? about the "traditional" hospital pushing position...

Manderlin923 · December 2010

I've heard squatting can open up the pelvis by 25% and any position that enlists gravity is best for mom/baby. I am not saying that they are the best for every woman (in fact, I pushed in side-lying position) but I'm wondering why more providers do not offer more positions if a woman is able (not had an epi so can move around) instead of the traditional semi-seated pose. Are some just not educated on the benefits? Do they know and just not care?

I know there are plenty of great OBs & CNMs who are supportive of trying new things and/or giving the mom plenty of freedom during labor (and some not so good CMs, too) It just seems to me every woman I've known that's given birth in a hospital (even the ones who didn't have epidurals/other pain meds) had to push in the knees up, semi-seated pose. I know, obviously, it's best for the provider to "catch" the baby. But why, if a woman is having a particularily hard time pushing does it seem that some providers don't suggest another position?

What are your thoughts? Have you tried different positions during a hospital birth and if so- who suggested them? A doula? Your doc? Or did you just go ahead and do your own thing?

heidihurd · December 2010

Prior to educating myself on my birthplan options, I had imagined going to the hospital and and lying in bed and pushing in the standard position... Then I was given the documentary "The Business of Being Born." I had no idea what I didn't know because of what we are exposed to here in the US. Other then making it easier on the doctors and nursing staff, my guess is that for the most part in the hospital women are hooked up to something! Meds or not, aren't women in the hospital hooked up to fetal heartrate monitors and maybe IV's for hydration? I love that families are becoming aware of their options as labor and delivery is NOT necessarily a medical condition.

I wouldn't trade my midwife, birthing center experience for anything! Should there have been an emergency, I was only 2 minutes away from the emergency room and the on call OBGYN the midwife has on staff. Since I knew I didn't want to do meds of any kind, I appreciated the freedom to move around and get in and out of the water. I believe that the movement and changing of positions helped me to have a fairly quick first time active labor period.... just about 3 hours.

My advice to women that do want to be in the hospital is to know what birthplan you want and most importantly find a doctor that absolutely supports YOUR plan! Other thoughts would be to have a midwife or doula present to help you and/or your partner be your advocate of your birthplan so you have the experience that you had hoped for.

KateLouise · December 2010

I birthed in a hospital. I was very active through labour, used the shower and the hot tub.

I started pushing in the hot tub (lying on my back) then my midwife wanted me out of the hot tub for better access as LO would come out a fraction and then slip back up.

She had me get on my back on the bed too.

So I guess she did this because she was concerned about baby and wanted to be able to see what was going on. In all honesty, however, I cannot imagine pushing in any other position.

Going into it, I was pretty gung-ho to push while squatting, but in the moment it simply never occurred to me, lying on my back felt really comfortable.

In hindsight the problem with baby slipping back up was me holding back form pushing. I was scared of tearing from one end to the other and so I'd push and then pull back.

LO was born after 1 hr and 20minutes pushing with no assistance needed.

desmerelda317 · December 2010

I don't know if it is a "doctor unwilling to allow other positions" thing or a "mother just doesn't know she has other options" thing. If I hadn't taken a natural childbirth class (we did Bradley) then I wouldn't have even known I had other choices. But, if the mom seems to be happy in that position, great! The classic "C" position (I think that is what Bradley calls it, if I remember correctly), isn't a bad position to push in. It is the lithotomy (completely flat on back with feet up in stirrups) that is an issue. Lithotomy was never even an option at my hospital with DS. I started in the "C" position and didn't like it so I got up and moved to all fours where I was comfortable; I didn't ask, I just did it. My provider had no issue with it, and if she had I wouldn't have cared - at that point it wasn't about her. And either way, I was on the table and my butt was in her face, it wasn't like it was an inconvenient way to push for her - she could still sit comfortably and catch when it was necessary lol. Squatting wasn't an option for me because I felt so much of my labor in my legs that they just weren't strong enough to support my body during contractions, even though they gave me a squat bar to hold onto, my legs were still too weak.

~adamwife~ · December 2010

My CNM had me lying on my sides to push with my first. He was posterior and I was having a really hard time pushing him out. After nearly two hours of side-lying I wanted to flip to my back to push and he was out shortly after. I also found pushing on my back to be the most comfortable with #2 (who thankfully only required 2 pushes).

plainjanie1 · December 2010

We had a hospital birth. I was very specific about NOT doing the traditional hospital pushing position and needed to have a doula to support me pushing in a different position because the OB wouldn't do it. I delivered our daughter laying on my left side. I would have prefered to squat, but they wanted me to stay on the bed...

