WEBVTT - Four Tips To Help You Push Your Baby Out 0:00:00.080 --> 0:00:03.560 The information in this podcast is provided for education and 0:00:03.600 --> 0:00:07.560 research information only. It is not a substitute for professional 0:00:07.600 --> 0:00:08.280 health advice. 0:00:12.240 --> 0:00:15.320 Welcome to the Kick your Expert led podcast, helping you 0:00:15.400 --> 0:00:19.800 explore and learn everything about getting pregnancy, birth, and becoming 0:00:19.840 --> 0:00:20.240 a parent. 0:00:20.560 --> 0:00:24.280 On the podcast and our online pregnancy program grow My Baby, 0:00:24.520 --> 0:00:27.440 we share my experience of helping more than four thousand 0:00:27.520 --> 0:00:28.080 babies to. 0:00:28.040 --> 0:00:30.760 Be born and our experience of running a women's health 0:00:30.760 --> 0:00:32.479 clinic and parenting for boys. 0:00:32.720 --> 0:00:35.680 We're here to help everyone to feel empowered in pregnancy 0:00:35.840 --> 0:00:38.680 and birth with real life, practical information. 0:00:41.960 --> 0:00:44.080 Welcome everyone. I'm Bridgid Maloney and. 0:00:44.040 --> 0:00:46.520 I'm obstetrician doctor Patrick Maloney. 0:00:46.080 --> 0:00:48.480 And welcome back to all our listeners. Thanks for joining 0:00:48.560 --> 0:00:50.960 us again, and also thank you to all our new listeners. 0:00:51.120 --> 0:00:53.080 Welcome aboard, Welcome aboard everybody. 0:00:53.360 --> 0:00:55.920 The best way if you're enjoying our podcast is to 0:00:56.520 --> 0:00:58.360 share it with a friend. Then you can talk about 0:00:58.400 --> 0:00:58.760 it together. 0:00:58.960 --> 0:01:02.880 Absolutely, that's how it gets around. Yeah, like all pregnancy stuff, 0:01:02.960 --> 0:01:03.520 word of mouth. 0:01:03.600 --> 0:01:05.240 Oh my god, it's so word of mouth, isn't it. 0:01:05.240 --> 0:01:08.360 We know that people choose their care providers, their hospitals, 0:01:09.120 --> 0:01:13.280 prams all based on our friends recommendations so if you're 0:01:13.319 --> 0:01:15.800 really enjoying our podcast, we would appreciate it if you 0:01:15.800 --> 0:01:17.000 shared it with your friends as well. 0:01:17.280 --> 0:01:19.520 All right, today we're talking about the point end of labor, 0:01:19.560 --> 0:01:20.360 the pushing bit. 0:01:20.640 --> 0:01:22.919 Yeah, and I'm not going to do salt and pepper 0:01:24.160 --> 0:01:27.640 push it. That seems to come up every single time 0:01:27.640 --> 0:01:30.200 someone talks about pushing it above that. We're above that, 0:01:30.440 --> 0:01:32.160 you know, it's in the back of my brain there somewhere, 0:01:33.120 --> 0:01:36.440 all right, All right, good, So what we want you 0:01:36.560 --> 0:01:40.480 to go away with with this episode is basically to 0:01:40.800 --> 0:01:44.679 learn about, well, when does this happen in the labor 0:01:44.920 --> 0:01:47.720 because some people think that that's all labor's about, but 0:01:47.880 --> 0:01:50.200 you know, it's sort of only part of it. 0:01:50.280 --> 0:01:51.680 Yeah, that's the TV bit, isn't it. 0:01:51.760 --> 0:01:51.960 Yeah? 0:01:52.000 --> 0:01:53.800 Yeah, sort of break your waters in the shops and 0:01:53.840 --> 0:01:57.160 water goes everywhere, and then you're pushing the next minute. 0:01:57.240 --> 0:02:00.440 Yeah, you're pushing. So we want to talk about when 0:02:00.480 --> 0:02:02.920 that happens in your labor and what to expect, and 0:02:03.240 --> 0:02:04.880 we've got some tips for pushing. 0:02:05.040 --> 0:02:05.320 Nice. 0:02:05.400 --> 0:02:07.120 We want you to go away with at least three 0:02:07.160 --> 0:02:10.120 tips to help you in this part of your labor. 