Have you ever heard the term ‘Purple Pushing’?
I hadn’t either, until after I was diagnosed with a grade 2 cystocele (bladder prolapse) and a grade 1 uterine prolapse.
You read that right ladies, all that preaching I’ve been doing about being safe to prevent prolapse, well it didn’t save me.
And I’m about 99% sure I know exactly why.
Two and a half plus hours of ‘purple pushing’. Now the details of the pushing phase are a little foggy in my memory, probably due to the extreme fatigue I was hitting by that point. But I do remember on more than one occasion, grunting through a push and my midwife telling me to stop ‘pushing into my throat’… READ: shut up and bear down. Well when you bear down like that, you’re not only pushing your baby out, you’re pushing everything out. It’s really a matter of what gives first.
And you’re thinking ‘So what? Isn’t that what we’re supposed to do? That’s how it is in the movies, and on TV and in every birthing video ever‘
Nope. The research says otherwise. Actually, current UK & Canadian recommendations advise against directed pushing. Directed pushing is when the midwife or OB tells the woman when and how to push, usually at the beginning, middle and end of a contraction (that’s right, 3 full body, everything you’ve got pushes per 1 minute contraction) while they count to ten and you turn purple in the face (hence purple pushing).
I remember my midwife telling me 2 pushes per contraction wasn’t good enough. I remember thinking there was absolutely no way I had it in me to put that much effort in, 3 times, every couple of minutes. No wonder I was passing out between contractions by the time we transferred to the hospital. It just didn’t feel right. It felt forced, and painful, and wrong. Birth shouldn’t feel like you’re working against your body. It should feel like your body is doing this amazing thing and you’re kind of just along for the ride and helping out a little, which is what it had felt like for me up until that point!
The fact is that pushing like this not only is exhausting, it is not effective, it is damaging your body and sometimes can increase the risk for your baby to go into distress before they are out.
Boy can I speak to how exhausting it can be to push like that. It is essentially flexing every muscle in your body, while holding your breath, for 10 or so seconds, 2-3 times in a row, every 2-5 minutes. For those of you who’ve been through it, you feel me. For those of you who haven’t, imagine doing a 1 rep max squat, 3 times in a row. Not fun. This has also been found in the research, the effectiveness of the maternal muscles in contracting effectively to push out the baby is related to how frequently they are asked to contract. So if you contract 3 times per minute, rather than once, the muscle contraction gets progressively less effective, decreasing the efficiency of the push.
If a woman is allowed to push spontaneously when birthing (i.e. when she feels she needs to), it has been found that she instinctively pushes with the peak of the contract, once per contraction, thereby maximizing the efficiency of the push and making the most of the effort she is putting in voluntarily (if you can call it that). If you triple that effort, without any marked increase in effectiveness, it is possible the woman may become physically exhausted, before the baby is born, increasing the likelihood of an instrumental delivery.
This is exactly what happened to me. I was SO tired, and we intended on going to the hospital to use a vacuum to assist. So we took a break from ‘coached’ pushing, I was basically left to push voluntarily for about 10-15 minutes during the transfer, and I believe that, coupled with the moving around required to get to the hospital, helped Nugget get to the point where we didn’t need a vacuum after all.
I also believe that pushing like this is what has caused my prolapse. You see any time you bear down (think actively pushing out a poop, sorry if that’s too vivid for some, but I think we’re way past that if you’ve read this far!) you are putting pressure on your pelvic floor. The act of bearing down creates tension in the diaphragm, core muscles and directs all of the pressure created in your abdomen downwards, onto, you guessed it, your pelvic floor and all of those lovely organs sitting on top of it. So if you think, 3 pushes per contraction instead of one, thats 3x the amount of pressure placed on all of those muscles and organs. No wonder 50% of women who have given birth vaginally are estimated to have some degree of prolapse!
This act of holding your breath and pushing also increases the risk of harm to the baby. Let’s think about this logically: when you hold your breath, you are not taking in oxygen. Now, sitting on the couch doing nothing and holding your breath for 10 seconds probably isn’t a big deal. But when you’re literally flexing every muscle in your body and also you are the only source of oxygen for another human currently contained within your body, you are consuming oxygen at a much higher rate. And if there is less oxygen circulating in the mother, there is less oxygen getting delivered to the baby. There is even evidence that bearing down for more than 5 seconds can cause late-decelerations in the baby’s heart beat, often a precursor to an emergency c-section.
So why are we still holding on to the era of ‘we must actively push the baby out’? There are a lot of reasons. The medicalization of childbirth, where it is made to be the most convenient for the doctor, woman on her back, with an epidural working against gravity. Another is our bodies are no longer the bodies of ‘natural’ humans. We no longer hunt & gather, walk miles and miles each day, squat to forage and toilet. Our musculature is different than that of our ancestors due to the vastly different environment we live in. More often than not, we hold a lot of tension in our pelvic floor muscles, and those interfere with childbirth, especially when we are tense and scared of the event at hand. But if we were to take care of all of those variables, the fact is we wouldn’t have to actively push at all to give birth. Do you see elephants and lions and any other mammal that has a uterus holding their breath and grunting on those nature shows? No. 99% of the time the baby animals literally just fall out of the mother, after the uterus does all the work!
This is why we have to take care of ourselves in pregnancy, be educated about our rights and options, and choose healthcare providers that align with our goals and intentions. We have to be our own advocates and stand up (both literally and figuratively in this case) for what we know is right! We have to listen to our bodies, and I mean really listen. We have to get to know them in great detail, know every sensation, what is normal and what isn’t. That way when big events like this come along, we are prepared to work with our bodies instead of against them.
And above all, Squat!
Just keep squatting everyone.