JoelsGirl07 · December 2010

Lithotomy (pelvic exam pose) was invented for the doctor to have easy access - it also makes it very convenient for them to do their interventions. If you look at historical drawings of birth prior to the 19th/20th century you won't find a lot of women in that position (but you also won't find a lot of doctors!). You may find them reclining, supported squatting, side lying, hands and knees....but rarely will you find one flat on her back. It pushes your tailbone in instead of making it flexible, and it is gravity-neutral if not antigravity. The only thing worse would be hanging by your ankles.

iris427 · December 2010

Because that's just the way it's done. Why don't they let you eat food in labor? Why do they insist on continuous monitoring for low risk mothers? Why do they make you hold your breath for a count of 10 when you push? Hospitals are institutions; they have red tape and rules and they have routines and people become set in their ways about those routines, even when there is a better solution. If you try to make sense of it, you'll go nuts!

skyejo · December 2010

iris427:
Because that's just the way it's done. Why don't they let you eat food in labor? Why do they insist on continuous monitoring for low risk mothers? Why do they make you hold your breath for a count of 10 when you push? Hospitals are institutions; they have red tape and rules and they have routines and people become set in their ways about those routines, even when there is a better solution. If you try to make sense of it, you'll go nuts!

It definitely depends a lot on the provider you have within that hospital. I had a MW and was permitted to eat during labor, had intermittent monitoring, no IV, had baby on my body for 3+ hours after delivery, etc. Birthing in the hospital wasn't a detriment at all for me, thankfully! I had a detailed birth plan so I wonder if that helped at all.

OP, I had a really hard time pushing since it was so painful. My MW let me push in whatever position I wanted, which was on my hands and knees, but I switched to my back when I couldn't hold my body up any longer and that's how Parker came out. For me, no position felt "good" at that moment.

emberlee3 · December 2010

I had a hospital birth. I was told that since I had no epi/meds, I could be in whatever position I wanted--for intermittent monitoring, cervix checks, pushing, and delivery. Side-lying was most comfortable for me. This was at a teaching hospital with a big midwifery practice, but I had an OB.

monkeyqueen · December 2010

With all three of my births, the nurses and Dr. guided me in different labouring and pushing positions. They are excellent there and very skilled in labour coaching (they don't push pain meds, at all). I ate during labour, had intermitten monitoring, no IV, breastfed right within minutes of baby being delivered, etc. It really depends on the hospital.

Mrs.Handy · December 2010

My MW was all about different positions. She wanted me to push on the toilet and I did for a little bit, but it was difficult. But honestly, I was exhausted (it was the middle of the night) and the most 'comfortable' was laying on my back or side-lying position.

Manderlin923 · December 2010

iris427:
Because that's just the way it's done. Why don't they let you eat food in labor? Why do they insist on continuous monitoring for low risk mothers? Why do they make you hold your breath for a count of 10 when you push? Hospitals are institutions; they have red tape and rules and they have routines and people become set in their ways about those routines, even when there is a better solution. If you try to make sense of it, you'll go nuts!

That's true, lol. I was mainly just curious what other women have done.

Totally laughing over hanging by the ankles thing, btw...

Thanks for the info ladies- I did hear the C shape was the worst because it creates a curve to the tailbone that makes it harder for the baby to get up and over....I could definitely be wrong though

eminen · December 2010

My hospital encourages squatting. They have a squat bar, showers, tubs and birthing balls in every room. I didn't have to search this hospital out or anything either it is my local Detroit Medical Center hospital. Although I believe I lucked out, it also seems as though this is a reoccurring theme.

nosoup4u · December 2010

Manderlin923:
Thanks for the info ladies- I did hear the C shape was the worst because it creates a curve to the tailbone that makes it harder for the baby to get up and over....I could definitely be wrong though

My doula told me this as well - she was trying to get me to do side-lying when I was pushing with DS2, but I was too out of it/exhausted to move. I tried squatting with both labors, and hands-and-knees briefly also, but I think I just get too tired when it's time to push to *want* to be in a more active position. Though side-lying would have been good, in retrospect.

Lina1030 · December 2010

I was most comfortable on my back in the bed inclined and remember swaying mylegs side to side in btwn pushes...I also did not want my legs being held up for some reason....my doula had suggested being on all fours leaning over the head of the bed and I did not like it at all! I labored on my side during contractions...my labor was so fast (about an hour) so I did not move around at all. It worked out great!