0:02:10.639 --> 0:02:12.120 Sounds good, all. 0:02:12.080 --> 0:02:15.920 Right, Pat, So I think let's start with what stage 0:02:15.919 --> 0:02:18.280 of labor is it time to push? 0:02:18.440 --> 0:02:22.600 Yeah, this is like this is it's a surprisingly complex 0:02:22.720 --> 0:02:27.519 question when you think that would be obvious the give 0:02:27.600 --> 0:02:29.639 or take the best time, you've got to be fully dilated, 0:02:29.760 --> 0:02:32.399 so the cervice has to be fully dilated, but there 0:02:32.480 --> 0:02:35.880 is some difference of opinion about what should happen after that. 0:02:37.480 --> 0:02:42.360 It's becoming much more accepted that in the setting of 0:02:42.440 --> 0:02:46.120 good progress and in the setting of a happy, healthy baby, 0:02:46.880 --> 0:02:49.720 that you don't start pushing the minute you have a 0:02:49.760 --> 0:02:52.640 vaginal examination and someone says, oh, you're fully dilated, to 0:02:52.639 --> 0:02:56.080 push baby at now, Because yeah, the cervix might be 0:02:56.080 --> 0:02:59.120 fully dilated, but the head might be very high, and 0:02:59.160 --> 0:03:01.080 it's an awful lot of work to push that head 0:03:01.560 --> 0:03:06.680 from right up high all the way out, And so 0:03:07.200 --> 0:03:11.080 a certain amount of time spent in what's collpacivescent, waiting 0:03:11.160 --> 0:03:16.840 for the uterus to push baby down a fair way 0:03:16.880 --> 0:03:21.760 down into the pelvis before you start the active pushing. 0:03:22.440 --> 0:03:27.280 Like the deliberate pushing is a great idea, and one 0:03:27.320 --> 0:03:29.760 of the main things that's going to help with is 0:03:30.120 --> 0:03:33.360 how long you have to push. For bearing in mind 0:03:33.400 --> 0:03:36.800 that very few people can push forever. It's hard work, 0:03:37.600 --> 0:03:41.800 and even a very fit athletic person is going to 0:03:41.840 --> 0:03:45.120 get worn out by the pushing process, and you might 0:03:45.120 --> 0:03:46.640 get to a point where you just can't manage an 0:03:46.640 --> 0:03:49.120 effective push anymore. And if the baby's still not out, 0:03:49.400 --> 0:03:52.800 then we're setting ourselves up for intervention in the form 0:03:52.880 --> 0:03:57.760 of vacuum or forces. So it's nice to start pushing 0:03:58.720 --> 0:04:01.960 when you've got a when you've got a fighting chance 0:04:02.320 --> 0:04:03.880 of having the baby all the way out before you 0:04:03.880 --> 0:04:04.600 get to exhaust it. 0:04:05.200 --> 0:04:09.160 And it's interesting that you start there, because when I 0:04:09.200 --> 0:04:14.120 was preparing for this podcast, my Google search brought me 0:04:14.200 --> 0:04:17.880 to a lot of American sites, and in the US 0:04:18.480 --> 0:04:21.320 for a lot of hospitals, as soon as it gets 0:04:21.320 --> 0:04:23.640 to ten as soon as someone gets to ten centimeters, 0:04:24.120 --> 0:04:27.239 there is the protocol to start getting them to push. 0:04:27.320 --> 0:04:31.279 Yeah, it's interesting, isn't it. I think worldwide you probably 0:04:31.560 --> 0:04:33.400 you would probably find it. I don't know this for 0:04:33.440 --> 0:04:36.560 a fact, but you would probably find that an early 0:04:36.640 --> 0:04:40.000 pushing approach is most adopted in the countries that are 0:04:40.000 --> 0:04:43.839 most at home with intervention, because you're gonna wear some 0:04:43.839 --> 0:04:48.479 people out if you do that, Yeah, Whereas if you wait, 0:04:49.480 --> 0:04:51.720 Remember we're only waiting if it's safe to wait. We're 0:04:51.920 --> 0:04:53.520 we're waiting, well man, well wab We're going to wait 0:04:53.560 --> 0:04:56.880 a bit. And if we wait, the ideal amount of 0:04:56.920 --> 0:05:00.839 time to wait I think is und till the point 0:05:01.000 --> 0:05:03.320 This might take an hour or more until the point 0:05:03.360 --> 0:05:05.679 where the woman can't help it push. 0:05:05.880 --> 0:05:06.080 Yeah. 0:05:06.320 --> 0:05:09.080 They're the best ones. Yep, okay, And it's a bit 0:05:09.240 --> 0:05:11.040 it's a bit gross, but I say to people, it's 0:05:11.080 --> 0:05:13.680 like doing half a pooh. Right. Imagine I imagine if 0:05:13.720 --> 0:05:15.279 you were on the toilet and you did half a 0:05:15.279 --> 0:05:18.200 poo and someone told you you should stop now when 0:05:18.240 --> 0:05:20.440 it was only half out right, that would be that 0:05:20.440 --> 0:05:24.400 would be very difficult to do, right, and your body's 0:05:24.440 --> 0:05:26.919 going to get I don't think, so I'll just keep going. 