• Coached pushing – are there any benefits?

    Date: 2010.10.13 | Category: Birth | Tags: ,,,

    Coached pushing, the practice where birth attendants shout “PUSH, PUSH” when they conclude that it is now time for pushing, is something everyone has probably heard of, or seen on television. The practice is still extremely widespread, and not only OBs do it. My homebirth midwife practiced coached pushing, something that made that portion of my labor slightly unpleasant. Let’s take a look at coached pushing, and why it is done. Are there any benefits?

    Coached pushing probably emerged as common practice in labor and delivery wards at the same time that anesthesia, most commonly epidural anesthesia, did. It does make some sense that laboring women need to be told when to push if the entire lower half of their body is numbed to the extent that they cannot feel what they are doing. However, coached pushing was extended to every laboring woman, and has now long been seen as normal practice. What could the benefits of coached pushing possibly be? Wouldn’t women know how and when to push all by themselves?

    Studies in to this topic (such as this one here – you’ll have to scroll down a bit) consistently show that there are no benefits of coached pushing, at least not for mothers and babies. Coached pushing has been found to reduce the duration of the second stage of labor, by a grand total of 13 minutes on average. Arguably, this could be seen as beneficial to birth attendants who would like to get home as soon as possible. At the same time, coached pushing probably satisfies the need of obstetricians to do a bit more than standing around, watching the natural process of birth unfold. But do those reasons justify coached pushing? Not if you take into account that there are risk involved too.

    In the above study, neonatal outcomes were the same in the coached pushing and physiological pushing groups, and there was no difference in the number of tears either. The risk of coached pushing include a higher possibility of maternal pelvic floor damage, and a reduced oxygen supply to the baby. If you’d like to take a look at some of the studies about coached pushing vs physiological pushing, Rixa Freeze has some great links (and a nice article!) here – Lie down and PUSH!!.

    To answer the question whether coached pushing has any benefits, the answer is a clear no. Pushing with the urge to push could potentially increase the length of the second stage of labor (yes, by 13 or so minutes), but that is not necessarily a disadvantage. My own experience with coached pushing was unpleasant. I did not expect my homebirth midwife to engage in it, but she did. Besides telling me when to push, she also told me that the baby needed to come out “NOW” (why?) and that I was putting her life at risk by not pushing when the midwife was telling me to. I did not have the urge to push when the midwife told me to push, but I did vomit every time I pushed anyway.

    My second birth, in comparison, was completely different. I gave birth completely solo. Nobody told me when and how to push, and I could assume whatever position felt most comfortable. At some point I realized that I was bearing down, and that the baby would soon arrive. I remember wondering if I should refrain from pushing, but then I noticed that my body was making me do it. My son was born very soon after. You can read my son’s unassisted homebirth story here.