Speaker 1: The information in this podcast is provided for education and
Speaker 1: research information only. It is not a substitute for professional
Speaker 1: health advice.
Speaker 2: Welcome to the Kick your Expert led podcast, helping you
Speaker 2: explore and learn everything about getting pregnancy, birth, and becoming
Speaker 2: a parent.
Speaker 1: On the podcast and our online pregnancy program grow My Baby,
Speaker 1: we share my experience of helping more than four thousand
Speaker 1: babies to.
Speaker 2: Be born and our experience of running a women's health
Speaker 2: clinic and parenting for boys.
Speaker 1: We're here to help everyone to feel empowered in pregnancy
Speaker 1: and birth with real life, practical information.
Speaker 2: Welcome everyone. I'm Bridgid Maloney and.
Speaker 1: I'm obstetrician doctor Patrick Maloney.
Speaker 2: And welcome back to all our listeners. Thanks for joining
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Speaker 1: All right, today we're talking about the point end of labor,
Speaker 1: the pushing bit.
Speaker 2: Yeah, and I'm not going to do salt and pepper
Speaker 2: push it. That seems to come up every single time
Speaker 2: someone talks about pushing it above that. We're above that,
Speaker 2: you know, it's in the back of my brain there somewhere,
Speaker 2: all right, All right, good, So what we want you
Speaker 2: to go away with with this episode is basically to
Speaker 2: learn about, well, when does this happen in the labor
Speaker 2: because some people think that that's all labor's about, but
Speaker 2: you know, it's sort of only part of it.
Speaker 1: Yeah, that's the TV bit, isn't it.
Speaker 2: Yeah?
Speaker 1: Yeah, sort of break your waters in the shops and
Speaker 1: water goes everywhere, and then you're pushing the next minute.
Speaker 2: Yeah, you're pushing. So we want to talk about when
Speaker 2: that happens in your labor and what to expect, and
Speaker 2: we've got some tips for pushing.
Speaker 1: Nice.
Speaker 2: We want you to go away with at least three
Speaker 2: tips to help you in this part of your labor.
Speaker 1: Sounds good, all.
Speaker 2: Right, Pat, So I think let's start with what stage
Speaker 2: of labor is it time to push?
Speaker 1: Yeah, this is like this is it's a surprisingly complex
Speaker 1: question when you think that would be obvious the give
Speaker 1: or take the best time, you've got to be fully dilated,
Speaker 1: so the cervice has to be fully dilated, but there
Speaker 1: is some difference of opinion about what should happen after that.
Speaker 1: It's becoming much more accepted that in the setting of
Speaker 1: good progress and in the setting of a happy, healthy baby,
Speaker 1: that you don't start pushing the minute you have a
Speaker 1: vaginal examination and someone says, oh, you're fully dilated, to
Speaker 1: push baby at now, Because yeah, the cervix might be
Speaker 1: fully dilated, but the head might be very high, and
Speaker 1: it's an awful lot of work to push that head
Speaker 1: from right up high all the way out, And so
Speaker 1: a certain amount of time spent in what's collpacivescent, waiting
Speaker 1: for the uterus to push baby down a fair way
Speaker 1: down into the pelvis before you start the active pushing.
Speaker 1: Like the deliberate pushing is a great idea, and one
Speaker 1: of the main things that's going to help with is
Speaker 1: how long you have to push. For bearing in mind
Speaker 1: that very few people can push forever. It's hard work,
Speaker 1: and even a very fit athletic person is going to
Speaker 1: get worn out by the pushing process, and you might
Speaker 1: get to a point where you just can't manage an
Speaker 1: effective push anymore. And if the baby's still not out,
Speaker 1: then we're setting ourselves up for intervention in the form
Speaker 1: of vacuum or forces. So it's nice to start pushing
Speaker 1: when you've got a when you've got a fighting chance
Speaker 1: of having the baby all the way out before you
Speaker 1: get to exhaust it.
