I recently published the evidence about pushing positions during birth (click here to read the article). The take-home point of the research evidence was that women should push in whatever position feels comfortable to them— there is no need to stay continuously upright or continuously lying down during the pushing phase. Today, Krista, one of my readers, shares her testimonial on how she followed this evidence-based practice with each of her three childbirth experiences. Her first-hand account helps bring evidence based birth to life!
My name is Krista and I currently live in Key West, Florida.
My daughter, Madeline, was my first baby and was born in a military hospital at Fort Lewis, Washington. I pushed in almost every position you can imagine. When the initial urge hit me I was standing next to the bed. The nurse had raised it so that it was more comfortable to rest my chest on the mattress as I breathed through contractions. I was pretty comfortable standing, but both the labor and delivery nurse and my midwife suggested that I get into the bed so that my legs did not get too tired. They raised the head of the bed so that I could kneel and kind of hang over the end. This was comfortable for awhile, but kneeling actually made my legs hurt more than standing. I pushed on my side for awhile before kneeling again and then lying down on my back.
I preferred standing and leaning on the bed. After a lot of pushing I ended up giving birth flat on my back with an episiotomy. My care providers, both the labor nurse and my midwife, were very supportive of me pushing in upright positions. They were open to any position I felt comfortable in and were helpful in suggesting positions that might move things along or alleviate some of the pain. In the end I was flat on my back because we had tried almost everything else and I was exhausted. At that point it was the most comfortable position for me.
My second baby, Houston, was born in the same hospital as my first. When I was pregnant with him I learned that the tub for laboring was now also a tub for laboring and birthing. The episiotomy I had with my first had extended to a fourth degree laceration and I was determined to avoid another tear, so I knew I wanted to try for a water birth. I pushed in an upright position while sitting in the tub. I pushed for a very short time, so I never really adjusted my position.
My midwife was extremely supportive and entirely hands off. She never asked me to switch positions and even advised the labor nurse to skip a heart rate check because getting a good read with the doppler would have meant me shifting and adjusting my position. It was my second baby, so I knew what to expect and had the confidence to do what felt right. My midwife sensed that and never intervened until my son was pulled out of the water. I cannot say enough about the benefits of laboring and birthing in a tub of warm water and would suggest that any woman desiring an intervention free birth and who has it as an option take advantage.
Benjamin is my third and was just born in July 2012 at a private hospital in Key West, Florida. My research indicated that this hospital did not support upright pushing positions, and that they used constant monitoring and other policies not based on evidence. I was afraid these policies might inhibit my ability to birth my baby vaginally and without pain medication. I arrived at the hospital fully dilated and ready to push. I was lying down in the bed for initial monitoring and that’s where I stayed. I had hired a doula for this birth, and between her and my nurse I could have switched positions and been more upright. I started to sit up, intending to squat on the bed, but it was actually more painful. I was having a lot of back pain, but for some reason the angle I was in on the bed made lying down more comfortable. I rolled onto my left side when I heard the monitor slow down. By switching to my side, I hoped to get his heart rate to pick up and avoid too much premature concern about his well being. It worked and that’s where I stayed. I pushed him out about an hour after I arrived.
The best advice I can give a woman about pushing positions is to really do what YOU feel is comfortable. When I was given the suggestion during my first birth to get in the bed and kneel rather than stand I went against my gut and got in the bed. I didn’t feel too tired to stand, but this was my first baby and I figured the nurses had to know something that I didn’t. Unless someone is advising you to adjust your position because there is a problem, trust your instincts. Even if you’ve never had a baby before you know more about how to do it than you realize.
All of my births, the last one in particular, have taught me that you never know exactly what is going to work and be most comfortable. In addition to trusting their instincts, I would advise women to avoid getting too wed to the idea of pushing in a particular position. Before I labored with my first baby I thought for sure that I would push from a squatting position. Ultimately squatting was never a position that I really felt comfortable with. With my third I was very concerned with not letting anyone dictate my position and I had prepared myself to avoid lying down in the bed at all costs. Imagine how surprised I was when lying down on my back/side was more comfortable that being upright.
Set yourself up for success and choose a supportive environment for your birth. Do not consent to interventions that might inhibit your movement when it is time to push. You might be moving around a lot and switching positions, so you want to maintain the ability to move about freely.
Thank you, Krista, for sharing your testimonial on Evidence Based Birth! Readers, what do you think? How many of you had care providers who actively encouraged you to push in whatever position you felt most comfortable?