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Our Charis Family
Physiological Pushing vs. Prolonged Valsalva Pushing
by Becky Rosser, Charis
midwifery student
The baby is almost
here …the anticipation builds… “Push, push, PUSH!”
The woman holds her breath, bears down, and pushes
with all her might… “1,2,3,4,5,6,7,8,9,10, good!” She does this again and again after reaching 10cm
until, at last, her baby arrives. This is
normal, right? Unfortunately, in most hospitals,
prolonged Valsalva pushing is still practiced
routinely during the second stage of labor. However,
there is an alternative, physiological pushing which
uses spontaneous bearing down and the body as a
guide for when and how to push.
Valsalva pushing is bearing down while holding one’s
breathe. Valsalva in itself is not only effective in
bringing about descent, it is necessary at some
point in most cases. However, with prolonged Valsalva there are many negative side-affects. Pushing with a closed glottis decreases the blood
returning to the lungs resulting in a
decrease of oxygenated blood leaving the heart. Consequently, there is a sharp drop in blood
pressure, decreased oxygen in arteriole blood, and
decreased oxygen to the baby. There is also
increased carbon dioxide levels leading to gasping
for air in panic and stress and a sudden increase in
blood pressure which overfills capillaries in the
face, neck, and eyes causing them to burst. Along
with these affects, an excess of blood remaining in
the head, face, arms and legs decreases the blood
flow and oxygen available to the baby. Prolonged Valsalva first came about when women started giving
birth in the lithotomy position in hospitals.
In this position
continuous bearing down while holding one’s breath
was the
most effective way to bring about descent and the
birth of a baby.
Although there are negative effects of prolonged
Valsalva, the Valsalva maneuver is sometimes done with
physiological pushing. There are spurts of bearing
down with a closed glottis lasting less than six
seconds with cleansing breaths between usually
occurring three times with each contraction. However, when this occurs spontaneously and the
woman is following her body’s lead, blood flow is
not constricted which means ample oxygen is being
supplied to both mother and baby maintaining a
healthy blood pressure as well as reducing fatigue. God designed a special reflex inside the vaginal
canal which causes a spontaneous urge to push. As
the baby descends down the birth canal, its head
stimulates the fetal ejection reflex which causes the
mother to bear down with
contractions. This spontaneous bearing down is
usually a combination of pushing with a closed
glottis and open glottis still allowing the flow of
blood and oxygen. The physiological urge to push
also uses contractions most effectively in bringing
about descent.
For the best interest of mother and baby, a
midwife should encourage physiological pushing. Using the effects of gravity often increases the
urge to push and aids in descent. The laboring woman
should be encouraged to push as her body tells her. First time mothers often need some guidance with
pushing as to where to direct the pushing and
sometimes to bear down some in order to bring
descent. It is also important to encourage breathing
throughout pushing as well as a cleansing breath
between each urge and avoid prolonged Valsalva.
As
with the rest of the birthing process, when a woman
goes into her instinctual state of mind and allows
her body to give birth to her baby, the outcome is
best.
Works Cited
Frye, Anne. "Active Pushing." Holistic Midwifery.
[Rev. ed. Vol. 2. Portland, Or.: Labrys, 2010. pp
444-449. Print.
Lowdermilk, Deitra Leonard, Shannon E. Perry, Kitty
Cashion, and Kathryn Rhodes Alden. Maternity &
Women's Health Care. 10th ed. St. Louis, MO: Mosby,
2012. pp 464-465. Print.
Osborne, Kathryn, "Pushing Techniques Used by
Midwives When Providing Second Stage Labor Care"
(2010). Dissertations (2009 -). Paper 44.
<http://epublications.marquette.edu/dissertations_mu/44>
Oshel, Susan (CPM)
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'Behold, I will
bring them from the north country, And gather them from the ends of
the earth,
Among them the blind and the lame,
The woman with child and The one who labors with child, together,
A
great throng shall return there...And My people shall be satisfied with My goodness, says the LORD.'
Jeremiah 31:8, 14
~~~
©2014 Charis Childbirth
Services, All Rights Reserved
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December 2014 |
