Medicine

Should We Stop Telling Women To Push During Labor?

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We're all familiar with the traditional image of a mother in labor: surrounded by white-clothed nurses and doctors who count to 10 and tell her to push. The scene is so ubiquitous that it's hard to imagine childbirth without it—but what if all our previous notions about pushing during labor were wrong?

Challenging Old Assumptions About "Directed Pushing"

That's what the staff at Medway Maritime Hospital in Kent wondered. After noticing a big rise in perineal tearing in 2013 and 2014, the staff began a program that, over a 12-month period, helped significantly reduce severe tearing during childbirth. Their results were published in the European Journal of Obstetrics and Gynecology and Reproductive Biology.

Their secret? Not asking women to push. 

"Directed pushing," whereby nurses count and encourage mothers to push during the second stage of labor, has long been part of standard obstetrical practice, Today's Parent says. However, the results from the Kent study suggest that a different approach may help prevent tears and other complications. Instead of pushing when nurses tell them to, mothers may be able to rely on their natural instincts to push when the time is right.

What We Still Don't Know

"Spontaneous" pushing has actually been recommended by some midwives and natural birth advocates before, but hasn't been widely used in hospitals. Now, however, many doctors are coming around: obstetrician Lawrence Oppenheimer told Today's Parent that "I've always felt that everybody yelling at the mom and telling her when to push might not be the best idea."

But we still have more to learn before the old ways are completely gone. For example, women who have epidurals may not be able to rely on their body's natural inclinations to push, given their reduced sensation. And, as of right now, we still don't have much evidence about the "best" way to deliver a baby. Still, the new study raises interesting questions, and suggests that in the next few years, our old images of childbirth may be replaced by some new, hopefully safer ones.

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