A laboring mother has an internal exam and it reveals her cervix is fully dilated. The caregiver tells her it is time to begin pushing. She says she feels like she needs to have a bowel movement, and she is grunting and groaning during contractions. What is the BEST way for the doula to help?
Explanation
Answer: B - If the mother is coping well, and seems to be spontaneously working with her body, she should be left alone to continue birthing the way she is. If the mother begins to lose focus, or pushing becomes ineffective, the doula might suggest changing positions and using exhale pushing. Some hospitals have policies that require a mother assume a specific position during the second stage, but this is counterproductive, and the mother should be allowed to assume whatever position gives her the most comfort and helps the baby move down the most effectively. Directed pushing with breath holding can be used, but does have risks such as less oxygen to the baby, which might cause fetal heart rate changes, leading to interventions such as forceps, vacuum extractor, or Caesarean birth.
