The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

How Homebirth Mom Handled Long Pushing Stage

I was curious, how do midwives handle a delivery where the patient is going without pain medication, and has pushed for hours and been unable to move the head down, because either the head is too large for the pelvis, or the mother is too tired to keep pushing (i.e., a situation where a doctor might use forceps or a vacuum).

I'm not a midwife, but rather had a homebirth, and I'd like to share how my midwives handled something similar to what you describe.

Not that transport is never needed, but there are a few reasons why the baby getting 'stuck' happens less often at home ...

• birthing positions like squatting (often supported from behind) and all fours open up the pelvis a great deal more than supine -- up to 30% more for a good squat, if I'm remembering correctly. Also, it's fairly common to move to the toilet if pushing seems to be ineffective. Psychologically we're used to opening up on the toilet to expel, so that often helps.
• allowing the latent phase between transition and pushing to do it's job (i.e. taking up slack of vaginal wall, letting the top of the uterus shorten to adjust to the smaller volume inside after the head is more engaged, giving the baby time to correct positioning on it own like many will do during the latent phase). If there is immediate maternal urge to push it's usually b/c everything is set up right; if it diminishes (according to my reading) it's usually b/c the body needs to make adjustments, which it can do if given the time. I had a latent phase myself ...

Can you tell me how the above most likely would have been managed in a hospital? Specifically: a woman in transition for several hours with no urge to push, dilated to 10 cm with partial os swollen and baby presenting at a slight angle (sorry I can't be more specific about presentation -- at the time I wasn't paying attention to the minute details they were discussing). Also of note the fht were excellent all the way through and when the waters broke they were crystal clear.

I was able to avoid drugs, episiotomy or any type of mechanical assistance and push my baby out on my own. Of course they stepped up the frequency of doptone 'monitoring' and encouraged me like the dickens. Maternal attitude going into the pregnancy and labor has a lot of do with it. I was internally motivated to birth my baby without medical interventions. Some midwives (good ones) will 'risk someone out' if they feel that the woman does not want to take on the responsibility for herself. I view medicalized births (in most cases, not all) to be a way to give up responsibility to the doctors and their machines. Sometimes needed? Of course, but usually or always? NO. But if a woman wants to have her birth managed for her, then absolutely she should be in a hospital. No one ever said everyone should birth at home with a midwife; that would be absurd.

Also, IMO, the attendant's attitude toward the whole thing can work wonders. If someone has said "Oh, things aren't going so well!" or "It looks like your baby is crooked; we need to ..." I would have fallen for it hook line and sinker. On the other hand hearing affirmative and empowering statements like "You can do this; you're baby will be here in a little while; you're baby is doing great (after listening to fht); you need to get up and adjust your baby, here we go!" can go a long way in keeping the mother focused on what she must do to give birth. IOW - if you tell a woman she can't birth her baby (i.e. 'we have to do such and such a procedure') instead of giving her body time to do it in its own way, then of course she's going to require mechanical intervention! You're telling her that she needs it at a very suggestible time; even a woman with the firmest resolve can crumble while in transition if she's not well-supported.

So far as maternal exhaustion goes I'm sure there are many ways to handle it ... some might try ginger root tea or a molasses enema or some other herbs. (A few midwives work with herbs, but I think most do not; mine do, which is important to me). Also, my midwife highly suggested napping every day the last few weeks to ensure my being well rested for birthing (she really pushes this for first-time moms). And for the last few weeks of pregnancy I took evening primrose oil (very high in essential fatty acids and helps keep energy levels up, but it's only advised once you're already 36 or 37 weeks since it can soften the cervix). People who plan to birth at home do things a little differently than people who know in the backs of their minds that the machines and knives are close at hand. Again: attitude and different preparations. The mind is a very powerful tool in health, just look at the effects sugar pills have on people who really believe that they're supposed to do [fill in your effect here]. Or faith healers. Truly believing in your body's ability to birth without medical assistance goes a long way in making it happen.

Some other anecdotes: I have three friends who had homebirths who pushed for 3-4 hours ... again they had to shift the baby ... w/each of them the baby born with the hand by the head or face ... AND none of them required an episiotomy or had even the slightest tear (two first births one 2nd)! Since I've seen so many examples of what can go wrong posted here, I thought it only fair to post about what can go right!