Speaker 2: And it's interesting that you start there, because when I
Speaker 2: was preparing for this podcast, my Google search brought me
Speaker 2: to a lot of American sites, and in the US
Speaker 2: for a lot of hospitals, as soon as it gets
Speaker 2: to ten as soon as someone gets to ten centimeters,
Speaker 2: there is the protocol to start getting them to push.
Speaker 1: Yeah, it's interesting, isn't it. I think worldwide you probably
Speaker 1: you would probably find it. I don't know this for
Speaker 1: a fact, but you would probably find that an early
Speaker 1: pushing approach is most adopted in the countries that are
Speaker 1: most at home with intervention, because you're gonna wear some
Speaker 1: people out if you do that, Yeah, Whereas if you wait,
Speaker 1: Remember we're only waiting if it's safe to wait. We're
Speaker 1: we're waiting, well man, well wab We're going to wait
Speaker 1: a bit. And if we wait, the ideal amount of
Speaker 1: time to wait I think is und till the point
Speaker 1: This might take an hour or more until the point
Speaker 1: where the woman can't help it push.
Speaker 2: Yeah.
Speaker 1: They're the best ones. Yep, okay, And it's a bit
Speaker 1: it's a bit gross, but I say to people, it's
Speaker 1: like doing half a pooh. Right. Imagine I imagine if
Speaker 1: you were on the toilet and you did half a
Speaker 1: poo and someone told you you should stop now when
Speaker 1: it was only half out right, that would be that
Speaker 1: would be very difficult to do, right, and your body's
Speaker 1: going to get I don't think, so I'll just keep going.
Speaker 1: And that's where you want to get to where there's
Speaker 1: an overwhelming, irresistible urge to push, because I think they're
Speaker 1: the best ones. Yeah, And there's they require less active
Speaker 1: coaching because the woman goes, I know I'm supposed to
Speaker 1: put I kind I can't help it push. Yeah. And
Speaker 1: they come late in the piece, so that if you
Speaker 1: if you save your save your efforts for those ones,
Speaker 1: then you're more likely to have the power push a
Speaker 1: baby out before something happens that triggers an intervention and.
Speaker 2: You might get bragging rights. I pushed the baby out
Speaker 2: in two pushes.
Speaker 1: Yeah, we try and avoid them.
Speaker 2: Brain, No, comparison itis is terrible. Don't listen to how
Speaker 2: long did it take people? I think that that is
Speaker 2: very different information than what I was reading. And in
Speaker 2: some hospitals, the protocol was I know that we're going
Speaker 2: to get into how long is too long to be pushing,
Speaker 2: But some hospitals were up to four hours. They would
Speaker 2: allow someone to push for four hours.
Speaker 1: Like, Yeah, I think we suffer from a lack of
Speaker 1: real evidence here, but I don't think many people could
Speaker 1: push effectively for four hours. No, that is an awfully
Speaker 1: long time to do something as intense as trying to
Speaker 1: push baby. Yeah. And one thing, one point I'm trying
Speaker 1: to make is we're really talking about people having their
Speaker 1: first baby here. The pushing phase for second and subsequent
Speaker 1: babies is often very brief. Sometimes it's kind of absent, Okay,
Speaker 1: So that's very different when a baby has come down
Speaker 1: that path before.
Speaker 2: And I just want to point out that technically this
Speaker 2: is called second stage, isn't it.
Speaker 1: Yeah. Yeah, from fully dilat until the baby's out.
Speaker 2: I think a lot of people would like to know
Speaker 2: what is happening to the baby during pushing. Is it
Speaker 2: more of a stress on the baby during the pushing
Speaker 2: phase than the contraction phase.
