Friday, April 21, 2006

Push

"Push," the obstetrician said, "PUSH!"

He was concerned because the baby's heart rate was dropping a bit and mother was not pushing effectively. The OB resident and the nurse in the room began calling "push", too. Pretty soon another nurse chimed in, and then the mother of the laboring woman. Soon there was a cacophony of shouts and accents, all exhorting the mother to "PUSH!"

It can get a little out of hand sometimes. There can be so many people yelling at the pregnant woman - in addition to the omnipresent TV - that she must not know who to listen to. The mingled shouts, I sometimes wonder, might confuse her more than instruct her. Sometimes I'll say, a bit sarcastically, to the NICU nurse with me as we wait to take care of the baby, "Do you think she'd push better if we started yelling push, too?"

I really prefer the way the midwives approach this aspect of delivery, the time when exhortation to push is needed. The midwives usually have a calmer atmosphere, and generally are the only person instructing the patient. The nurses in the room take their cues from the midwife's manner and don't raise their voices either. In the defense of the obstetricians, though, the midwives typically have low risk deliveries where the need to get the baby out might not be as urgent; also, there are are fewer people at a midwife's delivery, since the residents and medical students are not there. And, of course, some obstetricians take the quiet approach, too.

I think of this because of the recent delivery of Katie Holmes (congratulations, Tomkat!) and the discussion of silent deliveries that the Scientology church espouses. I think the Scientologists think it is better for the baby if there is silence. It may be preferable to have a quiet room, but anyone who takes care of neonates knows that they are so incredibly resilient that a little noise isn't going to do them much harm. For the mother, though, silence might be golden, or at least preferable to a chorus of "push."

P.S. Please welcome to the blogosphere Tales from the Womb, a new blog written by a frequent commenter on my blog, the neonatologist who signs himself Cherubsinthelandoflucifer.

17 Comments:

Blogger Ex Utero said...

I am sitting here laughing out loud. Its true. On one blog we talk about how bad home births are in terms of safety issues in the next, we freely admit what a weird world the DR is. This is a great site. I have smirked behing the mask many a time when there are 5 or 6 people yelling push, all of them staring at the baby's crown, hoping it will become a face. We do need to get our act together when it comes to thinking about how we could make the DR sane when deliveries are otherwise safe. On the other hand, I'd hardly put Scientology in the moderation category.

Thanks for the Webplug NeoDoc.

11:48 AM  
Blogger Sarabeth said...

For my one pregnancy in which I did push, I don't remember anyone yelling at me. I remember my husband giving me encouragement, and a bizarre phone call from my mother who wanted to speak with me while I was pushing, but no one yelled, "Push!" at me. I suppose I should be grateful for that.

12:26 PM  
Blogger Flea said...

Thanks for being bothered by the TV, ND.

I have had occasion to attend deliveries at which I turned off the TV in the room. No one noticed or cared.

That's just the problem. When American Idol isn't on, it's just a lava lamp to the folks.

Me, I care what's on TV. It would bother me very much if my baby were born during a beer commercial. It bothers me more that it doesn't seem to bother anyone else.

best,

Flea

5:47 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

The noise in the womb is somewhere between the sound of a vacuum cleaner and a chain saw. I wrote quite a bit about silent birth on my blog recently...and the what the baby hears in labor is muffled at best with all that noise! Once the baby is born and "out", the quiet and gentle handling is MUCH more important (as LeBoyer wrote.)

Ditto, Flea! :)

Hannah

6:56 PM  
Anonymous Anonymous said...

I have been mystified why the media has been making such a big deal about how weird the silent birth is- Cruise even said it doesn't apply to the mother. After watching Baby Story a number of times, I gave specific instructions in my birth plan and to my husband and doula that I did NOT want someone yelling PUSH, PUSH, PUSH at me. What happened? The nurse hollered PUSH PUSH PUSH at me anyway, and no one stopped her, and I was too busy to talk myself and tried to tune her out. The baby was not in distress, pushing did not go on for an unusually time- she just apparently liked the cheerleading part of it all. I hated it.

Fast forward a few years- after my distasteful experience the first time, I opted to drive to a different city an hour away for all my prenatal appointments so that I could deliver with a midwife in a birth center, not connected to a hospital. It was a really fantastic experience- they checked me and left us alone in a comfortable dim room to labor. Personally, if they'd had epidurals there, I would have given in and gotten one, because it was intense. Instead, I was in a tub and wow, did my body ever tell me when it was time to push. The midwife checked and let me go for it. The 5 other people in the room did not yell at me when to push and although I pushed a VERY short time (well under 10 minutes), I took a pause after the head was out and was tired with effort. The midwife simply spoke to me quietly to encourage me to fully deliver the baby. No bright lights, no yelling (except for me- a normally very quiet person; I roared through the pushing like I was trying to push a piano upstairs). What's so wierd about not wanting to have a roomful of people yelling at you while you give birth? I think people do it mostly because it's about the only thing they can do to make themselves feel useful in a normal birth, however misguided. Unmedicated, a woman needs no guidance on when to push. With an epidural, a simple instruction to do so would usually be appropriate.

12:37 PM  
Blogger neonataldoc said...

