A recent post on the Better Birth blog describes what a birth with purple pushing looks like.
Why do we do this? Is it helpful? Is there a better way to push?
The answers are:
A) We do this because of a strange combination of ideas: that women need to be taught how to push, that they won't know how/when to do it otherwise, that the faster the baby gets out of the birth canal the better. It probably evolved from women being heavily anesthetized and unable to feel the natural urge to push, thus creating a need to "coach" women how to push their babies out.
B) Not really, if you look at the risks (several, including more pelvic floor damage to the mother and reduced oxygen supply to the baby) and benefits (not many at all--possibly a slightly shorter pushing stage, but at the expense of both mother and baby). This comment from Dr. Joseph I. Schaffer, a researcher investigating coached vs. physiologic pushing, summarizes the current situation quite well: "Everyone uses coached pushing, but it has no known maternal or fetal benefits, and we found that it was associated with negative effects on several urodynamic indices."
C) Yes: it's called physiologic pushing, in which the woman follows her bodily cues and pushes only when and how her body tells her to. Physiologic pushing has a fairly characteristic pattern: the woman usually will not hold her breath, but instead will push for shorter intervals while exhaling or grunting; she generally uses open-glottis pushing, as opposed to the closed-glottis pushing of the Valsalva technique.
There's lots of research on coached versus physiologic pushing, so I will direct you to just a few:
- Bloom, S. L., Casey, B. M., Schaffer, J. I., McIntire, D. D., & Leveno, K. J. (2006). A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. American Journal of Obstetrics and Gynecology, 194, 10–13. (Available here; you need to scroll down a bit to get to the research summary).
- Less Pelvic Floor Damage Associated With Uncoached Pushing
- Schaffer et al, "A randomized trial of coached versus uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function," American Journal of Obstetrics and Gynecology, May 2005
- MCN Am J Matern Child Nurs. 2000 May-Jun;25(3):165.
- Caring for women with epidurals using the "laboring down" technique. MCN Am J Matern Child Nurs. 1998 Sep-Oct;23(5):274.