0:05:27.000 --> 0:05:30.039 And that's where you want to get to where there's 0:05:30.320 --> 0:05:35.400 an overwhelming, irresistible urge to push, because I think they're 0:05:35.440 --> 0:05:40.240 the best ones. Yeah, And there's they require less active 0:05:40.240 --> 0:05:41.960 coaching because the woman goes, I know I'm supposed to 0:05:41.960 --> 0:05:44.440 put I kind I can't help it push. Yeah. And 0:05:44.480 --> 0:05:47.200 they come late in the piece, so that if you 0:05:47.440 --> 0:05:49.679 if you save your save your efforts for those ones, 0:05:50.200 --> 0:05:53.120 then you're more likely to have the power push a 0:05:53.160 --> 0:05:58.800 baby out before something happens that triggers an intervention and. 0:05:58.760 --> 0:06:00.880 You might get bragging rights. I pushed the baby out 0:06:00.880 --> 0:06:01.560 in two pushes. 0:06:01.880 --> 0:06:03.080 Yeah, we try and avoid them. 0:06:03.120 --> 0:06:06.640 Brain, No, comparison itis is terrible. Don't listen to how 0:06:06.680 --> 0:06:11.080 long did it take people? I think that that is 0:06:11.720 --> 0:06:15.160 very different information than what I was reading. And in 0:06:15.200 --> 0:06:18.000 some hospitals, the protocol was I know that we're going 0:06:18.040 --> 0:06:20.280 to get into how long is too long to be pushing, 0:06:20.560 --> 0:06:22.800 But some hospitals were up to four hours. They would 0:06:22.800 --> 0:06:24.359 allow someone to push for four hours. 0:06:24.600 --> 0:06:27.720 Like, Yeah, I think we suffer from a lack of 0:06:27.760 --> 0:06:32.880 real evidence here, but I don't think many people could 0:06:32.880 --> 0:06:35.880 push effectively for four hours. No, that is an awfully 0:06:35.880 --> 0:06:37.840 long time to do something as intense as trying to 0:06:37.839 --> 0:06:42.039 push baby. Yeah. And one thing, one point I'm trying 0:06:42.040 --> 0:06:43.840 to make is we're really talking about people having their 0:06:43.839 --> 0:06:48.360 first baby here. The pushing phase for second and subsequent 0:06:48.360 --> 0:06:52.799 babies is often very brief. Sometimes it's kind of absent, Okay, 0:06:53.400 --> 0:06:56.640 So that's very different when a baby has come down 0:06:56.680 --> 0:06:57.400 that path before. 0:06:58.040 --> 0:07:00.520 And I just want to point out that technically this 0:07:00.560 --> 0:07:02.000 is called second stage, isn't it. 0:07:02.279 --> 0:07:04.880 Yeah. Yeah, from fully dilat until the baby's out. 0:07:05.040 --> 0:07:07.360 I think a lot of people would like to know 0:07:07.680 --> 0:07:10.240 what is happening to the baby during pushing. Is it 0:07:10.320 --> 0:07:13.680 more of a stress on the baby during the pushing 0:07:13.680 --> 0:07:15.080 phase than the contraction phase. 0:07:15.480 --> 0:07:17.920 It's a potential stress on the baby just to be 0:07:17.920 --> 0:07:22.280 coming down the birth canal and just to be for example, 0:07:22.640 --> 0:07:26.840 squishing again, maybe squishing against the court. Whether or not 0:07:27.160 --> 0:07:29.600 it makes a difference to the babies well being if 0:07:29.600 --> 0:07:32.200 the woman is actively pushing or not, I don't think so, 0:07:32.920 --> 0:07:36.400 but there is something physiologically challenging for the baby just 0:07:36.560 --> 0:07:39.160 to just to be coming out and just to be 0:07:39.160 --> 0:07:42.960 being born, and just to be fairly squished by that point. 