Speaker 1: It's a potential stress on the baby just to be
Speaker 1: coming down the birth canal and just to be for example,
Speaker 1: squishing again, maybe squishing against the court. Whether or not
Speaker 1: it makes a difference to the babies well being if
Speaker 1: the woman is actively pushing or not, I don't think so,
Speaker 1: but there is something physiologically challenging for the baby just
Speaker 1: to just to be coming out and just to be
Speaker 1: being born, and just to be fairly squished by that point.
Speaker 2: As an obstetrician, can you pick the point when someone's
Speaker 2: going to push, like do they make different facial Yeah?
Speaker 2: So there describe it for.
Speaker 1: Us well experience people in the birthing space. You can
Speaker 1: hear it from the corridor, So there's a change in
Speaker 1: the pitch of the noise, and somebody four or five
Speaker 1: centimeters makes a different noise to somebody is fully dilated.
Speaker 1: There's an acute intensity to the discomfort and the pain
Speaker 1: felt by women at full diletation that changes the pitch
Speaker 1: of the noise that they make and so you can
Speaker 1: actually hear it before you're enter the room. And that's
Speaker 1: in particular if it's their second or subsequent baby, and
Speaker 1: it's and it hasn't crept up on them. They've gone
Speaker 1: from a labor that was just sort of cooking along
Speaker 1: to suddenly bang straight into the fully dilated, let's push
Speaker 1: this baby out phase, and they make a different sound,
Speaker 1: So that's number one. And then and then secondly, they
Speaker 1: will find it nearly impossible to get comfortable, so they'll
Speaker 1: dance around the better bit. And that's and that is
Speaker 1: related to the fact that if you've got a head
Speaker 1: that's about to come out, it is almost technically impossible
Speaker 1: to be comfortable in the absence of an epidural, So
Speaker 1: they'll dance around the better bit. And then if you
Speaker 1: see somebody start to push all by themselves without being
Speaker 1: coached during a painful contraction, which you can sometimes see
Speaker 1: because the parent if you're watching that, the parente will
Speaker 1: start to bulge a bit and you think she's pushing
Speaker 1: without even anyone coaching. Yeah, terrific sign.
Speaker 2: Yeah, yeah, And I want to talk about coaching and
Speaker 2: spontaneous because I mean, gosh, that's everywhere, and there's a
Speaker 2: lot of people that are either put in either camp.
Speaker 2: You know, they're like, no coaching should be allowed, like
Speaker 2: everybody knows when their body is ready to push. And
Speaker 2: then there's other protocolized coaching. Yes, so let's talk about
Speaker 2: both of those things. So tell me what does coached
Speaker 2: pushing me?
Speaker 1: Yeah, I think coach pushing is pretty common, common for
Speaker 1: first timers, pretty common for epidural because sometimes those people
Speaker 1: really are ready to push their heads nicely down, long
Speaker 1: way down the service, fully dilated, and it really is
Speaker 1: time to push, but they're not feeling an overwhelming need
Speaker 1: urge to push sometimes until right at the end of
Speaker 1: the head's just about out. So coaching for some people
Speaker 1: really helps them focus. So painful contraction starts up. Will
Speaker 1: you coach the woman to take a big breath in,
Speaker 1: put a gin down towards her chest, and push firmly
Speaker 1: down towards her bottom, And you tend to be able
Speaker 1: to push for about fifteen seconds doing that, and then
Speaker 1: you're out of breath. Quickly let it go, take another
Speaker 1: breath and do the same thing again, so that you
Speaker 1: can get two or three cycles of that per contraction.
Speaker 1: So that's the most common form of coached pushing, and
Speaker 1: some people respond very well to that. Other people don't
Speaker 1: respond to that at all and actually want to be
Speaker 1: going internally in their mind into a near meditative or
Speaker 1: hypnotic state of inner peace in an attempt to remain
Speaker 1: internally focused and try and disregard the pain. And those
Speaker 1: people won't tell you they want to be coached out loud,
Speaker 1: but they might want something as simple as a rub
Speaker 1: to their lower back or a hold of their hand,
Speaker 1: and they've got it internally.
