After 30 years of assisting mothers in labor at home and in the hospital, I
have found some techniques that help empower mothers when they are pushing. In
the beginning and at the time of birthing it is very relaxing and easy for
some mothers to be on their side. If side-lying pushing does not seem to bring
progress, then an upright position, preferably a standing squat or kneeling
squat, can work well. Birth in a squatting position seems to encourage rapid
expulsion and tearing, so I ask mothers to lean back in a semi-recline for the
actual birth. I do use gentle perineal support, usually with a warm cloth and
oil as needed.
But when different positions have been tried and the fetal head is unable
to come under the pubic arch, I encourage the mother to lie flat on her back
with just a pillow under her head. I help her bring her legs up with the soles
of her feet together. I wrap a towel around her feet and have her grasp the
ends of the towel and pull as she pushes. This motion brings her legs back and
the position causes a widening of the outlet, even more than squatting. The
mother's elbows should be out and one should resist the urge to raise her
upper body because this action seems to make the push less effective. Coaching
the mother to "push the baby down and then up to the ceiling" seems to help as
well.
This position has saved many of my mothers from a c-section. I try to
suggest it after the mother has tried any positions she prefers and before she
becomes exhausted. I explain that, while it may seem to be a strange position,
it may shorten the time needed to push the baby out. At the time of serious
crowning, the towel can be abandoned and the mother may assume any position
desired.
It makes me sad when I see current writings that caution women to refrain
from lying on their backs at any time during labor. We all know why women are
told this, but we also know there are exceptions to everything. By the way,
this position works with or without regional anesthesia, for those practicing
in hospital settings where anesthesia is common.
� Mary Jo Terrill, RN, BSN,
MSW
Santa Barbara, California