0:07:43.320 --> 0:07:47.480 As an obstetrician, can you pick the point when someone's 0:07:47.480 --> 0:07:53.400 going to push, like do they make different facial Yeah? 0:07:54.000 --> 0:07:55.320 So there describe it for. 0:07:55.320 --> 0:07:59.360 Us well experience people in the birthing space. You can 0:07:59.400 --> 0:08:02.560 hear it from the corridor, So there's a change in 0:08:02.600 --> 0:08:09.560 the pitch of the noise, and somebody four or five 0:08:09.640 --> 0:08:12.360 centimeters makes a different noise to somebody is fully dilated. 0:08:13.240 --> 0:08:17.680 There's an acute intensity to the discomfort and the pain 0:08:17.800 --> 0:08:22.160 felt by women at full diletation that changes the pitch 0:08:22.240 --> 0:08:24.480 of the noise that they make and so you can 0:08:24.520 --> 0:08:28.800 actually hear it before you're enter the room. And that's 0:08:28.840 --> 0:08:31.320 in particular if it's their second or subsequent baby, and 0:08:31.320 --> 0:08:34.480 it's and it hasn't crept up on them. They've gone 0:08:34.480 --> 0:08:36.280 from a labor that was just sort of cooking along 0:08:36.640 --> 0:08:40.640 to suddenly bang straight into the fully dilated, let's push 0:08:40.640 --> 0:08:43.439 this baby out phase, and they make a different sound, 0:08:43.920 --> 0:08:46.200 So that's number one. And then and then secondly, they 0:08:46.960 --> 0:08:51.080 will find it nearly impossible to get comfortable, so they'll 0:08:51.120 --> 0:08:56.600 dance around the better bit. And that's and that is 0:08:56.679 --> 0:08:58.559 related to the fact that if you've got a head 0:08:58.559 --> 0:09:01.040 that's about to come out, it is almost technically impossible 0:09:01.080 --> 0:09:05.280 to be comfortable in the absence of an epidural, So 0:09:05.320 --> 0:09:08.680 they'll dance around the better bit. And then if you 0:09:08.760 --> 0:09:12.760 see somebody start to push all by themselves without being 0:09:12.760 --> 0:09:15.640 coached during a painful contraction, which you can sometimes see 0:09:15.640 --> 0:09:18.360 because the parent if you're watching that, the parente will 0:09:18.360 --> 0:09:20.840 start to bulge a bit and you think she's pushing 0:09:22.520 --> 0:09:26.000 without even anyone coaching. Yeah, terrific sign. 0:09:26.200 --> 0:09:28.840 Yeah, yeah, And I want to talk about coaching and 0:09:29.040 --> 0:09:33.679 spontaneous because I mean, gosh, that's everywhere, and there's a 0:09:33.720 --> 0:09:37.520 lot of people that are either put in either camp. 0:09:37.600 --> 0:09:41.480 You know, they're like, no coaching should be allowed, like 0:09:41.520 --> 0:09:45.160 everybody knows when their body is ready to push. And 0:09:45.200 --> 0:09:51.320 then there's other protocolized coaching. Yes, so let's talk about 0:09:51.400 --> 0:09:55.120 both of those things. So tell me what does coached 0:09:55.520 --> 0:09:56.000 pushing me? 0:09:56.480 --> 0:10:00.400 Yeah, I think coach pushing is pretty common, common for 0:10:00.440 --> 0:10:05.440 first timers, pretty common for epidural because sometimes those people 0:10:06.040 --> 0:10:08.480 really are ready to push their heads nicely down, long 0:10:08.520 --> 0:10:11.920 way down the service, fully dilated, and it really is 0:10:11.960 --> 0:10:14.680 time to push, but they're not feeling an overwhelming need 0:10:15.440 --> 0:10:18.439 urge to push sometimes until right at the end of 0:10:18.440 --> 0:10:23.600 the head's just about out. So coaching for some people 0:10:24.120 --> 0:10:30.840 really helps them focus. So painful contraction starts up. Will 0:10:30.880 --> 0:10:33.120 you coach the woman to take a big breath in, 0:10:33.960 --> 0:10:36.720 put a gin down towards her chest, and push firmly 0:10:36.800 --> 0:10:40.040 down towards her bottom, And you tend to be able 0:10:40.080 --> 0:10:43.160 to push for about fifteen seconds doing that, and then 0:10:43.160 --> 0:10:45.760 you're out of breath. Quickly let it go, take another 0:10:45.760 --> 0:10:48.320 breath and do the same thing again, so that you 0:10:48.360 --> 0:10:51.760 can get two or three cycles of that per contraction. 