Speaker 2: And do most people have any idea how that pushing
Speaker 2: phase what they might want before then, or do they
Speaker 2: sort of come up with it and tell you to
Speaker 2: shut up?
Speaker 1: Yeah? Some people have firm ideas when they're pregnant about
Speaker 1: how they want that bit to go. But surely you
Speaker 1: have to experience it to really know.
Speaker 2: Yeah, and do you what's your preference?
Speaker 1: What do you do? I'm very happy to coach people
Speaker 1: who want to be coached. Sometimes people politely say no, no,
Speaker 1: I don't need that. I'm just I'm going internally here. Yeah,
Speaker 1: and I want you to speak up if you're worried
Speaker 1: about something, fine, but I don't mind doing the coaching. Yeah,
Speaker 1: I'm smiling because I had a patient a few years
Speaker 1: ago whose husband was a coach. He was a motivation
Speaker 1: coach and a personal trainer, and he was unbelievable. It
Speaker 1: was just awesome. Yeah, because he had absolutely no shyness
Speaker 1: about about, you know, taking over the room and saying
Speaker 1: why do you good? Okay, here comes another one, Bang,
Speaker 1: let's go, and the big voice and everything, which sometimes
Speaker 1: people get funny about, but because that's what he did
Speaker 1: for a living, get people off there, button exercise.
Speaker 2: Yeah, and presumably maybe his partner exercised with him and
Speaker 2: was kind of used to his coaching method or whatever.
Speaker 1: Totally fine. Yeah, it worked for them, and I think
Speaker 1: that's the point that we do what works for people.
Speaker 2: Yeah, And I think that is the point because being
Speaker 2: militant about whether as a birth provider, whether someone should
Speaker 2: be coached or should be having spontaneous pushing, that's sort
Speaker 2: of not up to them, is it. It's up to
Speaker 2: the person who's doing the pushing.
Speaker 1: Of course. Yeah. Of course, we don't know for a
Speaker 1: fact that coaching works better than non coaching, So it's
Speaker 1: not like we've got evidence that the strong evidence that
Speaker 1: it helps.
Speaker 2: Yeah, you talked about epidural Can we just flesh that
Speaker 2: out a little bit, yep, because that is a bit different,
Speaker 2: isn't it.
Speaker 1: It is. If you've got a really strong you may
Speaker 1: not get an early urge to push, and in fact,
Speaker 1: you may not get an urge to push at all,
Speaker 1: and you may not get an urge to push until
Speaker 1: the head is like literally half out. So that's a
Speaker 1: downside of epidurals is that it might lead the push
Speaker 1: phase to be a bit less efficient. We don't think
Speaker 1: that that necessarily leads to problems, but it can lead
Speaker 1: to somebody who's fully dilated, their heads very close to
Speaker 1: out and they're like, when should I push? So I
Speaker 1: think that person would really benefit from coach pushing because
Speaker 1: we can often if they're completely pain free, because their
Speaker 1: EPI is very dense, very effective, then we can watch
Speaker 1: the watch the fiddle heart rate manta, the line that
Speaker 1: observes the contractions, tell that woman when there's a contraction
Speaker 1: and get her to start pushing. And it's cool to
Speaker 1: watch because eventually she'll she'll push because she's been coached
Speaker 1: to push, But then a point comes where she goes,
Speaker 1: oh okay, fine, I can feel at it's very common
Speaker 1: for an epidural to actually blockle all the pain, and
Speaker 1: eventually the head will come down so far that the
Speaker 1: pain comes back, and then she goes, oh, okay, okay,
Speaker 1: now I want her to push, And that's a good moment,
Speaker 1: right because that because you know, you close home. Yeah,
Speaker 1: And speaking of close to home, the other thing that
Speaker 1: you can see when someone's pushing like a champion is
Speaker 1: the is the aanus will open and sometimes a bow
Speaker 1: motion will come out. And people get super worried that
Speaker 1: that's going to happen and that they will be embarrassed
Speaker 1: by that or something. But your key gives will never
Speaker 1: be happier than when that happens, because it means that
Speaker 1: the head's about to come out.