Lina1030 · December 2010

Lina1030:
I was most comfortable on my back in the bed inclined and remember swaying mylegs side to side in btwn pushes...I also did not want my legs being held up for some reason....my doula had suggested being on all fours leaning over the head of the bed and I did not like it at all! I labored on my side during contractions...my labor was so fast (about an hour) so I did not move around at all. It worked out great!

I also pushed on my own, not instructed by the nurse/OB....I breathed my baby down (hypnobirthing method) and just listened to my body....our son was born in 2 pushes...within a few short minutes!

Mrs.Greeko · December 2010

I pushed in the traditional hospital position with my first despite not wanting too and being told when I was pregnant that I could deliver in any position I wanted.

I spoke to my OB about this in depth about six months after my DD1 was born. She basically said that 99% of the moms have the epidural so they can't really move anyway. And then she went on to say she's only delivered one baby not in the position and it was a drugged out crack addict who refused to lie down. So I asked her if I would have to physically refuse and fight to deliver any other way. She told me yes.

So I got my records transferred to a birth center.

I think they are generally taught that that is how babies are delivered and it is more comfortable for them so that is what they do.

Manderlin923 · December 2010

Lina1030:
Lina1030:

I was most comfortable on my back in the bed inclined and remember swaying mylegs side to side in btwn pushes...I also did not want my legs being held up for some reason....my doula had suggested being on all fours leaning over the head of the bed and I did not like it at all! I labored on my side during contractions...my labor was so fast (about an hour) so I did not move around at all. It worked out great!

I also pushed on my own, not instructed by the nurse/OB....I breathed my baby down (hypnobirthing method) and just listened to my body....our son was born in 2 pushes...within a few short minutes!

Wow, I'm jealous...I pushed for an hour and a half. I am doing hypnobirthing this time around though not sue if I'll take the class or do the home study course.

TwoSkis · December 2010

Just a lurker adding my two cents...

I had an epidural, and will again for my next birth. But even then, my nurse was very creative with my pushing positions. She did bring out the squat bar, and as long as she or DH was able to position my legs correctly for me, I was still able to hold myself up. She also had propped my feet on the bar itself to use as a brace (at which point the doctor walked in, and complained that that position would do nothing for me, and to lie down in the traditional way. As soon as he walked out, the nurse put my feet right back up on the bar saying I had been making far better progress that way.) We used other positions as well, including pulling on a sheet and side lying.

Just wanted to say that just because you have an epidural, doesn't mean you can't still get creative with how to get your baby out. Big Smile And, IMO, a good nurse should be able to work with that.

Lina1030 · December 2010

Manderlin923:
Lina1030:
Lina1030:

I was most comfortable on my back in the bed inclined and remember swaying mylegs side to side in btwn pushes...I also did not want my legs being held up for some reason....my doula had suggested being on all fours leaning over the head of the bed and I did not like it at all! I labored on my side during contractions...my labor was so fast (about an hour) so I did not move around at all. It worked out great!
I also pushed on my own, not instructed by the nurse/OB....I breathed my baby down (hypnobirthing method) and just listened to my body....our son was born in 2 pushes...within a few short minutes!
Wow, I'm jealous...I pushed for an hour and a half. I am doing hypnobirthing this time around though not sue if I'll take the class or do the home study course.

Aww...I wish you a fast, peaceful birthing day for your baby. I actually just watched the video...it was 1 minute of pushing as the baby was crowning....once the head came out 15 seconds later I pushed again and he was born! Mentally prepare yourself and visualize a peaceful, natural birth as your body was made to do..SOOO EMPOWERING! It's my holiday wish to you and all the mama's here!

Manderlin923 · December 2010

TwoSkis:

Just a lurker adding my two cents...

I had an epidural, and will again for my next birth. But even then, my nurse was very creative with my pushing positions. She did bring out the squat bar, and as long as she or DH was able to position my legs correctly for me, I was still able to hold myself up. She also had propped my feet on the bar itself to use as a brace (at which point the doctor walked in, and complained that that position would do nothing for me, and to lie down in the traditional way. As soon as he walked out, the nurse put my feet right back up on the bar saying I had been making far better progress that way.) We used other positions as well, including pulling on a sheet and side lying.

Just wanted to say that just because you have an epidural, doesn't mean you can't still get creative with how to get your baby out. And, IMO, a good nurse should be able to work with that.

That's really interesting- thanks for sharing. Did you have a "walking" epidural?

armybride6510 · December 2010

I haven't delivered yet, but I am taking my birthing class through the hospital I will be delivering at and they really recommend alternate positions and not laying on your back as much as possible. So I really think it depends.

