Directed Pushing
Though it is not technically an “intervention” in that something is done to you, we list directed pushing here because it is an unnecessary intrusion in the birth process. Being forced to push in a certain way and certain positions can results in loss of control, extra pain, and can contribute to tearing.
Almost all television portrayals of women giving birth show a woman flat on her back with her legs in stirrups. She’s surrounded by several nurses and perhaps her partner, all counting loudly “1, 2, 3 … 10″ as a way of instructing her how to push. They warn her to “pant, pant” when she shouldn’t be pushing.
This intervention into the 2nd stage of labor is generally unnecessary – when you are fully dilated after a natural labor, your body will begin to push on its own. The urge will be undeniable. Pushing contractions are generally spaced out more than dilation contractions. You get a nice rest in between each one.
Many care providers try to rush this stage along by shouting at a woman to push forcefully and continuously. They give episiotomies to encourage the baby to come faster and in come cases resort to assisted delivery with forceps or vacuum extraction.
They may also use these invasive procedures when a woman cannot effectively push – usually because she is flat on her back and strapped into stirrups. There are far more effective positions to give birth in – kneeling, on all fours, leaning forward on a bed or in water.
Active 3rd Stage Management
The third stage is the final stage of birth. Your baby has already been born and is in your arms. Now you must deliver your baby’s placenta.
Most of the time the placenta will come within an hour or so after birth, and all on its own. The birthing of the placenta is much easier than the baby – it has no bones and pretty much just slides out.
Some caregivers try to “actively” manage this stage of birth by giving the mother an artificial hormone injection in her leg and then pulling on the cord and pushing on the woman’s abdomen. Their reasoning behind this is to prevent bleeding and to allow the uterus to contract so that the placenta will release. You can aid this on your own by allowing your baby to suckle at the breast, which will allow your body to release the hormone necessary to contract the uterus. Allowing the placenta to detach from the uterus on its own will also prevent any bits of the placenta left behind in the uterus, which can cause excess bleeding.
A perceptive midwife or doctor can watch the cord and notice signs that the placenta has detached. Often if the mother moves into a supported squat the placenta will easily be born.
Pulling on the cord and rushing the mother along can lead to complications and it can also rob the mother and child of their first few moments together.