Speaker 2: Yeah, there's not room for both.
Speaker 1: Yeah, No, that's right. So and it's it's not you're
Speaker 1: not having a bow motion in the usual way. What's
Speaker 1: happening is that is the baby's heads pushing against the
Speaker 1: bow and causing it to open. Yeah, and that means
Speaker 1: you're nearly there.
Speaker 2: Yeah, And sometimes you won't even know that that's happened
Speaker 2: like that, we're pretty discretable, very discreted. It whipped away
Speaker 2: and there we go and can you now describe the
Speaker 2: different positions that you've seen women get into two push.
Speaker 1: Yeah. Again, this is a personal preference situation, and there
Speaker 1: is not, to the best of mine, powerful evidence about
Speaker 1: what's the best one. But anywhere from on your back
Speaker 1: to on your back with your legs in the air,
Speaker 1: to on your side, to standing up to squatting, they're
Speaker 1: all a matter of personal preference.
Speaker 2: One on, one knee, one leg extended, like, there's just
Speaker 2: every every variety whatever, and it's up to the care giver,
Speaker 2: to the birth provider to manage that because I would
Speaker 2: imagine you end up being a bit like an acrobat.
Speaker 1: Yes, and that I hope there aren't too many institutions
Speaker 1: worldwide who are trying to limit this for people. But
Speaker 1: one of the problems, one of the things we do
Speaker 1: like to sort of take care of in hospitals is
Speaker 1: the health and safety of the people who work there.
Speaker 1: So what we're looking for, if possible, is, for example,
Speaker 1: if someone wants to give birth in a squatting position,
Speaker 1: then we tend to put a bunch of mats around,
Speaker 1: so not only is the woman standing on a soft mat,
Speaker 1: but the caregivers can get down on the ground, Yeah,
Speaker 1: and help her with easing the head out, supporting the
Speaker 1: peraneum with crowning. And if you're going to do that,
Speaker 1: then you need to be down there near the ground
Speaker 1: where the baby's going to come out.
Speaker 2: Can we talk a little bit about when the head
Speaker 2: is actually on view and the ring of five people
Speaker 2: talk about?
Speaker 1: Yeah, so that's a very unpleasant sensation of burning that
Speaker 1: happens when the skin around the vaginal opening is really
Speaker 1: stretched as the head crowns up. And what we're kind
Speaker 1: of looking for at that stage is that the head
Speaker 1: will crown up slowly. And I always say to be
Speaker 1: what we're trying to do here is ease the head out,
Speaker 1: not blasted out. Okay, blasting the head out is sometimes
Speaker 1: the result of an irresistible urge to push. Can't help it,
Speaker 1: push really hard, bang, head shoots out in one go
Speaker 1: and there's a bigger tear. And there's actually quite good
Speaker 1: evidence that supporting the paranem helps with tearing, so that
Speaker 1: if we have an obstetric caregiver helping to support that
Speaker 1: perineal tissue between the vagina and the anus by giving
Speaker 1: it a little pinch between thumb and fingers, that we
Speaker 1: can support that tissue and help the head slowly ease
Speaker 1: out rather than blast out and cause a tear.
Speaker 2: So you're pushing, pushing, pushing all you might, but once
Speaker 2: you get to that stage, you're breathing your book.
Speaker 1: Yeah. So there's a few techniques there isn't there. There's
Speaker 1: the toff and puff method because it's hard to really
Speaker 1: push down for firmly towards your anus if you haven't closed.
Speaker 1: Your glottis in your throat. So so the most effective
Speaker 1: way to push down, imagine trying to do the World's
Speaker 1: biguse poo is we close. I've got a script, and
Speaker 1: it's hard to do that if you're also going yeah.
