One of the most debated issues in childbirth care focuses on whether or not to direct the mother's bids by telling her when and how to bid. It is the mother herself who naturally responds to the pujo reflex when she feels the need to do so, so why direct it?
In most deliveries, women are told when they should bid, but some centers, such as Medway Maritime Hospital in Kent, United Kingdom, initiated a program aimed at reducing high rates of severe perineal tearing. They decided to stop telling women when they should bid on delivery and the results have been amazing.
Less tears
Following the call of attention of the Royal College of Obstetricians and Gynecologists (RCOG) and the Royal College of Midwives of the United Kingdom for the increase in serious tears, the hospital modified its practice of targeted bids.
After a year of starting it, the incidence of women with severe tears fell from seven percent to one percent.
They were also encouraged to abandon the classic posture to give birth (lying on their backs or lithotomy) so that they could adopt other postures of childbirth. In vertical postures (standing, squatting, sitting or semi-sitting) the law of gravity favors the descent of the baby through the birth canal.
Another practice that they have modified has been to reduce the speed of childbirth and teach women to breathe during contractions.
On the other hand, instead of throwing the baby out at the shoulders, they began to hold the baby's weight as it came out thus reducing the pressure in the perineum.
The program has been so successful that the results were published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, and there are plans to extend it nationally.
The pujo reflex
The pujo reflex is part of the active expulsive phase of normal delivery. With each contraction the woman has an intense need to exert force to expel the baby.
With each bid, the baby opens up to the world. It goes down the birth canal until it is born. If during the labor the mother controls her own processes allowing her to move, giving her freedom to choose the position she wants, it is she who directs the birth according to her own instinctive and physiological needs.
When complete dilation occurs, the midwife encourages the woman to push, even when the mother does not feel that need, but sometimes it is enough to wait about 10 or 20 minutes until the pujo reflex manifests.
In recent years, several studies have been published that have compared the labor of women whose bids had been directed with those who had responded naturally to the reflex reflex. These investigations conclude that no differences were found in the duration of labor between one group and the other.
In addition, they suggest that women who receive instructions on how to bid in labor may be more likely to have problems associated with pelvic muscle and bladder dysfunction in the long term.
And with epidural?
The sensitive block of epidural analgesia can be so potent that it completely cancels contractions and the reflex reflex. In these cases, the woman depends on the midwife telling her when she should bid.
However, if the use of epidurals in low doses (walking epidural or walking epidural) was extended in the centers, this would allow pain relief but not completely cancel the sensitivity, causing the woman to feel the pressure of the head on the birth canal, she will know it's time to push.
