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