TwoSkis · December 2010

Manderlin923:
TwoSkis:

Just a lurker adding my two cents...

I had an epidural, and will again for my next birth. But even then, my nurse was very creative with my pushing positions. She did bring out the squat bar, and as long as she or DH was able to position my legs correctly for me, I was still able to hold myself up. She also had propped my feet on the bar itself to use as a brace (at which point the doctor walked in, and complained that that position would do nothing for me, and to lie down in the traditional way. As soon as he walked out, the nurse put my feet right back up on the bar saying I had been making far better progress that way.) We used other positions as well, including pulling on a sheet and side lying.

Just wanted to say that just because you have an epidural, doesn't mean you can't still get creative with how to get your baby out. And, IMO, a good nurse should be able to work with that.

That's really interesting- thanks for sharing. Did you have a "walking" epidural?

No, it was a full epidural- I didn't feel a thing except some tightness at the peak of my contractions. I think part of it was that the anesthesiologist did a great job of killing the pain but not full movement of my legs, and the other part was the nurse and my DH who would put my feet where they needed to be. After they placed my legs in the proper position, I could hold them there myself.

monona9 · December 2010

That's interesting that so many women have babies in so many completely different ways. I had my DD at UCSD's medical center on their birth center floor. I was allowed to eat and I wasn't hooked up to anything. I was in a room with just a queen size bed, tub, rocking chair, ball, birthing stool (to squat), a shower.. and I used it all to labor. My doula was instrumental in helping me b/c DH (and I) were clueless in how to use everything.

When I started pushing I was on the birthing stool with DH behind me in a chair and my arms resting on his thighs. It did feel good to push that way, but also scary b/c the midwife was laying on the ground with a flashlight (lol) to monitor and she had no access.. so we thought better to move it to the bed. It was completely my choice. I did some of it side lying but ended up on my back when DD came out. From my first contraction at home to DD coming out was a total of 43 hours (24 hrs in the hospital), with no intervention and I was exhausted!

After the head came out I grabbed her and assisted the delivery. I carried her up to my chest and she was there for a while. They did a delayed cord clamping. DD stayed on my chest through the delivery of the afterbirth. They didn't take her off of me until they had to weigh her I think.

I had a very positive experience with it all and can't imagine doing it any other way (well maybe not 43 hours part)

bea0422 · December 2010

JoelsGirl07:
Lithotomy (pelvic exam pose) was invented for the doctor to have easy access - it also makes it very convenient for them to do their interventions. If you look at historical drawings of birth prior to the 19th/20th century you won't find a lot of women in that position (but you also won't find a lot of doctors!). You may find them reclining, supported squatting, side lying, hands and knees....but rarely will you find one flat on her back. It pushes your tailbone in instead of making it flexible, and it is gravity-neutral if not antigravity. The only thing worse would be hanging by your ankles.

This! So well written I think your body will know exactly what to do, I really doubt any woman would find lieing flat on her back the most comfortable...reclining still gives your body the aide of gravity. (I am assuming that those who said laying down was most comfortable are talking about a reclined position and not the standard flat back legs in stirrups position) The most important thing is having a practitioner who will support your right to choose the best position for you in the moment

PDXPhotoGrl · December 2010

I can tell you that my sister, a 4th year medical student, was taught during her L&D rotation that the lithotomy is actually the best position for the mother. She got mighty pissy with me when I suggested otherwise. So at least some doctors are insisting on it for good faith, if mistaken, reasons.

lovesazzie · December 2010

It is much easier for the provider to assist, and I think in a lot of cases, that is just how they are trained.. It is just part of that "birth must be managed" mindset IMO.

A friend of mine was transferred to the hospital (from birth center) for a breech birth and was able to attempt a vaginal delivery. That doctor requested that she try hands and knees first, which surprised me!

MegGary · December 2010

I couldn't hold my own legs up let alone sqaut. I had labor shakes so bad that my only option was on my side or back. DH & MW held my legs up when I pushed. I'm sure a lot of times women don't know their options. They blindly go into labor & rely on their doctors & nurses to guide them.

My cousin said to me when I told her I was doing lamaz, "oh the nurses will tell you when to push. no need to take a class on it." Lets just say I'm still glad I took a class. lol

TofuMama7 · December 2010

This is my first baby, so I don't have a story about a previous birth to share, but the hospital I will be delivering at has "birthing bars" on every bed which are used for the squatting position. At the hospital class I asked about positions and was assured that I will be free to move around as much as I want and was encouraged to bring a birthing ball. DH and I are using the Bradley method (as well as some other research), so we will come in with quite a few ideas for positions.