Second stage, take center stage

When Amy announced the Fifth Healthy Birth Blog Carnival Get Up, Stand Up, which is based on the Lamaze Healthy Birth Practice “Avoid giving birth on your back and follow your body’s urges to push,” I knew exactly what I was going to write about. I have been planning a post on the second stage of labor, which is the pushing stage, for a while.

To me, this is the neglected part of birth, which is surprising, because it is, well, the actual birth part of the birth. Many women, even if they are the birth advocate types, focus more on the pregnancy, then some thought to the first stage of labor – the dilation and effacement process. OK, let’s not talk about what I think most women do. Let’s talk about my first birth.

I chose my provider and my place of delivery. I chose a midwife who delivered at the hospital near my house. I thought choosing a midwife meant I would have a “natural” birth, and having the baby in the hospital meant I would have a “safe” birth, and didn’t give it much more thought than that. Not that I didn’t give pregnancy, birth and parenting much thought. I was a pre-medical student and a voracious reader who worked in the health food industry. Trust me, there was thought. I read Mothering Magazine, Parenting Magazine, Healthy Pregnancy. I read What to Expect When You’re Expecting. This was 1999. The internet was decade younger, and so were my friends. I didn’t consider myself to be a particularly young mother at 25, but I was the first out of my group of friends to have a baby.

Since a recent newspaper article I had read (in the real paper, they didn’t have archives on the internet at the time, much less cesarean rates by hospital by state, thanks to the wonderful birth advocacy bloggers we have today!) said that my hospital of choice had a 50% primary cesarean rate the year before, I thought using a midwife and not electing to have an epidural would lessen my chances of a surgical delivery, since I was low risk in every other conceivable way. I was also terrified of the epidural, since my brother had just had a spinal tap, and said it was the worst experience of his life. Unlike many pregnant moms, I was told horror stories about spinal punctures, not labor pain. Ha! Imagine if it was the other way around. Anyhoo, back on track…second stage, right.

I ended up flat on my back (with pitocin and external fetal monitoring) pushing against a cervical lip for three hours, while being barked at and blamed by my CNM. I don’t look back on my first stage of labor as painful, even with pitocin, no epidural, and being placed on continuous monitoring. I remember that midwife trying to rub out my inflamed cervical lip with horror, however. I remember begging her to stop, and feeling defeated while I was forced to push, and push, and push, as my mother, husband, and even the labor nurse looked on with dread. I was unprepared for pushing the first time around, and terrified of it the second.

I was not allowed to labor down. I never felt the urge to push. I wasn’t encouraged to stand up. The bed wasn’t raised, I wasn’t told to get in the Captain Morgan position (*wink wink nudge nudge* Amy). I wasn’t allowed to be in any position but flat on my back. I was told by my midwife that my fetus showed signs of distress on the strip and this was the only safe say to be. Know that I know a heck of a lot more about pregnancy, birth, and cardiovascular physiology, I find this laughable and despicable on her part.

Finally, I peed (hey, it’s a medical and birthy blog – get used to the TMI!) all over the midwife (ha! karma!) and then the baby came out soon after. Maybe if I was allowed to walk around freely (like, to the bathroom to empty my bladder after my IV infusion…) I would have been able to deliver my son a little more easily.

It’s not just the attitude of the midwife that I found troubling. Looking back armed with a lot more knowledge, it was her bluster with an absolute LACK of evidence to back her up that I find truly appalling. I was at another birth recently, of my cousin Susan, and it was an affront to evidence based medicine from beginning til end. At one point in the fiasco of a second stage, the NICU doctor rushed in. The obstetrician was so horrified at the possibility of a shoulder dystocia that she called in every available practitioner on the labor floor. (The fetus was not predicted to be macrosomic, the mother was not a gestational diabetic, and there were no other predictors of dystocia, but the obstetrician mentioned it so many times during the pushing stage that the mother to be actually told her to “shut up about it already, I get it” and then the doctor said she had to mention it repeatedly for legal reasons….huh?) I was at the mother to be’s head, supporting her, talking to her softly, and supporting the back of her neck and head when she was pushing.

The NICU doctor placed herself right next to me, and when the pushing started up again, the NICU physician turned to me and started chastising me loudly, saying I was “doing it wrong”. She ordered me to painfully shove the mother’s head into her chest so that her chin was hurting her. She kept saying “harder!” to me, not the mom, and finally said “No, like THIS” and shoved her head so her chin hit her sternum.

I was furious. What was worse, the husband started watching me with every push, and would tell me if he thought I wasn’t pushing her head into her chest hard enough.

If my cousin wasn’t about to push out her son, and I wouldn’t have been completely out of line with a physician at an institution where I would most likely be doing clinical rotations, I would have LOVED to step out of the room with the NICU doctor and ask where the literature was on chin and neck positioning during the pushing stage, and what measurements had been done of the force of shoving the mother’s head into her sternum to determine the proper crushing force. Like the existing evidence on upright positioning, which the mother to be had to insist on after some time on her back. The NICU doctor didn’t tell anyone to stop directing her to do Valsalva (holding your breath and pushing against a closed throat instead of unrestricted breathing) pushing, and didn’t ask if anyone allowed her to labor down and wait for an urge to push before ordering her to push. That didn’t seem to bother the NICU doctor.

But I didn’t. I stayed with my friend, who asked to be repositioned even more favorably in an even more upright position. The obstetrician acquiesced (yay!) and the baby was born soon after.

This is the first post in a two part series. Being at a primip delivery can be hard,


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6 responses to “Second stage, take center stage

  1. Yes, being at a primp birth can be very hard! And that chin to sternum thing? Pfooey! All that does is make her neck, shoulders and back painfully sore for days afterwards.

    • MomTFH

      Ack, come back and read the post again if you have a chance – I actually finished that last paragraph! Yes, primip births can be hard, and the pushing stage is usually the hardest part.

      And the chin to sternum thing – right?? What did she think, the pain in her neck and sternum would somehow transfer to her pelvis and help? Ugh, I wanted to say – hey lady, stick to the babies, and I’ll handle the labor and delivery, OK?

  2. UGH. Sounds a lot like the second stage of my first birth. Flat on my back, not allowed to move, barked at to PUSHPUSHPUSH for four hours. Everyone was so gruff and cold. At some points I was all alone in the room, pushing dutifully like a good little patient, wondering where everyone went and why no one seemed to care that I was having a baby.

    • MomTFH

      Oh, how sad!

      Yeah, my no nonsense midwife seemed great for prenatals. I didn’t need a lot of stroking when I was pregnant, and I was a pretty independent learner, and busy working full time and taking organic chemistry. I didn’t want to spend a lot of time at the office being chatted up. But wow, when I was in labor, I regretted not screening for a better bedside manner!

      I hate seeing women barked at while they are pushing. It is such a pet peeve.

  3. Pingback: Science & Sensibility » The Fifth Healthy Birth Blog Carnival: Push it real good!

  4. Pingback: I get mail! « Mom’s Tinfoil Hat

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