Monday, October 24, 2011

Pushed into Supine Pushing Positions

When I was thinking about getting pregnant with my second baby, I visited my OB, Dr. Brian Wolsey, that "delivered" my first baby.  I had been gathering lots of information and knew I would do things differently with the second baby.  One of the questions I asked him was how he felt about me pushing in a different position besides flat on my back.  He got down on the floor (in his very nice clothes), and on one knee, contorted his body, and while looking and reaching up, said, "Well, it's kind of hard to catch a baby in this position."  He was more concerned with his comfort than mine when it came to pushing my baby out.

I never returned to his office.  

This is an important question to ask your care provider. The answer should be a respectful "Let's see how you feel when it comes time to push.  The benefits to using gravity and an upright position are ...    An example of when you might not want to use gravity is ..."

I've had a number of people return to class saying things like, "My doctor said I can hang from the rafters for all he cares" or "I can squat on the floor like I'm in the jungle!"  They seem happy with these responses, but in reality, your doctor is making fun of you.  He thinks its undignified and foolish.

If I am an OB -- or even a Certified Nurse Midwife -- working in a hospital, chances are, approximately 90% of the births I attend is with an epidural.  The mom is mostly on her back.  Like it or not, this is how I get used to catching babies.  This is what I am comfortable with.  Even to have a mom on hands and knees, well, this looks different to me, and I am not as comfortable with this situation.  I will find a way to get this mom on her back.  I will give her lots of excuses that sound really good, such as, "The baby is caught on the pubic bone and I need you to lean back."

If a woman is left alone to choose her birthing position, very often she will use gravity in some form or another.  Rarely will she lay flat on her back to push her baby out.  Squatting, for example, is known to widen the pelvis up to 30%.  Many OBs will not suggest a mom get up and squat, but instead, will cut an episiotomy to get the baby out quicker.  Or worse, perform a c-section because her hips were "too small."

I simply wanted to let women know that what position you birth your baby in is your choice.  This seems common sense, right?  I routinely hear women talk about their doctor wanting them in a certain position when it comes time to push.  Pushing while flat on her back can cause more problems that it fixes.  The only person benefiting from this position is the OB. 

When you ask your care provider this important question, listen for silly answers that are really meant to make fun of you.  Listen for responses that put his/her comfort above your own.  The good answers are the ones that inform and respect you and your comfort.  Follow what your body is telling you to do.  Don't let them push you around when it comes to pushing your baby out!  


Samantha said...

Laying on your back is the worst way ever to push *anything* out...would the doctors be most comfortable having a bowel movement in this position? I think's because it's not really effective. My midwife asked if I wanted to deliver on the toilet, where I was laboring, or on the birthing stool, but I actually wanted to be in the upright bed, bracing my hands on my's just what worked best for me. Every labor is unique!

Janie said...

I totally agree, but I have to say, I pushed in the birthpool leaning back but I had my feet a bit under me. Nothing like being flat on my back in the hospital bed, but I didn't ever have the urge to squat or be on all fours

Leah said...

I've heard a doctor say that the back is best for bigger babies so they don't get caught behind the pubic bone. What are your thoughts on that: why would they claim that; is there any truth to that?

chelle said...

When I asked my OB about pushing in alternative positions he asked "like what?" and I replied with a quick list and "what ever I feel is most comfortable at the time" his response was that I could not push squatting because "it would be to hard for me to catch the baby and he/she would most likely fall in the floor and get brain damage" and that I could not go on all fours because "the pushing and pressure may rupture your bladder" and "I don't want your butt in my face anyway"...this same man constantly bragged about his 8+ years of medical school and 35+ years experience when ever I questioned him about anything...Yes I changed OB's but seriously all that "experience" and the best excuse for his ' your delivery is all about me and my comforts' mentality is that the baby will fall in the floor and get brain damage ?!?!

JoyfulJ said...

