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