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Reconsideration of 'purple pushing' urged. (Labor and Delivery).
SARASOTA, FLA. -- Physiology suggests the standard positioning and pushing techniques used during labor and delivery require rethinking, according to Lisa Miller, certified nurse-midwife.
Long Valsalva's maneuvers--or "purple pushing"--and standard supine positioning should be reconsidered, she said at a perinatal symposium sponsored by Symposia Medicus.
Purple pushing--or closed-glottis pushing--during which the patient holds her breath for 10 seconds while pushing, is safe in the approximately 80% of women with low-risk pregnancies. But that doesn't mean it works best. Furthermore, in physiologically high-risk cases, the baby can't tolerate that kind of pushing, said the former labor and delivery nurse-turned-midwife, who is also a lawyer.
In one study of 10 healthy, near-term pregnancies, near-infrared spectroscopy used to evaluate fetal effects revealed that closed glottis and coached pushing efforts led to decreased mean cerebral 02 saturation and increased mean cerebral blood volume. All Apgar scores were below 7 at 1 minute and below 9 at 5 minutes.
Open-glottis pushing, on the other hand, allows the patient to exhale while bearing down and leads to minimal increases in maternal blood pressure and intrathoracic pressure, maintained blood flow, and decreased fetal hypoxia. Long Valsalva pushing can adversely affect maternal hemodynamics, which in turn adversely affects fetal oxygenation, said Ms. Miller, who also is president of Perinatal Risk Management and Education Services in Chicago.
Furthermore, several studies have suggested that in patients who have received epidural anesthesia, delayed pushing is safe and effective for reducing delivery difficulty and decreasing variable decelerations in the fetus.
Pushing in general should be limited to 6-7 seconds, and should be a spontaneous response to a strong urge to push. Coaching of the patient should be ...
- Delayed pushing doesn't increase fetal trauma. (Second-Stage Labor).
- Magazine article from: OB GYN News Walsh, Nancy February 1, 2002 700+ words
...a much better job of coordinating her intraabdominal and intrathoracic pressures to make a more forceful push." Open-glottis pushing, rather than bearing down while holding the breath, also should be encouraged. When the mother bears down while holding...
- maureen spring's column ON MONDAY: Summer daydreaming along the...
- Newspaper article from: Coventry Evening Telegraph (England) May 21, 2001 700+ words
...the front like a figurehead (there's always a grandma) to the next lock where they bend double, grunt a lot then turn purple pushing a massive wooden door through tons of un-yeilding water. Poor old grandma's patiently praying she'll be bobbed up...
