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The push reflex: an irrepressible desire
In natural childbirth, there is a push reflex causes the baby to be expelled. It is also called the expulsion reflex. “When it comes to a physiological childbirth (that is to say without epidural or any other medicinal aid), the woman will be subjected to a push reflex which will take place naturally when the baby enters the pelvis, when it is going to press on the muscle of the perineum and on the rectum ”, details Catherine Mitton, midwife in practice in Taluyers and in technical platform in Givors (69). This reflex, which occurs during contractions (just one is enough), Dr Bernadette de Gasquet, a specialist in maternity, describes it as “unstoppable desire”, a bit like the urge to have a bowel movement, or like the urge to vomit, even more difficult to contain. “The very low part of the abdominals pushes the uterus up and pushes the baby down, because it’s got to the point where it can’t come up,” she explains. The diaphragm then rises, much like during the vomiting reflex, the woman breathes out suddenly and the uterus contracts in an uncontrolled manner.
Just like the urge to have a bowel movement but much more powerful, the expulsive reflex of childbirth would be completely physiological. In women who choose to give birth without epidural, it takes place in a strong and automatic way, and allows the expulsion of the baby, generally without outside intervention. An episiotomy or mechanical extraction of the baby (forceps, suction cup) can however be put in place by the medical team.
When the epidural forces you to simulate this reflex
Unfortunately, this reflex surge does not always take place, or is sometimes not powerful enough. ” If there is an epidural, there will be no reflex flare », Assures Catherine Mitton. “The impressions will be disturbed, and this will depend on the dosage of the epidural. Some are well dosed, others a little less. So sometimes you have to set up a voluntary push, imagining that we are going to push as if to have a bowel movement. “Epidural anesthesia does indeed lead to muscle relaxation, especially in the perineum. Also, if the epidural is too dosed, the whole lower abdomen is sore, asleep under the effect of the anesthetic. “Depending on the dosage, there may be patients who do not feel that the baby is engaged and that it is in a position to come out”, continues the midwife. This will then take care oftell the patient when to push, when the conditions are right. For this, examinations are performed approximately every hour to monitor the dilation of the cervix and the state of health of the baby. At full dilation, i.e. approximately 10 centimeters, the patient will prepare to push according to the midwife recommendations. Sometimes, to help her feel where to push, the midwife will insert a finger into the vagina to press on the posterior wall, which pushes on the rectum. But Catherine Mitton wants to be reassuring : “It sometimes happens that the epidural is very well dosed, which then allows the woman to feel her baby push and keep certain sensations. But this is not the case for all epidurals. “
Note that the Dr Bernadette de Gasquet does not share this point of view at all. She ensures that the expulsion reflex takes place even if you are on an epidural or in a coma, but that the medical team does not want to wait long enough for this reflex to take place. In the context of a first child in particular, the descent of the baby can be quite long. For Dr de Gasquet, pushing too early even if the cervix is sufficiently dilated is not appropriate, and causes serious damage to the organs. The medical profession would actually put a lot on the back of the epidural, while it is not necessarily involved.
A gynecological position that does not make things easier
Under epidural, since the pushing reflex is not present or not felt enough, the medical team often invites the patient to settle in gynecological position : on the back, semi-seated, feet in the stirrups and legs apart. Unfortunately, this position, although more comfortable for performing pelvic exams, is not conducive to effective pushing. “On the back, the sacrum (bone that precedes the coccyx and brings together the iliac bones of the pelvis, editor’s note) can be blocked. There is less mobility and we lose the advantage of gravity to help us », admet Catherine Mitton.
Dr Bernadette de Gasquet regrets that this position is often imposed by the material, in the absence of a modular seat to allow another position. For her, the gynecological posture pushes downwards, brings down the organs and can lead to long-term consequences (incontinence, etc.). Not to mention that it requires a lot of effort from the patient, who gets very tired. Better to give birth in suspension with a strap, on the side, on all fours or even squatting. It is also often the positions popularized by women whose childbirth is not medicalized, notes Catherine Mitton. “Instead of moving the pregnant woman so that the baby comes down, you push her down. However, as when we have a bowel movement, a good position Normally enough for the expulsion to take place, there is no need to push ”, assures his side Bernadette de Gasquet.
Discover in video: How to grow well during childbirth?
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Can we train to push?
During the push reflex, the expiration will be slowed down in the glottis and completely spontaneous. Overall, Catherine Mitton and Bernadette de Gasquet agree that learning to breathe is useless. “It will only work when the right time is right,” says Dr de Gasquet. “We can try to learn during preparation sessions with a midwife, but nothing indicates that the way of breathing that we have learned will then be the one preferred by the midwife on D-day”, explains Catherine. Mitton. ” We don’t always choose. But we can still tell the midwife what we have learned and what we would like to do, especially in terms of position. “
At any rate, ” it is often difficult to realize how and where to push until you have had the feeling that goes with it », Underlines Catherine Mitton. To reassure her patients, she insists on the importance of teaching them the possible positions and the breathing techniques that will come into play. open glottis. The first will be to take a breath, block the air, and push. This should be avoided, however, because the glottis in the closed position locks the muscles, while an open glottis on expiration will favor a more flexible perineum. For the Dr Bernadette de Gasquet, author of the books Well-being and motherhood et Childbirth, Gasquet’s method, it is above all the position that must be prepared. She thus prefers a posture where you can push on your arms backwards while exhaling.