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What’s The Rush? 4 Expert Tips To Help Avoid An Instrumental Birth

EXPERT ADVICE: New research shows that it’s normal for the pushing stage in labour to take longer than current hospital time limits in Ireland.
 

What does that mean for you and your baby? Midwife Tracy Donegan explains.

A new study published last week in the US compared data from more than 42,000 women who gave birth in San Francisco. The results of the study showed that that 95 per cent of women who were having their first baby got through the 'pushing' stage in three hours and 20 minutes without an epidural. With an epidural, the pushing stage of labour was five hours and 40 minutes for 95 per cent of the women in the study – two hours longer.

Epidurals have their place in modern maternity care and can make a difficult labour one to remember for all the right reasons. This article will help you understand how to optimise your chances of avoiding an instrumental delivery and/or a Caesarean section when the only ‘emergency’ is that your time is up – with or without an epidural.

US obstetrician Dr Jeffrey Ecker commented on the new research saying: "Often what's best and most appropriate — and most difficult — during labour is patience."

It seems patience is something we’re lacking in Irish maternity units and with media coverage of high profile cases, it’s difficult for many health care professionals not to intervene ‘just in case’ (i.e. without any clinical indications), which causes unnecessary complications for a healthy mom and baby.

What's the rush?

In a busy maternity unit, the time limit on the second stage of labour can be as short as 45 minutes to a maximum of around two hours. Incredibly, that means that after 45 minutes you may be faced with an instrumental delivery for no other reason than it’s been X amount of minutes depending on how busy the unit is that day and how well you and baby are. Fear of litigation is driving time limits in Irish maternity units – not international best practice.

In a busy maternity unit, the time limit on the second stage of labour can be as short as 45 minutes to a maximum of around two hours

The conversation goes a little bit like this “you’re not pushing hard enough, push into your bum...hold your breath...keep it coming…keep it coming…get angry with your baby…does he take after his Dad – is he always late too? We’ll give you another 15 minutes and then we’ll have to call the doctor to give you a little bit of ‘help’."

Then the requisite 15 minutes passes and the doctor arrives to give you some ‘help’, which often comes in the form of a forceps and/or ventouse (vacuum) and/or a Caesarean section. If you’ve had a long, tiring labour and are exhausted from holding your breath for two hours (no longer best practice), then you may well be very grateful to the staff for intervening – but if there are no clinical reasons to intervene, what’s the rush?

This scenario plays out every day in every labour ward in the country. But what if your body doesn’t comply with the time limit? What if your body needs the full three hours for your baby to spiral and rotate down through your pelvis? What if your baby needs the full three hours to tuck his chin in to his chest and turn his body in a way that makes his birth progress perfectly?

What can you do to try and avoid an instrumental birth?

  • Avoid the epidural – prepare for birth without an epidural. Take an independent birth preparation class, such as GentleBirth, or a good active birth class. Practice these natural labour techniques in pregnancy and consider hiring a doula to support you and your partner.
  • If you have an epidural – ask for at least two hours of passive descent (when you’re fully dilated you rest and let your body do the work for you before any active pushing).
  • Without an epidural, follow mother-led pushing, in other words, no coached pushing.
  • Ask for more time if you and baby are well.

Asking for more time is not as daunting as it seems. Dads can ask two very simple questions – is my partner ok? Is our baby ok? Chances are everything is fine – but you’ve just run out of your allotted time and there are two other women being induced who need a bed in the labour ward and you’re holding things up. You and your baby have become bed-blockers!

It’s no secret that women tend to be ‘people pleasers’ and we don’t like to make a fuss…or attract attention to ourselves. We worry about what others think about us, including your midwife. So if asking for more time for yourself makes you uncomfortable, consider asking for more time for your baby to give your baby the healthiest most gentle birth you can – which almost always translates into the healthiest, most gentle birth for mom too.

Need more advice from Tracy? Head to our pregnancy expert forum For more information on navigating Irish maternity services in a positive way, read Tracy Donegan’s Irish Better Birth Book (Taking the Mystery and Fear) out of Childbirth or visit www.GentleBirth.ie for classes.
Leave a comment below.

About the Author

I’m Tracy Donegan, registered midwife and mum to 2 gorgeous boys. I’ve been working in Irish maternity services since 2005 and really enjoy helping Irish families have the best experiences possible. You may be familiar with my books – The Irish Better Birth Book and The Irish Caesarean and VBAC Guide, as well as the very popular GentleBirth Positive Birth app.

Comments

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Emster
Hi.
This interests me as my second child is due shortly. What are other countries doing in lines of pushing time limits before intervening? What are the reasons?
It's a tough balance, in Sweden a lot of women feel that midwives are overdoing it the other way, waiting too long and putting mothers and babies at risk in the name of doing things naturally and/or to avoid the cost of a caesarean. I certainly do not want intervention too soon (or too late), I was threatened with it on my first delivery (Ireland) when the pushing wasn't effective enough but "luckily" an episiotomy was sufficient to get (the big) baby's head out.

I'm also curious about holding your breath through pushing not being considered best practice anymore; what is best practice, and says who? I'm not disagreeing, I just want to bring this up with my midwife in preparation for birth. TIA
05/07/2017 12:32:06

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