This is always a hard one for me. I feel like I've seen some really beautiful labors get completely F*%#'d with and completely overtaken when the cervix hits 10cm. It's my birth wound too so it hits a passion project in me. If I could change anything about how birth is managed (I have a list, but if I could only pick one) I would change how the birthing phase is handled. You wanna know why? What the American medical system does in the second stage of labor or the birthing phase is complete bullshit and it's not based on physiology.
There I said it.
Let's think about it for a second, all of a sudden after a cervical exam, the provider proclaims you are 10cm and asks you to give them a little push to see how you do. You are now flat on your back exactly where you didn't want to be and next go the legs in the stir-ups. You feel the bed lowering. You feel like you have no choice. They take the bottom of the bed off, set up their stuff. You feel like you have no choice. All of a sudden you have a surge (contraction) and you're told to hold your breath and push push push, push until you can't push anymore. You feel you have no choice. You hold your breath, push and curl around your baby like they told you to and you hear things like "is that all you have? Come on deep breath in again and push, don't waste the contraction. Give it all you've got."
Push, push, push. Yelling, coaching, telling, demanding. Is that encouragement?
Where do I start with what's wrong with all of this?
....first off there's holding your breath to push against your already stressed pelvic floor and perineum causing long term damage. When you hold your breath you close the opening to get out. Go ahead, try it. Hold your breath and push and tell me how your pelvic floor feels? Pretty tense and closed up huh? How's a baby supposed to move through that?
Then there's the hours of unnecessary pushing before you even see the baby's head or know if the baby has done the internal rotation and extension they need to do to line up correctly to get out smoothly. Did you know in the European birthing model and specifically the British model, they don't even talk about pushing or breathing down anything, until the head is visible? Makes sense doesn't it? Don't do something before it's ready. You wouldn't sit on the toilet and push needlessly right after a meal. Why is this any different? Your baby isn't ready so why would you rush the process and cause distress, exhaustion and stress to both baby and mother? The American model forgets there is 2 stages in the birthing phase (aka 2nd stage) There's a Latent (restful) stage and an active stage. More on that in a minute.
Another point I'd like to make is, when you start pushing based solely on dilation it's one tiny piece to a larger puzzle. Where's baby in the pelvis? What is baby's position? Can you see baby's head? Can mother feel baby's head? There's no mention of letting baby have more time to rotate. As you are purple pushing or "Valsalva pushing", you are possibly and probably jamming babies head against a point they are not supposed to hit or in a position they are trying to get out of. Your baby may be showing signs of distress with the lack of oxygen when you are holding your breath for so long and over a long period of time. Pushing for hours when it's not needed and then exhaustion sets in. This is when you get the "failure to descend" stamped on your medical chart. This is when many are told, forceps, vacuum or cesarean. When all they needed was time, to get off their tailbone, and move their body.
Wanna know another thing wrong with pushing just because you are 10cm's? 10 cm actually means very little to me. Don't get me wrong, being fully dilated is an important step in the process, but do you wanna know a fun fact? Figuring out your cervical dilation is very subjective. It's based on 2 fingers spread apart and everyone's hands and fingers are different sizes so you get the idea. One provider could say one thing and another, will possibly get another number. Wanna know another fun fact? They just can't feel the cervix past a certain point so when they say you are xyz past 6cm's it's kind of a guess. When they say you are 10cm, they just can't feel or find the cervix.
The other piece that is typically robbed from typical hospital births is after you go through the intensity of transition to get to 10cm, what is meant to happen is a period of rest. My mentor, calls it the quietude, the rest, the nap. This is the latent time in 2nd stage. This is the time that your body needs to have in order to reset and go into the next phase of labor. The active birthing phase or active 2nd stage. When the cervix is fully dilated and the baby moves out of the cervical opening and begins the journey through the pelvis and then into the birth canal ( which is only 3.5-4 inches long) There's a series of cardinal movements that the baby does to maneuver through the pelvis (Here's a link to my favorite youtube video). After that, the baby will extend past the pubic symphysis which triggers the Natural Expulsive Reflex (NER) which aids baby in getting down and out without very little help from you. It causes an uncontrollable urge to bear down. Since at this point baby in an "S" shape (vs being tucked and in a "C" position), they are ready to birth and baby's head molds through the vaginal canal with the aid of the NER and the thickening fundus. Baby should ooze out, not be shoved out. So take the damn nap and ask them to leave you be until you feel the urge to push.
Back to the NER. I want you to think about it. Think of all the sphincters in your body. How do they react to something that needs to get out of your body? They open and release it and I'm sorry but your baby is no different from the other less than ideal things your body sometimes needs to release. The NER takes over so that you don't have to push for hours on end. Now think about this...Why is it that the uterus is the only muscle in the human body that doesn't function as nature intended? How come we are told so many lies about the natural functions of female born people? Why does the media portray birth to be so terrifying? To make money, that's why. Boring normal physiological birth doesn't make the bank. So we are fed fear and misinformation. Just check out the link above to see how ridiculous it is!
So why is this happening? What I suspect and have been told by the various doctors I've been privileged to teach, is that it's what's being taught in universities, and fostered in their residency. They break you down in residency and it makes you more susceptible to following suit instead of breaking the mold like they likely planned on. I don't have a clear answer for you on how to make it stop, but what you can do is stand up and ask questions about how your provider treats the birthing phase? Will they sit on their hands and only help when actually needed? Will they force you in a position that is more convenient for them, but completely goes against birth physiology? Do they frequently do episiotomies? Also ask them, how many actual physiological births have they witnessed? Will they support you in your choice to let your baby birth gently into the world and not purple pushed out? Will they support your choice of position and keep the bed intact. (You can put this in your birth preference list btw) You can always show them facts and data or find someone that will. I've had clients switch at 37/38 weeks!
I attached a graphic below and here is a link to data from Constance Beynon to help you and your provider understand the benefits of undisturbed birth.
Sounds fun huh? This is what happened to client after client and I'm fed up. A few have even been restricted in movement or told no, they can't move.
Blows the mind.
Like I said, they often break down the bed, preventing you from being able to birth on all fours and vertical like our bodies and physiology need us to. It's low-key confinement in my opinion. Do you know what I tell people I work with? If there is nothing wrong with you or baby, just move anyways, what are they going to do? Strap you down? Kick you out? No they will not and if they do, I smell lawsuit. Have your partner or doula help advocate for you. The providers are not in charge of you and it's not the law. They work for you. Don't forget that. Birth the way YOU need to!
Want to take a class with me? Please do! You will leave knowing about your amazing body and baby. You and your partner will know your rights and how to support birth hormones and what it needs to unfold on your terms. Reach out here! We go over this and soooo much more in all of my childbirth education classes so be sure to join in person if you are local to Manchester CT or virtually if you are on the East coast or Central time! Can't wait to work with you!