S2E36 - Coached Pushing, Helpful or Harmful?

Retained Placenta, Postpartum Haemorrhage and the Physiological Third StageShellie, Si and Kemi carry on the deep dive into the physiological third stage of labour. They cover the four recognised reasons a placenta can be retained: uterine atony, an incarcerated placenta, placenta accreta syndrome and infection. They also explain what an undisturbed third stage looks like and how its time limits are set. They then look at the main causes of postpartum haemorrhage, why checking for tears matters, and how early cord clamping and mismanaged cord traction can cause harm. They close with the finding that about 92% of NHS births involve medical management, and a reminder that your choices in the third stage are flexible and you can change your mind. The discussion continues next episode.Become an Untethered Rebel: https://birthuntethered.kit.com/products/untethered-rebel-subscription Book time with Shellie: https://www.theserenitydoula.co.uk/bookachatwithshellie Book time with Kemi: https://kemibirthjoyjohnson.com/work-with-me Website:⁠ https://www.theserenitydoula.co.uk/birthuntethered⁠ Patreon:⁠ https://www.patreon.com/14193903/join⁠ Spotify: ⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠ Apple Podcast:⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠ Youtube:⁠ https://www.youtube.com/@birthuntethered⁠Instagram:⁠ https://www.instagram.com/theserenitydoula/⁠⁠https://www.instagram.com/birth.untethered/⁠⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ Support us by buying our merch: ⁠https://www.theserenitydoula.co.uk/merch ⁠ Buy us a coffee:⁠https://buymeacoffee.com/shellie⁠⁠https://buymeacoffee.com/dujube⁠

Shellie, Kemi and Simon this week are discussing the birth of the placenta. We begin by answering a question from last week's episode about how the Ferguson reflex and the pelvic floor work in birth and pooing and why a baby isn't "pushed out like a poo." Simon demonstrates on an anatomical model, so seek out the video version of the episode this week on spotify, youtube or patreon. They then discuss how babies pick up bacteria during birth, and colostrum feeds that bacteria. They also cover research into faecal transplants, with a warning not to try it at home.Then onto discussing the third stage of labour: This is the stage that ends with the placenta being born. We speak about keeping the room calm, quiet, warm and undisturbed so the body can work as it should. Simon explains how the placenta implants and how it detaches, with a balloon demonstration of the uterus shrinking.Describing how the muscle fibres lock in as they contract, which clamps the blood vessels and stops bleeding and how synthetic oxytocin interferes with this process. We also discuss how a newborn's breathing settles, and why keeping the baby close to the parent helps.The discussion will be continued on next week's episode so be sure to join us again then.The next meeting of the untethered rebels will be on Tues 24th November, so join the rebels and we would love to see you there!Become an Untethered Rebel: https://birthuntethered.kit.com/products/untethered-rebel-subscription Book time with Shellie: https://www.theserenitydoula.co.uk/bookachatwithshellie Book time with Kemi: https://kemibirthjoyjohnson.com/work-with-me Website:⁠ https://www.theserenitydoula.co.uk/birthuntethered⁠ Patreon:⁠ https://www.patreon.com/14193903/join⁠ Spotify: ⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠ Apple Podcast:⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠ Youtube:⁠ https://www.youtube.com/@birthuntethered⁠Instagram:⁠ https://www.instagram.com/theserenitydoula/⁠⁠https://www.instagram.com/birth.untethered/⁠⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ Support us by buying our merch: ⁠https://www.theserenitydoula.co.uk/merch ⁠ Buy us a coffee:⁠https://buymeacoffee.com/shellie⁠⁠https://buymeacoffee.com/dujube⁠

