Hi Tania
Quite a reasonable question to ask and one which i have also asked. You will no doubt get plenty of feedback on this question not all the same either but here is mine....
I go by my own anecdotal evidence
If a woman is wanting to push, then encourage her to do what her body is telling her. If it is a multi you are sure to see some head on view within half an hour or so or at least some positive signs e.g. rupture of membranes, more "show". If it is a primip, you might like to check that the head is well down on abdominal palpation as it would be highly unlikely (I haven't seen it) that a primip is fully dilated and ready to push with a high head (correct me if I am wrong anyone). I have found that most of the time you will see some progress/second stage signs with this method. I guess the only thing that we are taught to "worry" about is a woman pushing on a cervix that is not fully dilated and causing oedema and hence slowing down the process and risking cervical tear. That is the only reason I would put a time limit on it at all but 9 times out of ten you will soon see progress including head on view. I think the risk of cervical tears/oedema is only applicable in instances where the woman is "coached" into the old "hold your breath and push" type pushing and not in the more natural self directed pushing sensation/actions that come naturally.
It is only after all of the above that I would consider doing a vaginal examination but the need for this is rare....
Keep questioning
Helen Cahill
P.S. I get really annoyed at the old "don't let her push until you have checked that she is fully dilated" argument which is still alive and well in hospital settings today!!!!!
----- Original Message ----- From: "Tania & Laurie" <[EMAIL PROTECTED]>
To: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]>
Sent: Wednesday, October 27, 2004 12:11 PM
Subject: [ozmidwifery] 2nd Stage of Labour
Hi all!
I'm a BMid student at UniSA and about to move into the 'independent' phase
of assisting women with birth. I have a question about 2nd stage, which I'm
hoping is not too ridiculous!
If you are with a woman who says she wants/needs to push, but you are not certain about dilatation as no VE has been performed (either because it's part of your practice, maternal request .....) what do you do?
I recently worked with midwife who performed a VE and determined dilatation
to be at about 6cm. Within about 15-30 mins the woman (a multi) expressed a
need to push. The midwife encouraged her to breathe through that urge and
not to push 'just yet'. This went on for about 20 minutes until finally we
were able to see some HOV, then it was 'go for it'.
So, I guess what I'm really asking is - do you allow women to go with their
bodies and what they are feeling (which would be my instinct, rightly or
wrongly who knows!) or wait for external signs that pushing 'ok'?
Cheers Tania
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