0:10:53.760 --> 0:10:59.360 So that's the most common form of coached pushing, and 0:10:59.440 --> 0:11:04.160 some people respond very well to that. Other people don't 0:11:04.160 --> 0:11:07.760 respond to that at all and actually want to be 0:11:07.840 --> 0:11:14.120 going internally in their mind into a near meditative or 0:11:14.960 --> 0:11:20.840 hypnotic state of inner peace in an attempt to remain 0:11:21.000 --> 0:11:26.800 internally focused and try and disregard the pain. And those 0:11:26.840 --> 0:11:30.120 people won't tell you they want to be coached out loud, 0:11:31.080 --> 0:11:34.000 but they might want something as simple as a rub 0:11:34.040 --> 0:11:36.520 to their lower back or a hold of their hand, 0:11:37.360 --> 0:11:38.640 and they've got it internally. 0:11:39.520 --> 0:11:43.640 And do most people have any idea how that pushing 0:11:43.679 --> 0:11:47.439 phase what they might want before then, or do they 0:11:47.440 --> 0:11:48.880 sort of come up with it and tell you to 0:11:48.920 --> 0:11:49.400 shut up? 0:11:49.840 --> 0:11:54.319 Yeah? Some people have firm ideas when they're pregnant about 0:11:54.320 --> 0:11:57.200 how they want that bit to go. But surely you 0:11:57.240 --> 0:11:58.880 have to experience it to really know. 0:11:59.080 --> 0:12:03.000 Yeah, and do you what's your preference? 0:12:03.120 --> 0:12:06.240 What do you do? I'm very happy to coach people 0:12:06.240 --> 0:12:09.520 who want to be coached. Sometimes people politely say no, no, 0:12:09.520 --> 0:12:13.000 I don't need that. I'm just I'm going internally here. Yeah, 0:12:13.080 --> 0:12:15.520 and I want you to speak up if you're worried 0:12:15.520 --> 0:12:21.080 about something, fine, but I don't mind doing the coaching. Yeah, 0:12:21.160 --> 0:12:23.600 I'm smiling because I had a patient a few years 0:12:23.640 --> 0:12:28.440 ago whose husband was a coach. He was a motivation 0:12:28.679 --> 0:12:31.600 coach and a personal trainer, and he was unbelievable. It 0:12:31.720 --> 0:12:36.560 was just awesome. Yeah, because he had absolutely no shyness 0:12:37.160 --> 0:12:40.840 about about, you know, taking over the room and saying 0:12:40.840 --> 0:12:42.760 why do you good? Okay, here comes another one, Bang, 0:12:42.840 --> 0:12:45.319 let's go, and the big voice and everything, which sometimes 0:12:45.320 --> 0:12:48.760 people get funny about, but because that's what he did 0:12:48.760 --> 0:12:51.280 for a living, get people off there, button exercise. 0:12:51.520 --> 0:12:54.800 Yeah, and presumably maybe his partner exercised with him and 0:12:54.840 --> 0:12:56.680 was kind of used to his coaching method or whatever. 0:12:56.760 --> 0:12:59.080 Totally fine. Yeah, it worked for them, and I think 0:12:59.120 --> 0:13:02.480 that's the point that we do what works for people. 0:13:02.640 --> 0:13:06.560 Yeah, And I think that is the point because being 0:13:06.679 --> 0:13:10.640 militant about whether as a birth provider, whether someone should 0:13:10.679 --> 0:13:15.720 be coached or should be having spontaneous pushing, that's sort 0:13:15.720 --> 0:13:17.800 of not up to them, is it. It's up to 0:13:17.840 --> 0:13:19.200 the person who's doing the pushing. 0:13:19.240 --> 0:13:22.160 Of course. Yeah. Of course, we don't know for a 0:13:22.280 --> 0:13:26.680 fact that coaching works better than non coaching, So it's 0:13:26.720 --> 0:13:28.800 not like we've got evidence that the strong evidence that 0:13:28.840 --> 0:13:29.199 it helps. 