Thanks, everyone. Yes, the delivery room can be a wild and crazy place. I think we know what we can do to make it better. For a variety of reasons, though, many of them not good reasons,we don't do those things.

5:30 PM  
Blogger Dream Mom said...

As much as I endorse giving birth in a hospital, I still say we have a long way to go to making it a pleasant experience. If it were up to me, I would like a dimly lit room, maybe some candles, soft music, fireplace (hey, parts are exposed!), no yelling and fewer people.

Instead, when I delivered, it was extremely bright, there were a ton of people, all talking and joking around loudly as if it were just another day in the OR. It might be for them, but I just waited nine months and this was the biggest event in my entire life. I felt very, very out of place. I felt like I was entering a party where I wasn't invited. I was very uncomfortable. I was freezing to death during and after the birth (I had a c-section.)hence the fireplace reference. Yes, I do understand medically WHY it's cold, but my teeth wouldn't stop chattering it was so cold.

I know we aren't paying for the ultimate experience but sometimes healthcare just isn't real patient friendly.

Also, secretly hoping I won't be the lead comment on the next blog you write:)

7:05 PM  
Anonymous Lisa said...

I delivered my first son six weeks prematurely in the same hospital that the Bradley Quints were being born the same night. I came in with a ruptured membrane. They assured me that it would be several hours before my contractions began. Twenty minutes later it felt as if someone had touched the top of my uterus. With-in ten minutes I was having screaming contractions. The nurse came in to tell me to shut up. Ten minutes later the head was crowning, and the same nurse that told me to shut up was delivering my pre-mature son. Fourty-five minutes after my contractions started, my son was born weighing 4lbs. There was no support staff in the room because the premiere birth of the decade was happening across the hall. I didn't even have a OB...I had an LPN. A home birth may have been more acceptable than this because at least I would have had someone used to delivering babies on their own. My last birth was at the hands of an OB who would have made a better mid-wife. He doesn't do cesarians unless someone is going to die. After 36 hours of unproductive labor I breathed my daughter into life and kept my musculature at the same time. That became important two years ago when I needed that unscared musculature and skin to reconstruct a breast after a radical mastectomy. I can't imagine a silent birth. But I can imagine births that are less intrusive than what are experienced now.

9:52 PM  
Anonymous Anonymous said...

I'm being anon. here because, well, I don't wish to be public. I have had one child. I am a fit, athletic woman (distance running, alpinist, skier, weight training, etc.) and I've done a reasonable amount of body awareness training.

When it came time to push, it was the darnedest thing. I felt like I couldn't quite...get a grip on the baby to push? Recruit the correct muscles? I don't know. I said as much to the DR nurses--the doc was not in the room at that moment--they helped me move around until I found a position in which I could push effectively.

No amount of yelling and/or encouragement would have been effective.

A TV? In the DR? Man, how pathetic. But of course, my daughter is now over 16 yo, so maybe times have changed.

What I wish could have been different? Not the delivery experience--the DR nurses were great, and my ob-gyn was just like I thought he would be, kind of stiff but the guy you want if the wheels come off. The rooming-in situation was foul. One suitemate's visitors all reeked of smoke, there were at least five of them, and kept talking about somebody who had just died a particularly unpleasant death from cancer. The second seemed to be a woman with legal problems--there was a uniformed officer by her bed, while the mother keep howling, "I WANT my BABY!" The third was a lovely Hispanic family. We kept exchanging chagrined glances. Not a good experience, and we went home as soon as we could, which turned out too early for me (but not my child). I really could have used a night in the hospital.

7:37 PM  
Blogger Janae said...

Ditto Flea.

The TV was not on when I had my kids. I barely remember there being a TV in the room. The lights were dim.

All the excitement came after their births. My son was born with a true knot in his umbilical cord. I'm not surprised, considering just how active he was in utero. It was even more exciting after my daughter was born in a completely intact sac. She was calm while they suctioned the fluid out of her lungs, but once they were finished, she screamed for the next hour plus. She finally stopped screaming when the nurse washed her hair. It was very funny. It's not as funny now when she screams at the same volume.:/

I think that if there are going to be changes, it's going to have to come from the women pushing it thru, like they did with enemas, shaves, husbands in the room, etc.

9:24 PM  
Blogger cluelesscarolinagirl said...

Never given birth, but I remember the agony of nasal surgery. I was hyperventilating and feeling miserable and had to listen to the doctor loudly discussing the minute to minute accounts of his son's debutante ball the night before.

7:06 PM  
Blogger Jody said...

Hi, I am a L&D nurse. I don't yell push, but sometimes, it is necessary to instruct a patient on when and how long to push....case being an epidural.

I have had someone lay back and declare to me that they were done, and would no longer be pushing and to fuck off, all the while her babies HR was in the 70's....your damn straight I sat her up and yelled "push". Screamed it actually.

A time and a place for it.

Wonderful blog!

4:28 PM  
Anonymous Anonymous said...

there is rarely need for yelling.
A bit more information for mom if HR is dangerously low is much more effective.

In general I despise deliveries like that. All i can think of is "SHut the hell up" The worst is the "Get mad, Get mad at that baby!" Highly inappropriate IMO

8:05 PM  
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