There are a lot of points during labor when mothers do not have any control over what’s going on with their body. The one thing they usually have control over, if giving birth vaginally, is their ability to push. But a report by Vice highlights the fact that in some hospital delivery rooms, women are being told to stop pushing, even when the urge is nearly irresistible. And in some cases, this may be happening for some very troubling reasons.

“If a woman’s cervix is fully dilated and she has the urge, she should be allowed to push, barring some unusual complication with mother or baby,” Dana Gossett, chief of gynecology at the University of California, San Francisco, Medical Center, told Vice.

Writer Kimberly Lawson gathered anecdotal evidence suggesting that in many situations, hospital nurses are telling women to stop pushing because the doctor or midwife isn’t available to deliver the baby. In some cases, women even report nurses forcing a baby’s crowning head back into the birth canal.

“I’ve never felt a more painful experience in my life [than] being strapped down and forced to hold a baby in,” says Elaina Loveland, a mother who was told to stop pushing because there were no beds available at the hospital when she arrived. “It was almost worse than the pushing. It was horrible.”

In addition to pain, women made to resist the urge to push may experience other complications. Delayed pushing sometimes causes labor to last longer, puts women at higher risk of postpartum bleeding and infection, and puts babies at a higher risk of developing sepsis, according to a study released in 2018. One midwife explained in the article that holding the baby in can damage a mother’s pelvic floor, which might later cause urinary incontinence.

In one extreme case, Caroline Malatesta, a mother of four in Alabama, said that when a nurse forced her baby’s head back in, she caused permanent damage. After four years of chronic pain from a condition called pudendal neuralgia, she won a $16 million lawsuit against the hospital.

Nurses aren’t necessarily being cruel when they instruct mothers to stop pushing, by the way. They may be hoping to prevent other complications, such as problems with the umbilical cord or shoulder dystocia. A doctor or midwife is better trained to correct such situations, and can also help prevent perineal tearing.

If hospital staff are instead making these decisions because of a shortage of obstetricians or hospital beds for expectant mothers, there’s a systemic problem that needs to be addressed. As people have grown increasingly aware of the high rate of maternal deaths after childbirth in the U.S., issues like these point out where there’s significant room for improvement.

Addressing the Dilemma: When You Can’t Push the Baby Out

The moments during labor are intense, and while pushing is often within the mother’s control, there may be instances where this natural urge must be resisted. Understanding the implications of such scenarios is essential for the safety and well-being of both mother and baby.

What Happens If You Can’t Push the Baby Out?

  • Medical Intervention: If a mother can’t push the baby out, medical intervention such as the use of forceps or a vacuum extractor may be necessary. In some cases, an emergency cesarean section (C-section) might be performed to deliver the baby safely.
  • Labor Prolongation Risks: Delaying pushing can prolong labor, increasing the risk of postpartum hemorrhage, infections, and possible sepsis in the newborn.
  • Pelvic Floor Damage: Forcibly holding the baby in can cause damage to the pelvic floor muscles, leading to long-term issues such as urinary incontinence and pelvic pain.
  • Potential Systemic Issues: Instances where mothers are told to stop pushing due to lack of available medical staff highlight systemic problems within the healthcare system that require attention and resolution.

How Can Healthcare Systems Improve to Prevent Such Situations?

  • Adequate Staffing: Hospitals should ensure adequate staffing levels so that there’s always a doctor or midwife available to handle unexpected labor and delivery scenarios.
  • Policy Review: Reviewing and revising hospital policies to prevent delayed pushing except for medically justified reasons is critical.
  • Patient Education: Educating expectant mothers on their rights and the normal labor process can empower them to advocate for themselves during childbirth.
  • Investigation and Accountability: Cases of injury due to delayed pushing should be thoroughly investigated, and hospitals should be held accountable to prevent future occurrences.

While the physical act of childbirth might be uncontrollable in certain aspects, it is crucial that healthcare providers create an environment that prioritizes the safety and autonomy of the birthing mother. Ensuring mothers are well-informed and that hospitals are adequately prepared can help mitigate risks associated with the inability to push during labor.

FAQ: When You’re Unable to Push During Childbirth

What happens if I can’t push my baby out during labor?

If you are unable to push your baby out, medical interventions such as vacuum extraction, forceps delivery, or a cesarean section may be necessary to ensure the safety of both you and your baby.

Why would a nurse tell me to stop pushing during labor?

A nurse may advise you to stop pushing if the doctor or midwife is not immediately available, or if there are complications that could put you or your baby at risk, such as umbilical cord issues or shoulder dystocia.

Can holding in a push harm me or my baby?

Forcibly resisting the urge to push can potentially cause complications such as prolonged labor, increased risk of infection, damage to the pelvic floor muscles, and increased stress for the baby.

Is it common for hospitals to be unprepared for a delivery?

It is not common, but situations like insufficient staffing or a lack of available beds can occur. Hospitals are working on systemic improvements to prevent these issues.

What are my rights if I’m told not to push during labor?

You have the right to understand why you are being told not to push and to have the risks and benefits of all procedures explained to you. It’s also your right to second opinions and to be treated with respect and dignity throughout your labor.

How can I advocate for myself during labor?

Educate yourself about the labor process, understand your birth plan options, communicate your wishes clearly with your healthcare team, and don’t hesitate to ask questions or express concerns.

What is shoulder dystocia, and why is it a concern during delivery?

Shoulder dystocia occurs when a baby’s shoulders get stuck in the birth canal after the head has been delivered. This can lead to complications and is one reason a healthcare provider might instruct you to stop pushing temporarily.

What legal recourse do I have if I’m injured because I was told not to push?

If you’ve sustained injuries because you were told not to push, and if negligence is suspected, you may have grounds for a lawsuit. Consult with a legal professional specializing in medical malpractice for guidance.

Can issues during labor be a sign of systemic healthcare problems?

Yes, issues like being told not to push due to the unavailability of medical staff can indicate systemic problems, such as understaffing or insufficient resources, which require broader healthcare system changes.

A version of this post was originally published on July 19. 2019. It has been updated.

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