Speaker 1: So that the idea is not that the huffing puffing
Speaker 1: really does anything. It just stops you pushing so hard.
Speaker 1: Ah yeah, radio, So that is a technique. And the
Speaker 1: other is just to say, Okay, I want you to push,
Speaker 1: but you gotta wind it back. I want to show
Speaker 1: me a fifty percent push, Yeah, show me a twenty
Speaker 1: percent push.
Speaker 2: And things to expect is that the team might have
Speaker 2: like a warm flannel on your paraneum yep, just to
Speaker 2: help with that hearing as well.
Speaker 3: Yeah, yeah, that's right, right, at the end, let's talk
Speaker 3: about prolonged pushing, because you know, we've talked about pushing
Speaker 3: a baby out, but we haven't really talked about.
Speaker 2: How long is too long? Yeah, and what are the
Speaker 2: dangers of pushing for too long?
Speaker 1: There are some dangers in being fully dilated for too long,
Speaker 1: but they apply to being fully dilated to very long.
Speaker 1: So if we look across the developing world today in
Speaker 1: twenty twenty five, in communities where women don't have access
Speaker 1: to expert obstetric care, there's still a phenomenon of getting
Speaker 1: to fully dilated, can't push the baby out. Powers is
Speaker 1: now baby's in a bad position, babies too big, and
Speaker 1: then without an expert intervention, that baby sits there for hours, days, weeks,
Speaker 1: baby dies. Women develops some obstetric fistula, so the pressure
Speaker 1: of the head in the pelvis means that blood can't
Speaker 1: get down to the vaginal and perennial structures, and it
Speaker 1: might be able to get in under arterial pressure, but
Speaker 1: it can't get out under venice pressure, and that tissue
Speaker 1: becomes necrotic, breaks down, and the tissue dies. Are causing
Speaker 1: an abnormal tract between the woman's bladder and vagina or
Speaker 1: balance vagina, and this is still a problem in the
Speaker 1: developing world. In developed countries, the issue is not that
Speaker 1: when not we wouldn't sit around till anything like that happened.
Speaker 1: The problem is more that we've only got so much
Speaker 1: pushing power, and that if we've been pushing for so long,
Speaker 1: it's very likely that they're getting less effective as we
Speaker 1: go along, and the chances of us getting over the
Speaker 1: line for an unassisted vaginal birth are going up. Sorry,
Speaker 1: the chances of us getting over the line for an
Speaker 1: unassisted vaginal birth are going down. The longer we wait.
Speaker 1: They's tending to think, oh, for wait a bit longer,
Speaker 1: I'll get there. No, there's a point where you're actually
Speaker 1: less likely to get there by waiting, because that any
Speaker 1: contractions after that point are quite ineffective. So that's led
Speaker 1: to this idea of there being time limits at full dialtation.
Speaker 1: They have to be interpreted interpreted with some some caution
Speaker 1: and with flexibility. You might have somebody who's been fully
Speaker 1: dilated for three hours, but it's still quite obviously pushing
Speaker 1: extremely well. Well, if the woman's well and the babies well,
Speaker 1: can't see the harm and keep going. But you might
Speaker 1: come in and someone saying I just I cannot push anymore.
Speaker 1: And so in broad terms, people tend to push pretty
Speaker 1: well for about two hours, and sometimes it's necessary to
Speaker 1: push for an additional hour if there's an epidural because
Speaker 1: of that issue with the epidural taking away some of
Speaker 1: the urgency to push. So does it mean you freak
Speaker 1: out and get the forceps out of that when the
Speaker 1: time move it's up. No, it just means that we
Speaker 1: move towards a model where we might go, where we
Speaker 1: might ease away from doing nothing, towards considering doing something.
Speaker 1: Make some funt calls, make sure there's someone in the
Speaker 1: room with the expertise to intervene if necessary.
