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What are you expecting to happen during your labor and birth? Out of all the words you are expecting to hear from your healthcare provider, "PUSH, PUSH!" is probably at the top of your list.

Directed or coached pushing is a practice so frequently dramatized in films and on television that it almost seems like it's inevitable. Is it? Or is it time to rethink coached pushing? 

Why coached pushing?

Coached pushing, directed pushing, or purple pushing they are all terms to describe one and the same practice, the practice in which a woman in labor is told to push not when she feels the urge, but when the doctor says so. Do you feel the urge to push before the doctor is ready? Too bad, you should wait. Is your healthcare provider tell you to bear down when you do not feel the urge? Too bad, too. The doctor knows best, you know. Do they really?

What are the advantages of this widely-spread practice? Studies show that directed pushing during labor shortens the total length of a woman's labor and delivery. Does that sound legitimate? Perhaps so, until you hear that the time "saved" is only 13 minutes on average. Is a shorter labor really that beneficial if you have to spend it doing something that is totally counter-instinctive?

There is a situation in which directed pushing may be justified, however women who have received an epidural so strong that it numbed their lower body to the point they can't feel anything. Even women in a coma can push a baby out with no problems, it is interesting to note. Then there are women who make a point of "breathing the baby out". In other words, letting the body do the work all by itself without adding conscious force to it. When left alone, pushing usually happens whether you help or not. Let's get back to that question for a second. Why coached pushing? Beyond giving the hospital staff or attending midwife a sense of control over the unfolding labor process, I really don't see any point. What's more, studies show that directed pushing also increases the chance of fetal distress during the second stage of labor. Not only are the benefits of coached pushing rather dubious, the practice may actually be dangerous.

Spontaneous pushing vs directed pushing my experiences

You may wonder what it is like to labor with someone directing you when to push and when not to, compared to a completely natural labor in which the body does its own thing. I have two children, and had two vaginal births.

My first birth included coached pushing, while the second did not. Coached pushing was something I had not considered before going into labor, but I was not surprised when my midwife started directing me after I had indicated that I felt the urge to push. I remember protesting that I was not having a contraction when she told me to push, and then the midwife "warning" me that the baby had to be born "right now". It was an unpleasant experience. I was on my back, like most laboring women, and felt the need to vomit during my attempts to push without a contraction helping me.

Pushing with vomit in your mouth is rather hard. Directed pushing did not ruin my birth, and it was nothing I required grief counseling for later :). Still, I did have vaginal tears I may not have had otherwise. During my second birth, I could push with the need, and labor in any position I felt comfortable with. Feeling the pushing contractions and then how my body naturally started pushing was really interesting. Forcefully pushing along with the contractions was the one thing that alleviated the pain of these final contractions. My baby was born easily, and my body did its pushing work just fine! Do you have any questions about coached pushing, or would you like to share your opinion? Feel free to leave a comment here, or on our labor and birth forum.

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