S. called me on Friday morning to say that she had an OB appointment that morning. Dr. T. checked her and said she was 4 cm, so she needed to go to the hospital to have the baby. We talked a bit about why. I asked if she was having pressure waves. She said she was having some, but they were not regular and she wasn’t having to relax through them.
(Hypnobabies students often are comfortable throughout their births. So even if a mom is having comfortable pressure waves every 5-7 minutes, if she has to relax through them to stay comfortable, then I feel confident saying she is in her birthing time.)
I said it sounded like Dr. T. was putting her on an induction track and that if she went in she would want to break her water (oh yes, she did say she was going to do that, S. remembers) I reminder her of the risks of that, especially because her baby was still so high. Then once her water was broken then they would want to start pitocin if things didn’t progress. (From a L&D nurses blog, this is what she calls a Back Door Induction. I am going to add this to my information when I teach about Inductions in my Hypnobabies Classes. Beware of the Back Door Inductions!)
S. called the OB to get more information, like her Bishop’s Score (I had reminded her that depending on what that score was, it could indicate the odds of a successful induction) and to say that she wanted to stay home until she was having consistent pressure waves. Not surpisingly, Dr. T. she felt S. was in her active birthing time and just didn’t know it, so she REALLY wanted S. to head in. Did I mention this was S.’s first baby? Really, what are the odds this baby is just going to fall out?
She decided to head in to the hospital once her DH got home. I asked her to call me when she left and I would meet her there. I honestly didn’t think she was in her birthing time and I could see that this could go so many different ways, but basically towards interventions and a possible induction. But I support my moms in whatever they decide. So I moved forward.
I did pray before I left and asked that if possible she have the baby by 8 PM and I could be home by 10 PM. I was hosting a Hypno-doula workshop the next day and had 9 doulas scheduled to come. I e-mailed them all and explained what was happening, that they should check their e-mails in the morning and if they didn’t see a follow up message, not to come.
I got to the hospital around 12:30. I met S’s parents. We hung out for awhile. S. was on the monitors and was having pressure waves here and there. Nothing super regular and she didn’t have to relax through them. Her parents went to get lunch. K. was her nurse and was great! Her parents came back an hour or so later and still not much was happening. We had been thinking the OB would be coming by, but she was seeing patients. So we figured she would end up there around 5 or 6. Her parents headed home and we continued to relax and just hang out.
S. and her DH were excited about the baby coming in the next day or so. (They were realistic that it could take 24 hours or longer.) I asked what she wanted to do if she was checked and was still 4cm. I reminded her she could choose to go home, since it would show she wasn’t in her active birthing time. I was certain she was not in her active birthing time as she didn’t need to relax through her pressure waves at all and they were not consistent. She said she would probably want her water broken, but if she was 6 or more cm she would refuse AROM and keep on doing what she was doing.
Dr. T. came around 6:15 and checked. She had the amniohook ready and didn’t appear to plan on asking if she could break her water. I spoke up and said, “It looks like the Doctor is planning on breaking your water.” S. said she wanted to know where she was at first. Dr. T checked and said she was 4.5cm and very stretchy. S said you can break my water. Dr. T did and then waited for quite a few minutes with her hand inside waiting for a pressure wave so she could see how the pressure wave felt against the cervix. (I had never seen an OB do this before.) S never had a pressure wave in those few minutes with the OB’s hand up there. Finally Dr. T. gave up on a pressure wave starting, removed her hand and left soon after.
S. rolled to her side, put on Deepening and within minutes was having pressure waves. I told her to let me know if she needed anything. Within a few minutes she said she needed more. So I was next to her, doing the relax cue and mini scripts through each pressure wave. The monitor wasn’t picking them up, so I had her DH help time some of them. I only knew she was having one when she started saying “peace” (a post hypnotic cue that helps direct her natural anesthesia right where she needs it.) She stayed nice and relaxed through them. They were coming every 4-5 minutes and lasting about a minute. I was worried the nurse may come in and want to add pitocin or something, since the monitors were not showing anything. But it was apparent she didn’t need that!
S. said they were very intense, but she was relaxing beautifully through each of them. The new nurse M. came in around 7 to introduce herself. She was really supportive of S’s birth plan. I told her the spacing of the pressure waves. S had a few while the nurse was in there. M. took off the monitors and left.
At 7:15 S. went to the bathroom. She had quite a few pressure waves on the toilet. Then she came out and sat on the ball. She mentioned some pressure in her bottom. Her mom came back around now with the cord for the MP3 player, so we could charge it. She came up and asked S. how she was doing. S. said, “It is intense!” then turned right back off and relaxed. I told her mom that I thought the baby would be here in an hour or so.
The nursery staff came in and introduced themselves. I felt like this was distracting a bit to S, but they patiently waited until after a pressure wave and then were quick and quiet and S was able to relax quickly again. Her mom went out into hall to wait.
S wanted to get onto the bed. So her DH and I helped her up. She was still doing great, but said she was feeling a lot of pressure in her bottom and a little pushy. I asked if she wanted the nurse to come in and check her. She said yes. So we called the nurse in. This was around 8 PM. She was checked and was almost complete. (9.5cm)
They called for the OB and S. was starting to have an overwhelming urge to push. The nurse said, “Don’t push.” I whispered, “Just follow your body. Breathe your baby down and out.” So S just went with what she was feeling, gently breathing out and down, rather than fighting that urge.
A different OB came into the room while they were getting things set up. I let S. know an OB was there and she could do whatever she wanted to. The nurse kept saying don’t push, but S. was doing great, gently pushing the baby out.
