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Help the mother have a safe birth

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HealthWiki > A Book for Midwives > Chapter 12: Pushing: stage 2 of labor > Help the mother have a safe birth


Contents

Check the mother's and baby's physical signs


The mother's physical signs

Check the mother’s blood pressure and pulse every 30 minutes or so during stage 2 for signs of pre-eclampsia, infection, or bleeding. Write down the numbers each time.

If the mother’s blood pressure is 140/90 or higher she may have pre-eclampsia. If it suddenly drops more than 15 points in the bottom number, she may be losing blood. If her pulse is faster than 100 beats a minute between contractions, she may be dehydrated, have an infection, or be losing blood.

The baby's physical signs

The baby’s heartbeat is harder to hear in stage 2 because it is usually lower in the mother’s belly.

An experienced midwife with good equipment may be able to hear the baby’s heart between contractions. You can hear it best very low in the mother’s belly, near the pubic bone. It is OK for the heartbeat to be as slow as 70 beats a minute during a pushing contraction. But it should come right back up as soon as the contraction is over.

If the baby’s heartbeat does not come back up within 1 minute, or stays slower than 100 beats a minute for more than a few minutes, the baby may be in trouble. Ask the mother to change position, and check the baby’s heartbeat again. If it is still slow, ask the mother to stop pushing for a few contractions. Make sure she takes deep, long breaths so that the baby will get air. See some reasons why the heartbeat may be slow.

See information if the baby’s heartbeat is fast.

Support the mother's pushing

When the cervix is open, the mother’s body will push the baby out. Some midwives and doctors get very excited during the pushing stage. They yell at mothers, “Push! Push!” But mothers do not usually need much help to push. Their bodies push naturally, and when they are encouraged and supported, women will usually find the way to push that feels right and gets the baby out.

Let the mother choose the position that feels good to her


Half-sitting Lying on the side Hands-and-knees
This position may be the most comfortable, and makes it easier for the midwife to guide the birth of the baby's head. This position is relaxing and helps prevent tears in the vagina. This position is good when the woman feels her labor in her back. It can also help when the baby's shoulders get stuck.



Standing Squatting or sitting on a pillow Sitting on lap or birth chair
These 3 positions can help bring the baby down when the birth is slow.


Note: It is usually not good for the mother to lie flat on her back during a normal birth. Lying flat can squeeze the vessels that bring blood to the baby and the mother, and can make the birth slower. But if the baby is coming very fast, it is OK for the mother to lie on her back.


If the mother needs help pushing

A woman’s own urge to push usually brings the baby down best. But sometimes a mother needs suggestions for comfortable positions and methods of pushing. She may need help if she does not get an urge to push even after her cervix has been completely open for several hours — or if the way she is pushing does not seem to be bringing the baby down. Tension and fear can make it hard for her to open up and let the baby out. Or she may need help pushing when the baby is in trouble (his heartbeat is too slow) and the birth must happen very fast.

Here are 3 ways of pushing that often work well:

a woman panting.
uunnh!
uunh!

Pant pushing: The mother pants and gives several short, strong pushes during each contraction.

a woman making a growling noise.
aaarrrg!!

Moan or growl pushing: The mother takes a deep breath. Then she gives a long, low moan or growl and a strong push during the contraction.

a woman holding her breath.
nnnn..............

Hold-the-breath pushing: The mother takes 2 deep breaths, holds the second breath, and then during the contraction, pushes as hard and long as she can. She should keep her chin on her chest. This may be the best method if the baby is coming slowly.

During each push, the mother should keep her mouth and legs relaxed and open, her chin down on her chest, and her bottom down.

Sometimes women push down and pull up at the same time. This pulling holds the baby in instead of pushing her out. Pulling slows progress and makes labor more painful. Encourage the mother to hold her bottom down and keep her thighs relaxed and open. She can also try the hold-the-breath method for pushing.

a woman sitting with her bottom on a mat.
YES!
This mother is pushing her bottom down.
a woman sitting with her bottom up.
NO!
This mother is lifting her bottom up.

If the mother is tense or having trouble pushing, these things may help:

Ask the mother to change positions. Ask the mother to open her mouth and relax her jaw. Apply clean, warm, wet cloths to her genitals.
a woman making a sound as she relaxes her jaw.
uuu nhh!
Put a gloved finger about 2 centimeters into her vagina and press straight down towards her bottom. (Do not rub the vagina.)
Ask the mother to pull her knees up towards her body.
Support the mother's pushing
a midwife speaking to a woman in labor.
Keep pushing. Beautiful! I can see the head!

If a mother has difficulty pushing, do not scold or threaten her. And never insult or hit a woman to make her push. Upsetting or frightening her can slow the birth. Instead, explain how to push well. Each contraction is a new chance. Praise her for trying.

Tell the mother when you see her outer genitals bulge. Explain that this means the baby is coming down. When you see the head, let the mother touch it. This may also help her to push better.



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