Is Mother Directed Pushing Possible in the Hospital?

I love Lamaze’s 5th Healthy Birth Practice: Avoid giving birth on your back and follow your body’s urges to push.

Their video is great, but here is an example of what more likely happens in a hospital setting.

Polly is having a wonderful un-medicated hospital birth – things have progressed quickly and the staff has been supportive about her birth preferences.   It has been a calm and peaceful un-medicated birth.

She starts having an urge to push and the nurses check her to confirm she is 10 cm and then call her OB, who is about 15 minutes away.

The feeling in the room has changed.

“Don’t push!” The nurse keeps barking at her as she bustles around getting the room set up.

Polly struggles not to push.

“Don’t push!” the nurse orders as more people fill the room, including an on staff OB.

Polly can’t help but push.

“Don’t push!” the nurse chastises her as she gets the mom into the stranded beetle position.

Oops, I meant something like this –

Polly’s OB arrives.  Now there is a new urgency in the room.

“PUSH! 2,3,4,5,6,7,8,9,10”

Polly starts pushing at their command.

“Push again!”

Polly tries to rest and she is chastised again, “Keep going, one more push!”

“PUSH 2,3,4,5,6,7,8,9,10”

It is as if now that the OB is here it is a huge rush to get the baby out.

Polly keeps following orders and after X minutes her baby is born.

This is so frustrating to see when it happens to my doula clients.  (there is one hospital in my area that is very supportive of mother directed pushing, but at the other hospitals it is an uphill battle).

I teach about Mother Directed Pushing (MDP)  in my Hypnobabies class and I try to help make it happen at births I attend by telling the nurses way before pushing – “Mom wants to push in hands and knees position (or whatever mom wants) – I also remind her she wants to do mother directed pushing.    But somehow when the pushing stage begins, most care providers fall back into their “normal routine” and it takes a lot of work to get them out of that routine.

I try to balance what the nurses are barking at my client with “Follow your body, you are doing great!”  and remind care givers mom is doing MDP.  But the mom has to choose who to listen to.  (These are in situations where mom and baby are doing well.  If there is a problem with the baby then certainly I would let the nurses take charge… I always check, “Is baby doing ok?” )

So YES it is possible, but it takes preparation and support to make it happen. I made this video showing 2 hospital births where it did and give tips for mom, birth partner and doula as to how to help make it happen for you!  I would love nurses to watch it too and give feedback.

Is it possible to do Mother Directed Pushing with an Epidural? Yes!  I have seen it done with moms who can feel what is going on.  Here is an amazing video of a mom doing so!

So here is a set of tips to help make MDP happen.

  • Talk to your care provider during pregnancy to see if they are open to different pushing positions and MDP.
  • Tell your nurse before pushing starts you want to use different pushing positions and MDP.
  • As pushing phase begins, quickly get into alternative pushing position (once you get in the stranded beetle position, it is hard to get out.)   Having a supportive nurse or doula can help so much with this!
  • Follow your body and push when you feel the urge.    If you don’t have a strong overwhelming urge to push, you may want to start by breathing the baby down and out, or change to a new more upright position.
  • If the care providers are coaching you, remind them you are doing MDP and ask them to stop.
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6 Comments on “Is Mother Directed Pushing Possible in the Hospital?

  1. I just wanted to share a really positive MDP story. MDP in the hospital is definitely possible! I think it all goes back to choosing your care provider carefully. With my second child (a hypnobaby) I was in the care of a CNM practice. I discussed MDP early on and my midwife was on board. During my birthing time, when I told my midwife that I needed to push, her only response was to mildly say, “okay, we should take your pants off then” (I was in my normal clothes). I choose the pushing position that felt best for me (on my knees, leaning over the upright back of the bed) and pushed when I wanted to, as hard as I wanted to. The only sounds in the room were my vocalizations and my midwife and husband’s gentle words of encouragement. There was no hustle or bustle and everyone was calm and relaxed. My daughter was born in about 7 pushes and was handed to me immediately. It was an amazing experience in part because I was totally calm and in control (yay Hypnobabies!) and also because I had a supportive midwife who truly respected my wishes for my daughter’s birth.

  2. I just wanted to reiterate that it is entirely possible to do MDP with an epidural also. I try and use it as much as possible. I just allow mom to push if she can feel the contractions at all. I hate the counting and will forgo it unless mom requests and and just have them push for however long and how many times they feel like they can. I also move them side to side quite often and even have them sitting up in bed. It is much more relaxed and calm. Sometimes, I feel like it may take a little longer, but not much and the feelings of peace and calm that come from this are very much worth the extra 10 min it takes to get baby out, imo.

  3. Thanks for posting this! I had in my birth preferences for my son’s birth that I wanted MDP, but it didn’t end up happening. After reading this, I know better how to handle things next time.

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

  5. The narration of your birth story was so helpful. Pushing is where I finally lost all control and is the last bit of confusion I have in going for my #vbac this July. This has been so helpful to SEE that there are so many different options! Absolutely awesome!

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