One of the things women look for most in prepartum classes is to learn to push correctly at delivery; since during the phase of the expulsion the role of the maternal pushes are essential so that the baby can descend through the maternal pelvis and go outside.
Pushing is the force that the mother uses to push the baby through the birth canal. It is a reflex act as long as the woman is living her labor without an epidural, with which in these cases they are always done correctly, since without anesthesia and as long as the pregnant woman moves freely, and adopts the position that ask the body in most cases birth is physiological.
In this case we would talk about spontaneous pushing, in which the mother feels the need to push at the right time, in the right way, in the right direction and with the right intensity.
However, the generalization of the use of Epidural anesthesia It has made that on many occasions the woman does not feel those needs to push, does not know where to direct the push and cannot even exert the necessary force to help her baby to be born.
In these cases, health professionals should guide the woman (directed pushing), who does not feel the contraction, when to start and end the push, where to direct the force and sometimes, we can ask her to stop pushing.
This occurs at the end of the delivery period, when the baby's head is crowning through the maternal vulva, and the professional who attends the delivery (midwife or gynecologist) determines that the perineum is too tight not to tear if the mother continues to push with so much force; It is then that we try to eliminate the pushing force, leaving only the force of contraction and gravity to help the baby's head come out.
The goal of both spontaneous and directed pushes is the same. However, scientific evidence points out that the systematic performance of the second alters the physiology of childbirth, since it increases the probability of health intervention with instrumental episiotomies and represents a real risk for the perineum of women, which can cause injuries that they translate into urinary, gas, or fecal incontinence; pain in the perineum, coitalgia, prolapses, and other dysfunctions.
As we said before, pushing is a reflex caused when the baby's head rests on an area of the maternal perineum, and generally the urge to push appears with the contraction; in this way both forces are united, the force exerted by the mother with the abdomen and the uterine contraction.
Obviously, the direction of pushing is fundamental and although it seems obvious we must direct our force towards the vagina. It is a shame that postpartum women continue to come for consultation saying that the midwife or gynecologist told them that they should “push as if they wanted to poop”; Since by exerting so much force towards the posterior perineum (towards the anus) we lose not only effectiveness, but we also increase the risk of perineal injury.
Contractions and the abdominal press are the "motor of labor" which helps the baby to come out; the ideal would be to perform 3 pushes in each contraction, followed by a period of rest between contractions in which the mother and baby rest.
There are two types of bids:
1. Push on expiration or exhalation (open glottis): We take an inspiration and after finishing it, we slowly release the air while activating the transverse muscle (we imagine as if we were hugging the baby with the abdomen) and directing the force towards the vagina.
2. Apnea push (closed glottis): we take an inspiration and after finishing it we keep the air inside the lungs, we do not let it go; and in apnea we do the push. It is similar to doing a classic crunch, bringing the chin to the chest to keep the glottis closed and activating the rectus.
Pushing can be practiced in the last weeks of gestation, to have confidence on the day of delivery; to train the abdominal muscles and know how to perform them correctly. Normally they work in the maternal preparation classes with the midwife; But they can also be practiced privately in the office, where we sometimes use intravaginal devices that inflate like a balloon and resemble the baby's head.
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