Unintended Consequences

As I was reflecting on how to get better understanding of pregnancy, birth, and long term outcomes out to the public when my data would compete against millions of others passionate thought, opinion and experience …I was trying to figure out why a pregnant woman would believe me rather than her doctor, doula or Childbirth Educator I realized the way is to show people self evident facts that make things (seemingly unrelated data) line up and become demonstrable, self evident, provable and not shakable…That my friends I what I am looking for and it is truth. So here goes one of the MOST vicious pieces of information, but pregnant women, nurses, midwives doulas and doctors need to hear it ! The worst thing we can do to a baby is prolong the pushing stage of labor..Iknow,Iknow there are at LEAST 5 medical studies which “prove” you can “labor women down” ..That means leave the baby in the birth canal for hours and just let the uterine contractions expel the baby with out the mother pushing. This s is preached by every nurse because it allows any patient with an epidural to be left alone while she is completely dilated for hours. The doctor can see his or her other patients and come at the last minute to “catch” the baby while the mother says “it was great, I just pushed twice and the baby came out”. a lay midwives and doula group heavily promote this . BUT It initiates every form of fetal stress on the baby for (in some cases MANY hours.) First the nature of a second stage contractions (pushing) is that the pressure on the baby in pounds of pressure per square inch is twice that of active labor by actual measurement of displaced water pressure.IE 60lbs. vs. 120 lbs of pressure per square inch or greater . This squeezes the baby, head, mashes the umbilical cord in some babies and decreases the blood flow to placenta and therefore to baby.The nature of a second stage uterine contraction is that it peaks very fast and holds that amount of pressure for a longer time than earlier contractions which is necessary to expel the baby. This causes the baby to start a complex biological process to change the way he acquires oxygen to a drive to breath via the lungs. The lower oxygen in the baby’s body also makes him or her more venerable to infection. We call this the triple insult. It is a biological event that happens with every birth but when it is prolonged and the aggravated with the lowered maternal blood pressure caused by epidurals it changes how the fetus copes with low oxygen and INCREASES risk for mid brain injury. More on that and what to do with my next post. Tonya Brooks

Research Scientist, Midwife, Mother

3 thoughts on “Unintended Consequences

  1. Tonya, for the unmedicated birth, do you think the complications hold true for spontaneous pushing vs directed pushing. In other words, should the naturally laboring woman be allowed to follow her own body’s urges or will that cause an undesirable delay in the second stage? Thanks for your write up. I look forward to more!!

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    • Good question! Spontaneous pushing is usually best but in about 20% of labors women will not have any pushing urge at all . This usually occurs when the fetus has to turn to descend and deliver. This is when big maternal effort that isn’t instinctual pushing has to occur or labor will simply hang up , uterine contractions may slow or stop. I would say a good rule would be if the fetus is descending despite much effort leave Mom to her own instincts, if not see if correct positioning of Mom’s body will improve pushing urge and descent. If all this fails and second stage is slowing ,encourage resting usually lateral positions work best the restart pushing. THIS CAN NOT BE DONE WITH VBACS because the lower segment continue to thin out and small but real risk of rupture is increased. In all prolonged second stages baby is at increased risk for aspiration, TMJ problems,thus nursing and latch on and increased risk of infection.These risk are light but they are very real.

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    • I think most women have very strong pushing urges about 80% of the time and don’t really need help or encouragement to push. But in about 20% of labors babies descend posterior (head facing mothers front) and that group have no pushing urge or it hurts to push and they may need some direction.

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