Coached pushing is not the harmless “help” birth spaces make it out to be. Kemi Birthjoy Johnson and Shellie break down why shouting at women to bear down, breathe on command, and push through every contraction can work against physiology, increase trauma, and make outcomes worse for both mothers and babies.Together, they expose the history behind coached pushing, what it actually does to the body, and why “purple pushing” became so embedded in maternity care in the first place. From the Ferguson reflex and pelvic floor mechanics to blood flow, oxygenation, and the impact of position, this episode makes the case for why instinctive, undisturbed pushing deserves far more respect. You’ll discover:What physiological pushing actually looks and feels likeWhy coached Valsalva pushing can reduce oxygen flow to the uterus and babyHow lithotomy and back-lying positions change the mechanics of birthWhat the research says about second-stage length, Apgar scores, NICU admission, perineal injury, and incontinenceWhy the “two-hour rule” is a poor substitute for real assessmentHow epidurals change the picture, and where coaching still fails to show clear benefitKemi and Shellie also trace the origins of coached pushing back to mid-20th-century obstetric ideology, showing how convenience, control, and outdated assumptions got baked into practice. They challenge the idea that women need to be told how to birth and make a compelling case for listening to the body, not the room full of people shouting over it.If you’ve ever wondered whether all that directing actually helps, or if you’ve felt that birth spaces too often confuse intervention with care, this conversation is essential listening. It’s sharp, fiery, evidence-backed, and deeply committed to one thing: protecting women’s autonomy at the moment it matters most.Become an Untethered Rebel: ⁠https://birthuntethered.kit.com/products/untethered-rebel-subscription⁠ Book time with Shellie: ⁠https://www.theserenitydoula.co.uk/bookachatwithshellie⁠ Book time with Kemi: ⁠https://kemibirthjoyjohnson.com/work-with-me⁠ Website:⁠ ⁠https://www.theserenitydoula.co.uk/birthuntethered⁠⁠ Patreon:⁠ ⁠https://www.patreon.com/14193903/join⁠⁠ Spotify: ⁠⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠⁠ Apple Podcast:⁠⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠⁠ Youtube:⁠ ⁠https://www.youtube.com/@birthuntetheredInstagram:⁠ ⁠https://www.instagram.com/theserenitydoula/⁠⁠⁠⁠https://www.instagram.com/birth.untethered/⁠⁠⁠⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ ⁠Support us by buying our merch: ⁠⁠https://www.theserenitydoula.co.uk/merch ⁠⁠ Buy us a coffee:⁠⁠https://buymeacoffee.com/shellie⁠⁠⁠⁠ https://buymeacoffee.com/dujube

In S2E36, Kemi Birthjoy Johnson and Shellie explore coached pushing, “purple pushing,” the Valsalva maneuver and the contrast to physiological or undisturbed pushing —and why shouting instructions to push may work against the body’s natural instincts. They discuss spontaneous pushing, the role of birth positions, and what the evidence says about maternal fatigue, pelvic floor injury, and outcomes for babies.The conversation also looks at how coached pushing became common, whether strict time limits for the second stage of labor are useful, and how people can make informed choices that support physiological birth.Become an Untethered Rebel: https://birthuntethered.kit.com/products/untethered-rebel-subscription Book time with Shellie: https://www.theserenitydoula.co.uk/bookachatwithshellie Book time with Kemi: https://kemibirthjoyjohnson.com/work-with-me Website:⁠ https://www.theserenitydoula.co.uk/birthuntethered⁠ Patreon:⁠ https://www.patreon.com/14193903/join⁠ Spotify: ⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠ Apple Podcast:⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠ Youtube:⁠ https://www.youtube.com/@birthuntethered⁠Instagram:⁠ https://www.instagram.com/theserenitydoula/⁠⁠https://www.instagram.com/birth.untethered/⁠⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ Support us by buying our merch: ⁠https://www.theserenitydoula.co.uk/merch ⁠ Buy us a coffee:⁠https://buymeacoffee.com/shellie⁠⁠https://buymeacoffee.com/dujube⁠