Leah, I don't have any scientific proof or anything only experience, my first son was born a day after his due date at 10 lbs even, I birthed standing up a midwife kneeling below me, I pushed for 40 minutes, It would have taken me much longer and would probably have needed some kind of 'assistance' if I had been on my back.
My second son was 8 1/2 lbs born 3 days early and I pushed on my hands and knees and caught him myself, I probably wouldn't have needed help but I don't think I could have birthed him in 5 pushes (I took my time with him lol because my first son basically shot out I was pushing so hard and tore me bad because of the speed, though I suppose his fist on his cheek didn't help since his head was already 14").
I don't see any situation where birthing on your back is in any way better, unless the assistance of forceps/vacuum is truly necessary.

Angie said...

Great post. I like that the bottom line is push where is best for you. It is important for a woman to be able to listen to her body. It will guide you! I had my first flat on my back (cause I didn't know there was another choice) and it was awful!!! I remember thinking I wish I could get up, if only I could get up. And the pain in my hips was intense. I felt like my hips were trying to spread for the baby to move through, but just couldn't spread. It was very painful! I didn't even think to ask to get up. This was the only image of labor I had ever seen. For my next I was squatting by the bed and when he got stuck my midwife guided me what to do (the gaskin move sp?) and my 10.5 lbs baby boy came. It was very intense and poor guy broke his collar bones. I remember when she had me move to hands and knees and turn my hips I could suddenly feel him move and come free. If I would not have been able to move around and had been on my back...I feel the outcome would have been very different. And recovery for me was so much better. After my first I had lots of low back pain for weeks. I did not have that with my 2nd or 3rd child. Again great post!

AtYourCervix said...

It truly is a response from the care provider (re: birthing supine or lithotomy) that it's "better" that way --- only for the provider!

Signed, the L&D RN who hates supine/lithotomy position at births.

Ginger said...

I've noticed you've done a lot of "what not to do" posts lately, which are greatly helpful to those who have hospital births. As a homebirther, I would really love some "what to do" posts, since fetal monitoring, elective c-sectioning, IV, and supine pushing don't occur at home at all. :)
Puh-lease! ;;)

Mama Birth said...

@Leah --I have heard (just heard) that occasionally a woman may get on her back in order to move dystocia, with legs up and pulled back-

Occasionally what is needed is a "change".

The point is- what position you are comfortable with.
Frankly- I find it disturbing when a doctor has a favorite "position" whatever it is, even if it is sidelying or the classic-

Why? Because birth is primal and should be mother led. Sidelying is a great position, but should be used when mother deems appropriate.

Kate said...

My first birth was a cytotec induction, 8 hrs of labor, nubain (which I did not approve and had a horrible reaction) epidural, and then 3.5 HOURS of pushing flat on my back ending in a vacuum extraction and our son in the NICU for five days (complications from the induction!)...needless to say my second birth was completely different! At a birth center with two wonderful midwives. I had basically gone through transition laboring on the toilet and came out, made it as far as the doorway between the room and bathroom, knelt down with a contraction and had her right there! 20 minutes of kneeling/ squatting (with a birth ball for extra support) and no tearing, no soreness, hardly even any recovery needed! No one should be made to birth laying back!

Janie said...

Ginger, there are lots of great blogs out there about homebirth - donna is more of a bradley birth blogger

Ginger said...

Janie, we used Bradley with our homebirth. I've never heard that the Bradley method is just for hospital birthing. :?
Could you give me some links please. I haven't found many great homebirth blogs.
Thanks so much!

Bluebonnet Mama said...

I birthed at a birthing center, with a midwife, and somehow ended up on my back with the midwives pushing my legs up by my head whenever I pushed. I hated it. It was horrible. They were also directing me to hold my breath and push as much as I could, and I couldn't catch my breath after that when they were pushing my legs up by my head!! The CNM said something about getting the baby around my pubic bone. This was probably in the 2nd hour of pushing. I'd started out pushing upright but leaning back in the tub, and she was actually birthed on the birthing stool.

I'm almost positive I either sprained or broke my tailbone during labor. She was posterior and I was induced with Cytotec. There are several things I would change about my labor/birth if I could go back and do it again, and I think I've mentioned them all in this post!!