Pushing before being fully dilated can lead to serious complications for both the mother and baby. Women are often eager to start pushing when they feel the urge, but following doctor’s orders and waiting until complete dilation is crucial for a safe delivery. This article will examine the risks, causes, prevention, and management of pushing too soon.
Quick Answers
– Pushing before complete dilation can cause swelling of the cervix, tear the cervix, or even rupture the uterus.
– It increases the risk of postpartum hemorrhage, fetal distress, shoulder dystocia, and infection.
– The main causes are the mother’s urge to push before being instructed, inadequate labor support, and failure to check for complete dilation.
– Doctors can help prevent complications by frequently checking dilation, providing encouragement during labor, and instructing the mother when it is time to push.
– If a woman starts pushing too soon, management includes stopping pushing, using deep breathing techniques, applying warm compresses to the perineum, and allowing labor to progress naturally.
What risks are associated with pushing before full dilation?
Pushing before the cervix is fully dilated carries several serious risks for both the mother and baby:
Risks for the mother
– Cervical lacerations or swelling – Pushing too soon can cause the cervix to swell or the delicate cervical tissue to tear. This significantly increases bleeding risk.
– Cervical rupture – In rare cases, the forceful pushing can completely rupture or “break” the cervix. This leads to severe hemorrhage and requires emergency surgery.
– Uterine rupture – Forcing out the baby before the cervix is open can also lead to rupture or tearing of the uterine wall. Rupture causes massive internal bleeding and is extremely dangerous for the mother.
– Postpartum hemorrhage – Lacerations and swelling of the cervix often lead to abnormal postpartum bleeding and hemorrhage.
– Infection – Tears in the cervix allow bacteria to enter the sterile womb environment, raising the risk of infection of the uterus, uterus lining, and pelvic cavity.
Risks for the baby
– Fetal distress – Pushing against an undilated cervix puts immense pressure on the baby and can cause changes in the fetal heart rate. It also reduces oxygen flow to the baby.
– Shoulder dystocia – If the baby’s head delivers but the shoulders get stuck against an undilated cervix, nerve damage and broken collar bones can occur.
– Low Apgar scores – Lack of oxygen from fetal distress results in lower Apgar scores at birth, indicating poor health.
– Infection – Bacteria can also enter the womb and infect the baby during delivery through an undilated cervix.
What causes a woman to start pushing too early?
There are several reasons why a laboring woman may begin to push before she is completely dilated:
– The urge to push – Many women naturally feel an overwhelming urge to push when the baby’s head descends. It is extremely difficult to resist this urge.
– Inadequate labor support – Without proper guidance from nurses and doctors, mothers may start pushing based on their natural urges.
– Lack of cervical checks – If cervical dilation isn’t monitored routinely, premature pushing may inadvertently occur.
– Miscommunication – The mother may mistake directions to “breathe baby down” as license to actively bear down and push.
– Epidural complications – Some epidurals partially numb the urge to push. Others come with bothersome side effects, tempting the mother to actively push.
– Exhaustion – Complete labor is exhausting. The urge to speed things along by pushing can be very tempting after hours of natural labor.
– Fear – Anxiety about labor progression or the baby’s wellbeing may drive some women to start pushing in an attempt to speed up delivery.
How can doctors and nurses help prevent complications?
Doctors, nurses, and midwives play a key role in preventing premature pushing and its associated risks:
– Frequent cervical checks – Dilatation should be assessed at least every 1-2 hours to determine the optimal timing for pushing.
– Instruction on when to push – Clear directions must be provided about when to push and when just to breathe through urges.
– Labor support – Consistent encouragement and guidance for breathing techniques may help resist premature pushing.
– Position changes – Getting the mother into favorable positions through different labor stages may progress dilation and delay pushing urges.
– Breathing coaching – Providing instruction, demonstrations, and encouragement on proper breathing can promote relaxation and delay pushing.
– Pain relief – Options like hydrotherapy, massage, epidurals, and medications can all help manage the pain and urge to push too soon.
– Reassurance – Explaining to the mother why waiting is important and offering continuous support can help her cooperate.
How is premature pushing managed during labor?
If a woman starts actively pushing before complete dilation, her nurse or doctor will immediately intervene with the following steps:
– Stop pushing – The most urgent step is to instruct the mother to stop bearing down while contractions occur.
– Breathing techniques – The mother will be coached to use panting and light pushing breathing rather than forceful pushing.
– Position change – Getting the mother into a side-lying position takes some of the pressure off the cervix.
– Warm compresses – Applying warm towels to the perineum can reduce pushing urges and discomfort.
– Cervical massage – Gently stretching the cervix can sometimes manually encourage further dilation.
– Delayed pushing – The mother may be instructed to push more gently or avoid pushing altogether for several more contractions.
– Medication – Drugs like terbutaline or nitroglycerin may temporarily relieve the urge to push.
– Labor progression – If possible, labor will be allowed to naturally progress until the cervix is completely open.
– C-section – If complications arise and natural progression stops, an emergency C-section may be required for delivery.
Are there situations where pushing is allowed before complete dilation?
In some specific circumstances, a woman may be instructed to gently push prior to achieving full cervix dilation:
– Prolonged labor – After 2-3 hours without continued dilation, gentle pushing may encourage labor progression.
– Epidural side effects – The numbness from an epidural may necessitate some pushing to aid rotation and descent.
– Shoulder dystocia – Gentle pushes may be used to try dislodging a stuck baby shoulder.
– Operative delivery – Early pushing can be helpful during use of forceps or vacuum devices.
– Fetal distress – If signs of distress emerge, the provider may recommend immediate pushing to expedite birth.
– Severe maternal exhaustion – Allowing some pushing can provide relief if the mother is severely fatigued.
– Final cervical lip – With just a small portion of cervix remaining, pushing may be approved.
Conclusion
Pushing too soon before the cervix is completely dilated can jeopardize the health of both mother and baby. While the urge to push is strong, women must wait for the go-ahead from providers before actively bearing down. This prevents complications like hemorrhage, uterine rupture, infection, and fetal distress. Doctors and nurses play an important role in preventing premature pushing through frequent cervical checks, patient instructions, labor support, and intervention when needed. While early pushing is only rarely recommended, each labor scenario is different and management must be personalized. Overall, resisting the temptation to push before complete dilation leads to the best outcomes.