0:13:29.360 --> 0:13:32.319 Yeah, you talked about epidural Can we just flesh that 0:13:32.360 --> 0:13:35.160 out a little bit, yep, because that is a bit different, 0:13:35.200 --> 0:13:36.000 isn't it. 0:13:36.000 --> 0:13:41.280 It is. If you've got a really strong you may 0:13:41.360 --> 0:13:44.640 not get an early urge to push, and in fact, 0:13:44.679 --> 0:13:46.640 you may not get an urge to push at all, 0:13:47.440 --> 0:13:50.240 and you may not get an urge to push until 0:13:50.240 --> 0:13:55.400 the head is like literally half out. So that's a 0:13:55.640 --> 0:13:59.959 downside of epidurals is that it might lead the push 0:14:00.040 --> 0:14:03.439 phase to be a bit less efficient. We don't think 0:14:03.520 --> 0:14:09.720 that that necessarily leads to problems, but it can lead 0:14:09.760 --> 0:14:12.200 to somebody who's fully dilated, their heads very close to 0:14:12.280 --> 0:14:14.600 out and they're like, when should I push? So I 0:14:14.600 --> 0:14:18.200 think that person would really benefit from coach pushing because 0:14:18.360 --> 0:14:21.360 we can often if they're completely pain free, because their 0:14:21.360 --> 0:14:25.800 EPI is very dense, very effective, then we can watch 0:14:25.800 --> 0:14:29.160 the watch the fiddle heart rate manta, the line that 0:14:29.680 --> 0:14:34.120 observes the contractions, tell that woman when there's a contraction 0:14:34.640 --> 0:14:37.960 and get her to start pushing. And it's cool to 0:14:37.960 --> 0:14:42.640 watch because eventually she'll she'll push because she's been coached 0:14:42.640 --> 0:14:45.240 to push, But then a point comes where she goes, 0:14:45.240 --> 0:14:48.160 oh okay, fine, I can feel at it's very common 0:14:48.160 --> 0:14:50.480 for an epidural to actually blockle all the pain, and 0:14:50.560 --> 0:14:52.480 eventually the head will come down so far that the 0:14:52.480 --> 0:14:55.240 pain comes back, and then she goes, oh, okay, okay, 0:14:55.280 --> 0:14:58.040 now I want her to push, And that's a good moment, 0:14:58.160 --> 0:15:01.640 right because that because you know, you close home. Yeah, 0:15:01.680 --> 0:15:03.560 And speaking of close to home, the other thing that 0:15:03.600 --> 0:15:05.520 you can see when someone's pushing like a champion is 0:15:05.560 --> 0:15:09.320 the is the aanus will open and sometimes a bow 0:15:09.400 --> 0:15:12.360 motion will come out. And people get super worried that 0:15:12.360 --> 0:15:14.400 that's going to happen and that they will be embarrassed 0:15:14.400 --> 0:15:16.320 by that or something. But your key gives will never 0:15:16.360 --> 0:15:18.800 be happier than when that happens, because it means that 0:15:18.840 --> 0:15:19.840 the head's about to come out. 0:15:19.880 --> 0:15:21.000 Yeah, there's not room for both. 0:15:21.560 --> 0:15:24.480 Yeah, No, that's right. So and it's it's not you're 0:15:24.480 --> 0:15:26.800 not having a bow motion in the usual way. What's 0:15:26.840 --> 0:15:30.280 happening is that is the baby's heads pushing against the 0:15:30.280 --> 0:15:33.200 bow and causing it to open. Yeah, and that means 0:15:33.240 --> 0:15:33.840 you're nearly there. 0:15:34.040 --> 0:15:37.320 Yeah, And sometimes you won't even know that that's happened 0:15:38.000 --> 0:15:41.080 like that, we're pretty discretable, very discreted. It whipped away 0:15:41.120 --> 0:15:46.080 and there we go and can you now describe the 0:15:46.280 --> 0:15:51.640 different positions that you've seen women get into two push. 0:15:51.720 --> 0:15:58.520 Yeah. Again, this is a personal preference situation, and there 0:15:58.680 --> 0:16:01.240 is not, to the best of mine, powerful evidence about 0:16:01.400 --> 0:16:06.840 what's the best one. But anywhere from on your back 0:16:07.240 --> 0:16:08.840 to on your back with your legs in the air, 0:16:09.120 --> 0:16:14.160 to on your side, to standing up to squatting, they're 0:16:14.200 --> 0:16:15.520 all a matter of personal preference. 0:16:16.200 --> 0:16:20.640 One on, one knee, one leg extended, like, there's just 0:16:20.880 --> 0:16:27.040 every every variety whatever, and it's up to the care giver, 0:16:27.640 --> 0:16:32.800 to the birth provider to manage that because I would 0:16:32.800 --> 0:16:34.480 imagine you end up being a bit like an acrobat. 