Sunday, November 13, 2011

Don't Push the River, It Flows By Itself

By Laura Shanley
Excerpted from Shanley's book, Unassisted Childbirth
Learn more from Shanley and subscribe to her newsletter at UnassistedChildbirth.com


It is a little known fact that aside from a slight push or two in the last seconds of labor, forced pushing (pushing when a woman has no impulse to do so) is not necessary, or even desirable, for the laboring woman. The saying, "Don't push the river, it flows by itself," definitely applies to labor. Nancy Tatje-Broussard writes in her article, Second Stage Labor: You Don't Have to Push, "The birth process need not be a pushing affair. It can be a gentle unfolding, in harmony with the natural rhythms of life." (Mothering, #57)

Tatje-Broussard began studying the concept of pushing after an older friend of hers shared her story of a medicated flat-on-your-back birth 20 years earlier. The friend had been given general anesthesia which had rendered her unconscious through most of her labor, but she woke up in time to see her daughter's head emerging. Quickly she called to the nurses who were playing cards at a nearby table.

Tatje-Broussard wondered, if women were able to give birth easily while unconscious, why must they exert tremendous effort while awake? She found that up until the 1920s women were not instructed to push during the second stage of labor. (The second stage is the time between the full dilation of the cervix and the delivery of the baby.) Around that time, doctors "determined" that the second stage was dangerous to the unborn baby. Pushing, they hoped, would get the baby out faster. At one time, mothers were even told to begin pushing at the onset of labor.

By the mid 1950s many people had begun to realize the importance of relaxation during the first stage of labor. The second stage however, was, and continues to be, associated with great physical effort. Doctors, nurses, midwives and "birth coaches" often encourage a woman to push even when she has no impulse to do so.

By the 1980s scientific evidence showed that the second stage of labor was not dangerous for the baby, but actually helped to stimulate her digestive, eliminatory and respiratory systems. Pushing, on the other hand, can be dangerous to both a mother and her baby. When a woman is pushing she is holding her breath. Oxygen therefore, is not going to her uterus, which makes contracting more difficult and painful. It is also not going to her baby. This can lead to a drop in the fetal heart rate and possible brain damage.

Susan McKay agrees. In her paper, Humanizing Birth in a Technological Society, she writes, "Urging a woman to push harder and longer may, in fact, make things worse as the baby's head and umbilical cord are compressed through the mother's intensive effort, leading to (heart rate) decelerations and fetal hypoxia (oxygen deprivation)." (Quoted in Birth as an American Rite of Passage by Robbie Davis-Floyd)

Tearing of the perineum is more common for women who have pushed over a long period of time and studies show that pushing does not necessarily get a baby out faster.

Midwife and author, Ina May Gaskin, wrote about a birth she attended in an Amish community in her article, Childbirth the Amish Way:
"Just as soon as there was any sign of pushing, the baby was crowning. The only sign of her pushing was a slight catch of her breath. She did not make a sound or grimace. Eighteen other births had obviously taught her how to let her uterus do the work, while the rest of her took it as easy as possible." (Mothering, #43)
Jan Fletcher told of her labor experiences in a letter to Mothering titled, "No More Professional Pushers."
"My first birthing experience was accompanied by a frantic chorus of "Push! Push! Push!" for at least 30 minutes. Being an inexperienced "birther," I took their exhortations seriously.  ...Five people were yelling at me to PUSH!, and in my efforts to appease this throng, I pushed so hard that I broke my tailbone. For my second birthing, I made up my mind that I wasn't going to push at all. If the baby took a while to come out, so be it. Sure enough, the second birth was also accompanied by a chorus of "Push! Push! Push!"-- only this time I ignored it. Breathing quietly, relaxing, and hesitating ever so slightly with each breath was all it took. Jessica came out leaving my tailbone in one piece and thereby sparing me six weeks of postpartum pain." (Mothering, #49)
Giving birth is not unlike having a bowel movement. In a normal bowel movement one allows the body to do its work. Once the feces has entered the rectum only a slight push is necessary to excrete it. The concept that labor must be "hard work! The hardest work I've ever done in my life," (as I've often heard women say) is simply a fallacy. In fact, author Pat Carter believes neither the woman nor her uterus need to work hard to produce a baby:
"It only takes a little bit of effort from the fundus to send a baby merrily and successfully on its way, provided pain inhibition has not set up opposition to its efforts. Little, if any, more power than the walls of the colon have to exert to perform its function of ejection - actually less power than it takes to sneeze." (Come Gently Sweet Lucina)
On a more aesthetically pleasing level, giving birth can be compared to painting a picture or having an orgasm. It is more a matter of "allowing" it to happen rather than "making" it happen.