Speaker 2: You can talk saying that you've got the ability to
Speaker 2: sort of make those decisions. But there are some hospitals
Speaker 2: that are heavily protocolized about time of pushing.
Speaker 1: Yes, and I think think they're probably hospitals in the
Speaker 1: developed world where they're more they're very comfortable with intervention.
Speaker 2: So again it might be worthwhile just asking that question.
Speaker 1: What would happen in this situation? Yeah, yeah, that scenario
Speaker 1: that I just described is really one where the baby
Speaker 1: as well. If we run into a situation where woman's
Speaker 1: been pushing for two and a half hours and now
Speaker 1: the baby is showing on monitoring the field heart rate
Speaker 1: or listening to the fieldal heart rate that there are
Speaker 1: distinct decelerations in the field heart rate with every contraction
Speaker 1: that are starting to take a long time to recover.
Speaker 1: That's a baby that is struggling to manage physiologically with
Speaker 1: the last bit of the labor and that's an indication
Speaker 1: for intervention.
Speaker 2: Is there also an indication for intervention because you're trying
Speaker 2: to prevent prolapse helvi golgen prolapse then or future?
Speaker 1: Yeah, that's a good question. Women who've had prolonged second
Speaker 1: stages are potentially at higher risk or developing pervict corgan
Speaker 1: prolapse and needing surgery for that later on. It's a
Speaker 1: little hard to know sometimes whether the problem with the
Speaker 1: pervic floor was created by the prolonged pushing or created
Speaker 1: by the passage of the large baby yeah, chicken or
Speaker 1: the egg which actually did the harm. And probably if
Speaker 1: we look at someone who needs prolapse surgery in their
Speaker 1: forties and we look back at their obstetric history, we'll
Speaker 1: more commonly see things like a baby that came out
Speaker 1: op so looking up instead of down, or a baby
Speaker 1: that was more than four and a half kilos, or
Speaker 1: one or two babies that required forceps. Those things are
Speaker 1: more likely to appear in that woman's obstetric history rather
Speaker 1: than just prolonged second stage.
Speaker 2: Yep, we don't want to put people off pushing. Now.
Speaker 2: We promised people three of your top tips far away. Good, Okay,
Speaker 2: what's your number one.
Speaker 1: I think that if you are pushing coach or actively
Speaker 1: pushing coached, or otherwise, there's a I have noticed without
Speaker 1: formal evidence, this is a experience that a good technique
Speaker 1: is to wait for the contraction to start and be established,
Speaker 1: let it ramp up a little bit, take a big
Speaker 1: breath in, put your chin down towards your chest, and
Speaker 1: push firmly down towards your backside.
Speaker 2: Yeah, because sometimes you've come home and you've said, yeah,
Speaker 2: I just I want to tell people that effective pushing
Speaker 2: isn't going.
Speaker 1: H Yeah, So that's true. I mean, you can make
Speaker 1: as much noise as you want, but if you're making
Speaker 1: a lot of noise, you can't also be doing that technique.
Speaker 2: Oh, I didn't mean about the noise. I meant, like,
Speaker 2: you know, making the noises if you're pushing, but actually
Speaker 2: nothing's actually concentrated down at your belly.
Speaker 1: Level, So just making the noise isn't enough, And in fact,
Speaker 1: really really good pushing makes less noise because you're push
Speaker 1: the power down. Yeah with the goddess closed. Yeah okay,
Speaker 1: so so that so that's number one. That that's a
Speaker 1: a technique that I've seen time and time again to
Speaker 1: be quite effective for pushing.
Speaker 2: All right, what's your second tip?
Speaker 1: Ah that if you that if you're going to have
Speaker 1: coached pushing and you want your team, your support people,
Speaker 1: your partner, whoever's there as part of that, word them
Speaker 1: up first, go to the classes, work out how to
Speaker 1: do it, and let that person have the confidence to
Speaker 1: talk them, to talk you through it, to count them
Speaker 1: down with you, whatever, whatever you want. But work on
Speaker 1: that support person's confidence to really own that role.