0:16:34.840 --> 0:16:41.040 Yes, and that I hope there aren't too many institutions 0:16:41.040 --> 0:16:44.680 worldwide who are trying to limit this for people. But 0:16:45.680 --> 0:16:48.000 one of the problems, one of the things we do 0:16:48.120 --> 0:16:51.080 like to sort of take care of in hospitals is 0:16:51.240 --> 0:16:53.520 the health and safety of the people who work there. 0:16:54.640 --> 0:16:59.760 So what we're looking for, if possible, is, for example, 0:16:59.760 --> 0:17:02.200 if someone wants to give birth in a squatting position, 0:17:02.800 --> 0:17:04.639 then we tend to put a bunch of mats around, 0:17:04.720 --> 0:17:06.840 so not only is the woman standing on a soft mat, 0:17:07.359 --> 0:17:10.560 but the caregivers can get down on the ground, Yeah, 0:17:10.600 --> 0:17:15.159 and help her with easing the head out, supporting the 0:17:15.280 --> 0:17:19.879 peraneum with crowning. And if you're going to do that, 0:17:19.920 --> 0:17:22.040 then you need to be down there near the ground 0:17:22.040 --> 0:17:23.120 where the baby's going to come out. 0:17:24.600 --> 0:17:27.000 Can we talk a little bit about when the head 0:17:27.080 --> 0:17:31.280 is actually on view and the ring of five people 0:17:31.280 --> 0:17:31.720 talk about? 0:17:32.240 --> 0:17:38.320 Yeah, so that's a very unpleasant sensation of burning that 0:17:38.720 --> 0:17:42.240 happens when the skin around the vaginal opening is really 0:17:42.280 --> 0:17:45.960 stretched as the head crowns up. And what we're kind 0:17:45.960 --> 0:17:50.359 of looking for at that stage is that the head 0:17:50.400 --> 0:17:55.000 will crown up slowly. And I always say to be 0:17:55.280 --> 0:17:57.600 what we're trying to do here is ease the head out, 0:17:57.440 --> 0:18:01.600 not blasted out. Okay, blasting the head out is sometimes 0:18:01.640 --> 0:18:04.800 the result of an irresistible urge to push. Can't help it, 0:18:04.840 --> 0:18:07.240 push really hard, bang, head shoots out in one go 0:18:07.680 --> 0:18:11.840 and there's a bigger tear. And there's actually quite good 0:18:11.840 --> 0:18:15.600 evidence that supporting the paranem helps with tearing, so that 0:18:15.720 --> 0:18:22.640 if we have an obstetric caregiver helping to support that 0:18:22.760 --> 0:18:25.880 perineal tissue between the vagina and the anus by giving 0:18:25.880 --> 0:18:30.879 it a little pinch between thumb and fingers, that we 0:18:31.040 --> 0:18:35.720 can support that tissue and help the head slowly ease 0:18:35.720 --> 0:18:38.040 out rather than blast out and cause a tear. 0:18:38.400 --> 0:18:41.760 So you're pushing, pushing, pushing all you might, but once 0:18:41.800 --> 0:18:44.000 you get to that stage, you're breathing your book. 0:18:44.480 --> 0:18:46.600 Yeah. So there's a few techniques there isn't there. There's 0:18:47.160 --> 0:18:50.159 the toff and puff method because it's hard to really 0:18:50.400 --> 0:18:57.720 push down for firmly towards your anus if you haven't closed. 0:18:57.760 --> 0:19:01.720 Your glottis in your throat. So so the most effective 0:19:01.720 --> 0:19:03.680 way to push down, imagine trying to do the World's 0:19:03.720 --> 0:19:06.639 biguse poo is we close. I've got a script, and 0:19:06.680 --> 0:19:11.960 it's hard to do that if you're also going yeah. 0:19:11.960 --> 0:19:14.959 So that the idea is not that the huffing puffing 0:19:14.960 --> 0:19:17.440 really does anything. It just stops you pushing so hard. 0:19:17.520 --> 0:19:21.119 Ah yeah, radio, So that is a technique. And the 0:19:21.440 --> 0:19:24.320 other is just to say, Okay, I want you to push, 0:19:24.440 --> 0:19:26.959 but you gotta wind it back. I want to show 0:19:27.040 --> 0:19:30.000 me a fifty percent push, Yeah, show me a twenty 0:19:30.000 --> 0:19:31.320 percent push. 0:19:31.359 --> 0:19:34.920 And things to expect is that the team might have 0:19:35.040 --> 0:19:39.399 like a warm flannel on your paraneum yep, just to 0:19:39.400 --> 0:19:40.480 help with that hearing as well. 0:19:40.600 --> 0:19:44.840 Yeah, yeah, that's right, right, at the end, let's talk 0:19:44.840 --> 0:19:49.000 about prolonged pushing, because you know, we've talked about pushing 0:19:49.000 --> 0:19:51.240 a baby out, but we haven't really talked about. 