We’ve all seen some movie scene or the other in which a woman’s face contorts in pain as she pushes during labour, surrounded by a chorus of ‘push, push, PUSH!’ Expectedly, unless it’s an elective c-section, most women enter the labour ward mentally prepared to push during labour and they brace themselves themselves for what is to come.
Pushing during labour may cause tear:
But did you know that 9 in 10 women suffer from some kind of vaginal tearing during childbirth? The damage varies greatly but in the worst cases, women are left to suffer from incontinence and lifelong nerve problems!
Between 2013 and 2014, there was a steep rise in the number of women in England who suffered from perineal tearing. This led the Royal College of Midwives to take some form of action.
With the support of the Royal College of Obstrecians and Gynecologists, they piloted a trial program at Medway Martime Hospital in Kent.
During the trial, the conventional pushing during labour was not advocated. A simple change such as not pressuring women to lie on their backs and ‘push’, went a long way.
The hospital reduced the number of third and fourth-degree perineal tears by seven-fold, from seven to just one percent!
The hospital’s head of midwifery, Dot Smith, attributes the alarming number of women experiencing vaginal tearing to the misconception that women have about the need to “push, push and then push harder” in labour.
“When we saw 22 cases of third-degree tears in a month, we said, this is is not good enough,” Smith said.
During the trial program, the hospital also encouraged women to give birth by standing up, or squatting on their knees. This was normal and widely practiced until the 1950’s.
Midwives also encouraged breathing naturally through contractions instead of pushing during labour.
In addition, as opposed to the conventional method of pulling the babies out as soon as their heads emerged, the midwives allowed the baby to follow the natural birth rhytm and come out at their own pace. They supported the weight of the baby to reduce pressure on the perineum.
As you can guess, the program was a hit. It was so successful that the findings were published in the European Journal of Obstetrics and Gynaecology. There are also plans to implement these practices nationally.
A simple measure has already made such a significant impact on reducing unintentional damage to the bodies of women in labour by 85% in some maternity wards.
To push or not to push
In her article To Push or Not to Push, Mickey Morgan, founder of HypnoBirthing, says that pushing during labour is counterproductive.
“Forced pushing creates stress for the birthing mother, which is self defeating in that it closes the sphincters of the vagina ahead of the descending baby.”
About 25 years ago, Morgan introduced the concept of mother-led breathing, as opposed to staff-directed breathing and pushing.
She has found ample evidence that directed or forced pushing results in:
- Fatigue for the mother in labour
- Increased morbidity of both mothers and babies
- Inefficient uterine surges or contractions
- Increased risk of hypoxia (depriving the body of adequate oxygen supply)
- Fetal heart rate anomalies
- Damage to the mother’s pelvic floor muscles
- Rupturing of eye and facial blood vessels
- Tearing of the perenium
- Increased need for episiotomy (surgical cut at the opening of the vagina)
While the results of this study is hardly surprising for midwives and gynaecologists, it is great news for women everywhere that finally these methods are getting the formal recognition that they deserve. Pushing during labour can be damaging and there are safer ways for women to labour.
It’s good to be well-informed about such things for most first-time mums go into the labour ward not really knowing what to expect. Keep this in mind when the big day comes!