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What happens if you push before dilated?

Some women will instinctively push before their cervix is fully dilated. This is often treated as a complication, and a common approach is to encourage the woman to stop pushing due to fear that cervical damage will occur. However, there is no evidence to support this concern.

midwifethinking.com - Supporting women's instinctive pushing behaviour during birth

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Include information about the physiology of birth in antenatal education/preparation. Reinforce the message that women have an innate ability to birth without direction. Provide an environment that facilitates physiological birth and instinctive behaviour – low lighting, minimal disturbance, comfortable furniture that supports mobility and movement (floor mats, beanbags, birth pool, shower). Avoid asking the woman if she needs to push, or feels ‘pushy’ as this may suggest that she should and could interfere with her inward focus and instinctive behaviour. If the woman tells you she feels the urge to push, reassure her that this is good, but don’t encourage her to push. There will come a point when she is spontaneously pushing rather than feeling an urge to. Avoid vaginal examinations to ‘diagnose’ full dilatation. If you are not going to provide instructions about pushing based on cervical dilatation, there is no benefit in knowing this information. Do not disturb the woman’s instinctive pattern of pushing and breathing. Avoid directions and, if you must speak, gently reinforce her ability to birth. Avoid directions or distractions as the baby’s head is emerging to facilitate the woman’s instinctive perineal protecting behaviours (such as gasping, screaming, closing her legs, holding her baby and perineum).

References

Aasheim V, Nilsen ABV, Lukasse M et al (2011). ‘Perineal techniques during the second stage of labour for reducing perineal trauma’. Coch Data Sys Rev, 12: CD006672. DOI: 10.1002/14651858.CD006672.pub2. Aderhold K and Roberts JE (1991). ‘Phases of second stage labor: four descriptive case studies’. Jour Nurse- Midwif, 36(5): 267-275. Aldrich C, D’Antona D, Spencer JAD et al (1995). ‘The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour’. Brit Jour Obs Gyn, 102(6): 448-458. Bergström L (1997). ‘”I gotta push. Please let me push”: social interactions during the change from the first to second stage of labour’. Birth, 24(3): 173-180. Borrelli SE, Locatelli A and Nespoli A (2013). ‘Early pushing urge in labour and midwifery practice: a prospective observational study at an Italian maternity hospital’. Midwif, 29(8): 871-875. Bosomworth A and Bettany-Saltikov J (2006). ‘Just take a deep breath: a review to compare the effects of spontaneous versus directed Valsalva pushing in the second stage of labour on maternal and fetal well- being’. MIDIRS Midwif Dig, 16(2): 157-165. Downe S, Trent Midwives Research Group, Young C et al (2008). ‘The early pushing urge: practice and discourse’. In: Downe S (ed.). Normal childbirth: evidence and debate, 2nd edition. London: Churchill Livingstone: Elsevier. Kopas LM (2014). ‘A review of evidence-based practices for management of the second stage of labour’. Jour Midwif Wom Health, 59(3): 264-276. NICE (2014). Intrapartum care: care of healthy women and their babies during childbirth. NICE clinical guideline 190, London: NICE. Prins M, Boxem J, Lucas C et al (2011). ‘Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trails’. BJOG, 118(6): 662-670. Roberts J, Goldstein S, Gruener JS et al (1987). ‘A descriptive analysis of involuntary bearing-down efforts during the expulsive phase of labor’. Jour Obs, Gyn Neon Nursing, 16(1): 48-55. Tieks FP, Lam AM, Matta BF et al (1995). ‘Effects of valsalva maneuver on cerebral circultation in healthy adults: a transcranial doppler study’. Stroke, 26(8): 1386-1392. Yildirim G and Beji NK (2008). ‘Effects of pushing techniques in birth on mother and fetus: a randomized study’. Birth, 35(1): 25-30.

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