Of course, this isn't to say that if a woman has the urge to push, she should ignore the feeling. But certainly, she shouldn't feel she has to push just because she's been told that this is the way babies are born.

Giving birth is a creative act, and like all creative acts it cannot be forced to conform to society's unnatural time constraints. The insistence on pushing in labor is simply a reflection of our cultural attitude that force and haste are superior to trust and patience.



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9 comments:

  1. I LOVE Laura Shanley and all that she stands for - a proud Jewish woman who kept her sons whole.

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  2. I found this to be so very true... I had an (unintentional) unassisted homebirth, and she basically slid right out, with only a few easy pushes in the last minute before she emerged. It was amazing. I put the whole birth story on my blog: http://mommyerin.blogspot.com/2011/09/lucys-birth.html
    I'm so grateful to know how my body was made to work and to have taken Bradley childbirth classes... everything just happened so naturally and without any effort on my part. The only effort I had to put forth was to allow myself to relax!

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  3. This is sort of misleading. I birthed my first baby with midwives. I was prepared for a calm birth. I had seen the videos of quiet birthing and wanted that for myself. I did no "purple pushing" - I waited until my body was pushing itself. And when my body pushed on it's own, I roared. I couldn't possibly be quiet.

    It *was* the hardest work I've ever done in my life, but that doesn't mean I wasn't letting my body do it and staying out of the way of it.

    To say that 2nd stage labor should be quiet or easy if done "the right way" is a little disingenuous and unfair to first time moms who don't know what to expect, and may feel they are doing something wrong if they don't fit into this picture you are painting. The point of peaceful birth is to get out of the way and let your body give birth the way it was uniquely designed to. If your body wants to to be quiet, be quiet. If it wants you to roar like a lion, then roar like a lion. Honor your body, honor the process.

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  4. This is also very interesting to me, because during the birth of my daughter (my second) I was completely overwhelmed with a *very* strong push sensation -- from within. No one was telling me to push at all (in fact, had they had a chance, they would have told me to stop!) but my body took over and with three extremely intense pushes, birthed my baby -- the final push not only birthing her head, but the entire baby onto the bed. It's curious to me that other women don't have this intense bodily urge! But I guess everyone is different!

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  5. Touched my the last lines of this post and the sentence on the t-shirt!
    I was lucky to have two homebirths (with a wonderful midwife) and I am grateful to have welcomed my two babies in a natural, peaceful way!

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  6. That's the beauty of nature. Everything will come naturally. We will have to be patience.

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  7. 'It is more a matter of "allowing" it to happen rather than "making" it happen.'

    This is exactly right. This is how I would describe my last son's birth. I went from 7cm to BABY in 5 mins, and I never pushed at all. I just relaxed my body and let it do what it needed to do.

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  8. I love this. I love this blog. It's about everything I believe in. When I finally conceive my child, I will take everything I read on here and put it to use.

    Thank you for every single blogpost.

    ~Jill

    www.highheelsandhuggies.blogspot.com

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  9. I appreciate what this is saying, but I wish someone had warned me it might not be an option and that I had learned how to push with vigor if needed. I had a natural, drug-free birth with midwives, but my baby went into distress due to a pinched cord. By the second stage of labor his heart rate was dangerously low and they were prepping the OR for an emergency c-section. To save my baby's life it was push him out immediately, or let them cut him out.
    I prepared myself for pain during labor, but I expected a "gentle" pushing stage where my body did what came naturally. When I heard my baby's heart rate get slower and slower as I waited for the next contraction, it became clear I had to push hard and fast. I probably wasted 20 minutes with inefficient, unfocused pushing. Eventually I figured out how to use my breath and direct my muscles to push effectively even without contractions. My baby was born just in time.

    It would be awesome of birthing classes including some instructions on pushing during an emergency, because it was the one thing for which I felt totally unprepared. Don't waste your breath grunting or screaming, instead channel your energy straight down. Moms, if your baby is in distress know that you DO have the strength to do what it takes and push him/her out!

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