Speaker 2: And find out if that person who's pushing things that
Speaker 2: actually she wants something different. She doesn't want a coached
Speaker 2: pushing stage. What does she want.
Speaker 1: The person who's doing the coaching needs to be open
Speaker 1: minded to the fact that the plan might change. Yeah. Okay,
Speaker 1: so first tier, you don't know exactly how much got
Speaker 1: hurt and you might change your mind.
Speaker 2: Yeah, yeah, just don't be a deer in a headlight.
Speaker 1: Yeah, well exactly, yeah, that's exactly right. So your job
Speaker 1: is there as a support and encouragement person, and it's
Speaker 1: important to own that role, step up and do it. Yeah,
Speaker 1: even though you're in a weird situation and there's you're
Speaker 1: in a hospital and people are around and you feel
Speaker 1: like you can't have an active role in that situation.
Speaker 1: The challenge is to still is to do it anyway.
Speaker 2: And I reckon one of our my tips is with
Speaker 2: that support person, work on what words of encouragement you
Speaker 2: want to hear.
Speaker 1: Yeah.
Speaker 2: So I mean not that you ever say this to me,
Speaker 2: but I can't stand being told I'm a good girl
Speaker 2: and you know you've done something, Oh good girl.
Speaker 1: It's like oh yes, but no, yeah, this is a
Speaker 1: job for a woman.
Speaker 2: This is a woman's Yeah.
Speaker 1: Yeah. Yeah.
Speaker 2: It might be like you're doing so well, you're nearly there,
Speaker 2: You've got this. Gosh, you're strong, like I can see
Speaker 2: you're working so hard, whatever it is, But work on
Speaker 2: those words of encouragement together beforehand, because you might just
Speaker 2: be repeatedly saying something that your partner are saying would
Speaker 2: you shut up in her brain? And she doesn't need that,
Speaker 2: she needs you to be sort of helping her.
Speaker 1: Absolutely, And then I guess the third one is changing position.
Speaker 1: So if you've been pushing for a while, it really
Speaker 1: doesn't doesn't feel to you like that is working like that,
Speaker 1: that that those pushes are effective. Then maybe you know
Speaker 1: that they're ineffective. Then maybe they're Maybe they are ineffective.
Speaker 1: Maybe you're really not in a great position. And sometimes
Speaker 1: we'll see somebody change over to all fours or something
Speaker 1: like that and suddenly, bang, it's much better. Just that
Speaker 1: they just have more of a knack of automatically naturally
Speaker 1: pushing in that different position. So definitely like that. And
Speaker 1: then when we're right at the business end and that
Speaker 1: the heads crowning, a tip is being being open to
Speaker 1: paraneal support.
Speaker 2: That's four tips. Okay, you've got four tips people.
Speaker 1: Being open to paraneal support.
Speaker 2: Ye.
Speaker 1: Yeah, there's there's good evidence that paranoral support reduces nasty tears.
Speaker 2: Right, all right, everyone, I hope that's given you enough
Speaker 2: information to.
Speaker 1: Push like champions on.
Speaker 2: No one's watching, everyone will be watching. No, No, you've
Speaker 2: got it, you've got it. If you have the ability
Speaker 2: and the power to push your baby out.
Speaker 1: Those tips are useful and some things that I've seen
Speaker 1: work very well in the past. H and thank you
Speaker 1: for listening.
Speaker 2: If you like our information, you want more, We've got
Speaker 2: our free newsletter. Jump onto our website which is grow
Speaker 2: mybaby dot com dot au and you can sign up
Speaker 2: for our free newsletter which just gives you weekly tips
Speaker 2: that mirrors your whole pregnancy. Really useful.
Speaker 1: Sounds good?
Speaker 2: All right, have a great week. We'll see you next week.
Speaker 1: Thanks for listening, everybody, Bye and our