When Dr. T got there about 8:15, the tone changed. Now even though she was told NOT to push for the last 15 minutes, now she HAD to push. The nurse instructed S. to hold her breath and they counted. I tried to remind them that she is doing mother directed pushing. They ignore me. I whisper in S’s ear to follow her body, do what feels right. It is hard to ignore their directions/yelling and she purple pushes.
She pushed with a lot of force and F. was born about 15 minutes later at 8:33. He was 7 pounds 9 ounces. S. had a lot of tearing, maybe because of all the purple pushing? So Dr. T. was working until 9:15 repairing.
I wish that they had let her take her time pushing. It is frustrating when they tell mom don’t push, don’t push. Then when the OB gets there, they want her to hurry and push the baby out! Why not let her push in her own way? If she isn’t making progress or baby is in distress I can see why they would want to help direct her. But she was making slow progress and baby was fine.
Overall it was a fast, easy and good birth. S. was happy with how it went, though she wasn’t “comfortable” due to the intensity of the pressure waves, she was in control and relaxed. I can only assume that had she stayed home instead of going in and having her water broken she would have stayed comfortable and slowly progressed and gone into her birthing time on her own in the next few days.
As it was her birthing time went full gangbuster when her water broke and she went from 4 cm to baby in her arms in about 2 hours.
Kinda crummy that they had her go in when she wasn’t even in full labor, but at least it worked out that she had the baby the same day!
Interesting that they would yell to either push or not push. I understand them saying not to push if the baby has the cord wrapped around it’s neck and they need to fix that before pushing more, but other than that, why do they direct the pushing?
Directed pushing… I try to always tell my doula patients that this is what they do in the hospital, and it is very hard to not listen to it. It is very frustrating to see it happen over and over again.
My ‘favorite’ doula moment, is when a nurse kept telling the mom that she had to breath better. The mom was doing the long low moaning sounds, and I kept thinking, “she is breathing.” I had no idea what the nurse wanted her to do, so happily we ignored her
I am don’t know if I can say much as I haven’t had a baby myself but I am so irritated when I hear of doctors doing this. I am hearing impaired and I realized that it might serve me well to turn my hearing off when medical staff start telling me what to do.
I can understand the nurse telling her not to push if she was not fully dilated. 9.5 is not fully dilated. I once had a woman push with a rim left of cervix. I did the listen to your body thing. And the cervix swelled up pretty bad. This was a bad thing since the poor woman had no epidural so she wanted to push. I then was told to apply ice to her cervix and put her in trendelenburg. It worked. But I should have waited for her to become fully dilated. I caused her problem by not having enough experience at the time and “trusting birth.” I have not repeated this preformance since.
I usually start out with Mother directed pushing. But with many multips that does not work. I used to only do mother directed pushing. But then I had mothers who got exhausted way before the main event. If the baby can passively descend, the mother can save her energy for the big event. If a mother gets exhausted, she may need an epidural or a C-section. So better not to push before it is time.
I am so glad that she did not end up with pitocin! (I can attest to the fact that that happens a lot) Thanks for letting me know about this story. As a doula (and as a nurse for me) I know just what you mean about trying to provide your client with info, help her speak up for herself but not seem like you are trying to push you own agenda an in the end, facillitate the patient making her own decision. It is a delicate dance! I am happy all was well for mom and baby but I am left wondering mysef if they had let her do mother directed pushing. It is SO FRUSTRATING as a nurse to hear residents and docs telling people to “not push” if they are fully dilated or close to it. And you are right, one the provider gets there it is too often “PUSH! PUSH! PUSH!” if the baby isnt in distress and mom is pushing effectively in her own way, there is NO NEED TO INTERVENE!! On another note, I am hearing more and more about these hypnobirthing programs and I want to learn more!
Hypnosis for childbirth is really great! I may be a bit biased because I have used Hypnobabies and teach it. But I also get the chance to hear moms wonderful birth stories and when I am their doulas, I get to SEE their births too! It is so wonderful to see moms unmedicated and comfortable! A great link for more information for birth professionals is http://www.socalhypnobabies.com/PromoBookletGENERIC.pdf
The OB that came in between the first nurse checking and the hired OB arriving rechecked her and said she was fully dilated right after they called the OB, the baby was still high. She also wasn’t PUSHING hard at any of these points. I can see that pushing hard core (purple pushing) against a completely dilated cervix could cause swelling. But I would think if mom was following her body and gently pushing it would help it dilate the rest. At this point when they were telling the mom not to push, she was just grunting at the top of her pressure waves.
I could see if mom was pushing for a LONG time and not making progress that certainly then directing the pushing would be a better way to go, then mom running out of energy. Also moms with epidurals often need that direction, I know I did, because I couldn’t feel what I was doing. But this mom wasn’t even given a chance to do mother directed pushing. Except for the 15 min while wating for the OB. When she was trying not to push. If the baby and mom are fine, why not let mom do directed pushing for 30 minutes and see if she is making progress? I can understand if baby or mom is not tolerating it well, or progress is not being made, that then a change of plan would be in order.
So how exactly is mom-directed pushing different from “purple pushing”? It’d be wonderful to hear a post all about that specific topic if you ever have time. I’m having baby #3 in October and interested in birthing differently this time around (had epidurals and Pitocin with my other births, birthed on my back, basically tied to the bed with IV and blood pressure cuff, etc.).
I am going to work on a pushing post right now!
I had that happen to me, first they said don’t push (I didn’t listen) and then I had a whole room full of people yelling PUSH PUSH PUSH! If I hadn’t been so focused on giving birth to my baby, I would have yelled at them all to SHUT UP I AM PUSHING!