Midwives in Kent, England, are recommending a big change to how women give birth, but one that could turn around outcomes that have caused some women to lifelong problems.
You know the birth scenes in movies where everyone's going, "Push, push, push"? Yeah, no more of that, according to the protocols of a new midwife-led program Medway Foundation Trust in Kent. Instead, when the big contractions hit, women are encouraged to stand or give birth on their knees. Instead of pushing, birth coaches encourage women to breathe through the contraction.
What's the big deal about pushing? It's not like these suckers are going to slide out on their own, right?
The problem with pushing, particularly when the laboring woman is lying flat or upright but reclined, is that it directs pressure fully on the perineum (the skin between the vaginal opening and the anus). Some doctors opt to surgically cut the skin—called an episiotomy—others leave it to tear. Nine in ten women leave birth with some form of tearing.
Either way, unnecessary and unintnetional damage is often caused—so much so it made the team Kent look for changes.
Dot Smith, head of midwifery at Medway Foundation, explained that the need to push is just a myth, but the need to protect the perineum is a necessity. “When we saw 22 cases of third-degree tears in a month, we said, '‘This is not good enough,'” she told the Daily Mail.
And the changes worked. "The protocol has reduced cases of traumatic tearing from seven percent to just one percent of patients, and successfully cut unintentional damage caused to the body during delivery by 85 percent in some maternity wards," Sarah Young writes in the U.K.'s Independent.
The team undertook this change after the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives called for action, after research found a disturbing and rising trend in severe tears to the perineum—nearly 14,000 women from 2013 to 2014.
While the U.S. counterpart to the RCOG, the American College of Obstetricians and Gynecologists, also recently changed their recommendations regarding pushing during labor. As Mom.me reported some months ago, they didn't call for an end to the so-called "Valsalva pushing," but they did encourage doctors to allow women who prefer to spontaneously push (i.e., push when they feel like it and without coaching) be allowed to do so.
They also said it's OK to not instruct women to push immediately after the baby's head has fully descended, and that waiting 1 to 2 hours—until she indicates her body feels like pushing—is safe and acceptable.
But with the dramatic reduction in tearing that they've seen over in this U.K. trial program, maybe actively discouraging timed pushing would be better for everyone.