To Push or Not To Push
After an alarmingly increase in perineal tearing in England between 2013 and 2014, the Royal College of Midwives decided that they needed to take action. They formed a collaboration with the Royal College of Obstetricians and Gynecologists and executed a trial program at Medway Maritime Hospital in Kent. The program results showed that the hospital reduced the amount of third and fourth-degree perineal tears from 7 percent to 1 percent, showing an 85 percent reduction overall. This was achieved by not forcing women to lie on their back and "push". Research shows that nine in ten women experience some form of vaginal tearing during childbirth. In some of the most severe cases, women have to endure pain from incontinence and nerve damage that can cause permanent nerve problems. Evidence has also revealed that directed or forced pushing results in the mother being fatigue, increased morbidity for both baby and mother, inefficient uterine contractions, increased risk of hypoxia, fetal heart rate abnormalities, damage to the pelvic floor muscle, rupture of the eye and facial blood vessels, tearing of the perineum and an increase need for episiotomy.
If you have ever been in labor, you know that the phrases "push harder" and "you are almost there" are said what seems like a hundred times. Well Dot Smith, head midwifery of Medway Maritime Hospital, says that the high number of tears are a direct result of the misconception that women need to "push, push and then push harder" in labor when in fact they don't. "When we saw 22 cases of third-degree tears in a month, we said, "this is not good,' Smith stated. Prior to the 1950's women were encouraged to birth standing up, squatting or on their knees and midwives would instruct them to breathe naturally through their contractions versus pushing through them. We know the saying "the baby decides when he or she wants to enter this world" and during that time the midwives believed that. So much so, that instead of pulling the baby’s head out when they saw it emerge, they would simply wait and let it come out on its own and only assist supporting the weight of the baby as to reduce pressure on the perineum. The success from the program was documented in the European Journal of Obstetrics and Gynecology with the intention of implementing it on a national level. In some areas this simple adjustment during delivery has already shown a decrease in unintentional damage to women by 85 percent.