0:19:51.080 --> 0:19:53.600 How long is too long? Yeah, and what are the 0:19:53.680 --> 0:19:55.760 dangers of pushing for too long? 0:19:56.280 --> 0:19:59.040 There are some dangers in being fully dilated for too long, 0:20:00.960 --> 0:20:04.960 but they apply to being fully dilated to very long. 0:20:05.400 --> 0:20:08.159 So if we look across the developing world today in 0:20:08.240 --> 0:20:13.600 twenty twenty five, in communities where women don't have access 0:20:13.600 --> 0:20:18.280 to expert obstetric care, there's still a phenomenon of getting 0:20:18.320 --> 0:20:21.639 to fully dilated, can't push the baby out. Powers is 0:20:21.720 --> 0:20:24.080 now baby's in a bad position, babies too big, and 0:20:24.119 --> 0:20:31.000 then without an expert intervention, that baby sits there for hours, days, weeks, 0:20:31.480 --> 0:20:36.520 baby dies. Women develops some obstetric fistula, so the pressure 0:20:36.880 --> 0:20:40.600 of the head in the pelvis means that blood can't 0:20:40.640 --> 0:20:44.959 get down to the vaginal and perennial structures, and it 0:20:45.040 --> 0:20:47.080 might be able to get in under arterial pressure, but 0:20:47.119 --> 0:20:49.920 it can't get out under venice pressure, and that tissue 0:20:49.960 --> 0:20:54.440 becomes necrotic, breaks down, and the tissue dies. Are causing 0:20:54.480 --> 0:20:59.560 an abnormal tract between the woman's bladder and vagina or 0:20:59.640 --> 0:21:01.639 balance vagina, and this is still a problem in the 0:21:01.680 --> 0:21:06.440 developing world. In developed countries, the issue is not that 0:21:06.600 --> 0:21:10.040 when not we wouldn't sit around till anything like that happened. 0:21:11.440 --> 0:21:14.440 The problem is more that we've only got so much 0:21:14.440 --> 0:21:18.480 pushing power, and that if we've been pushing for so long, 0:21:18.600 --> 0:21:22.760 it's very likely that they're getting less effective as we 0:21:22.800 --> 0:21:25.760 go along, and the chances of us getting over the 0:21:25.800 --> 0:21:31.120 line for an unassisted vaginal birth are going up. Sorry, 0:21:31.160 --> 0:21:33.400 the chances of us getting over the line for an 0:21:33.440 --> 0:21:37.680 unassisted vaginal birth are going down. The longer we wait. 0:21:38.440 --> 0:21:40.000 They's tending to think, oh, for wait a bit longer, 0:21:40.040 --> 0:21:42.320 I'll get there. No, there's a point where you're actually 0:21:42.440 --> 0:21:46.200 less likely to get there by waiting, because that any 0:21:46.240 --> 0:21:50.040 contractions after that point are quite ineffective. So that's led 0:21:50.080 --> 0:21:52.520 to this idea of there being time limits at full dialtation. 0:21:53.720 --> 0:22:00.920 They have to be interpreted interpreted with some some caution 0:22:01.040 --> 0:22:05.040 and with flexibility. You might have somebody who's been fully 0:22:05.040 --> 0:22:07.760 dilated for three hours, but it's still quite obviously pushing 0:22:07.800 --> 0:22:10.600 extremely well. Well, if the woman's well and the babies well, 0:22:10.800 --> 0:22:13.320 can't see the harm and keep going. But you might 0:22:13.359 --> 0:22:15.960 come in and someone saying I just I cannot push anymore. 0:22:16.920 --> 0:22:20.960 And so in broad terms, people tend to push pretty 0:22:20.960 --> 0:22:24.280 well for about two hours, and sometimes it's necessary to 0:22:24.320 --> 0:22:27.000 push for an additional hour if there's an epidural because 0:22:27.040 --> 0:22:29.840 of that issue with the epidural taking away some of 0:22:29.840 --> 0:22:32.240