction) and I am holding my breath and pushing as hard as I can and seeing stars***, begging them to let me push at least "in twos" (everybody laughed when I said that). After a few minutes of pushing, doctor gives me an episiotomy and my mom and mil tell me it was because I didn't push fast/hard enough, even though I was giving it my best (kind of hard to do when you're about to pass out from lack of oxygen). Anyway, after the episiotomy the baby slides right out (only 6lb15oz after all). I have this reallly painful episiotomy that does not heal well and is really painful for about 8 weeks and the only thought I have to console myself with is ITS MY FAULT because I didn't push him out fast enough. The whole thing was over in tops 10 minutes. I feel that if I had been allowed to labor down, and if they had let me push more spontaneously instead of making me push to a count a of 10, that I would not have needed the episiotomy. I think the doctor just wanted to get back home to his nice warm bed. I ended up feeling "rushed" through my birth experience and traumatized by everyone in my face yelling and counting AT ME and then getting cut for no good reason. I would love to have a midwife next time I deliver, in fact, I would rather have an unassisted homebirth than get treated like a piece of meat that needs to get delivered and moved in and out as fast as possible.

If all that took 10 mins than laboring down wasn't really an option. Hopefully your doc cut an epis b/c you were tearing not the speed things along. The head must have been low enough.....