The Latest on “Laboring Down”

The Latest on “Laboring Down”

Recently NPR published an article on a study that determines that “delayed pushing made no difference in whether women had C-sections or not” and that actually, “delayed pushing had some adverse consequences.” I was shocked to hear this, as were many of my colleagues — both doulas and midwives.

I describe my practice as evidence-based, but with an important caveat. In this profession, we see over the years that the evidence changes — sometimes wildly. “Laboring down,” or allowing baby to passively descend without active pushing, can be a very useful tool for a parent on an epidural. The study determined there were no benefits to laboring down and identified some risks, but I fully expect another study to be done in a few years that proves the exact opposite.

There’s a lot I don’t know about this study: were those given epidural anesthesia also switching sides, trying hands-and-knees if possible, moving as much as they could safely move? Did they have support people using rebozo and other techniques to keep the baby rotating and descending through the pelvis, or were they laying on their backs waiting for baby to descend? I know from personal experience — and many doulas and midwives will tell you — that laboring down is a gift for a person on an epidural. It postpones the “pushing clock” that adds a lot of pressure to deliver within a certain timeframe, especially because pushing on an epidural can prove more challenging than without one. It allows tissues to stretch more gently and over a longer period of time, and it tends to be easier on the baby (fewer dipping heart-rates) than when pushing begins with baby still high up in the pelvis. So, I don’t know the methodology of this study, but as with EVERYTHING in birth — I believe in using the evidence available to the extent that it supports what makes sense for you — and weighing it judiciously with other research and with your care providers’ experience. Scientific research is not fact written in stone, but malleable and ever-changing, an evolving conversation in which there’s always something new to be said but we’re never done talking. I regard this as the latest in a long line of research on birth that tends to contradict itself. We aren’t meant to know it all, and there is no right way to birth a baby.

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