This episode is a detailed look at caesarean birth covering what happens in theatre and recovery to the potential short- and long-term effects for parent and baby. Shellie and Kemi discuss informed consent, advocacy and doula support, rising intervention rates, differences in care models, and evidence on risks including complications, NICU admission, PTSD, and future pregnancies.Become an Untethered Rebel: https://birthuntethered.kit.com/products/untethered-rebel-subscription Book time with Shellie: https://www.theserenitydoula.co.uk/bookachatwithshellie Book time with Kemi: https://kemibirthjoyjohnson.com/work-with-me Website:⁠ https://www.theserenitydoula.co.uk/birthuntethered⁠ Patreon:⁠ https://www.patreon.com/14193903/join⁠ Spotify: ⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠ Apple Podcast:⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠ Youtube:⁠ https://www.youtube.com/@birthuntethered ⁠Instagram:⁠ https://www.instagram.com/theserenitydoula/⁠ ⁠https://www.instagram.com/birth.untethered/⁠ ⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ Support us by buying our merch: ⁠https://www.theserenitydoula.co.uk/merch ⁠ Buy us a coffee:⁠ https://buymeacoffee.com/shellie⁠ ⁠https://buymeacoffee.com/dujube⁠

Shellie and Kemi explore the history of caesarean birth and the changes that have made the surgery safer. From antisepsis and anesthesia to antibiotics, checklists, and modern monitoring. They also examine what “safer” means in practice, discuss risks including infection and blood clots, and question how informed choice and respectful care shape birth outcomes.A candid, evidence-focused conversation for pregnant people, birth workers, partners, and anyone seeking a deeper understanding of caesarean birth and maternity care. Become an Untethered Rebel: https://birthuntethered.kit.com/products/untethered-rebel-subscription Book time with Shellie: https://www.theserenitydoula.co.uk/bookachatwithshellie Book time with Kemi: https://kemibirthjoyjohnson.com/work-with-me Website:⁠ https://www.theserenitydoula.co.uk/birthuntethered⁠ Patreon:⁠ https://www.patreon.com/14193903/join⁠ Spotify: ⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠ Apple Podcast:⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠ Youtube:⁠ https://www.youtube.com/@birthuntethered ⁠Instagram:⁠ https://www.instagram.com/theserenitydoula/⁠ ⁠https://www.instagram.com/birth.untethered/⁠ ⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ Support us by buying our merch: ⁠https://www.theserenitydoula.co.uk/merch ⁠ Buy us a coffee:⁠ https://buymeacoffee.com/shellie⁠ ⁠https://buymeacoffee.com/dujube⁠

Dr. Stuart Fischbein joins Shellie and Kemi Birthjoy Johnson to discuss instrumental birth, including when forceps or ventouse may be genuinely helpful, the different risks involved, and why essential obstetric skills are disappearing.Together, they explore consent, intervention cascades, medicalised birth, fear-based protocols, and the importance of collaboration between obstetricians, midwives, doulas, and parents. This episode offers an honest look at assisted vaginal birth and why skilled, individualised care matters.Become an Untethered Rebel:⁠https://birthuntethered.kit.com/products/untethered-rebel-subscription⁠Book time with Shellie:⁠https://www.theserenitydoula.co.uk/bookachatwithshellie⁠Book time with Kemi:⁠https://kemibirthjoyjohnson.com/work-with-me⁠Website:⁠https://www.theserenitydoula.co.uk/birthuntethered⁠Patreon:⁠https://www.patreon.com/14193903/join⁠Spotify:⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠Apple Podcasts:⁠https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠YouTube:⁠https://www.youtube.com/@birthuntethered⁠Instagram:⁠https://www.instagram.com/theserenitydoula/⁠⁠https://www.instagram.com/birth.untethered/⁠⁠https://www.instagram.com/kemibirthjoyjohnson/⁠Support us with merch:⁠https://www.theserenitydoula.co.uk/merch⁠Buy us a coffee:⁠https://buymeacoffee.com/shellie⁠⁠https://buymeacoffee.com/dujube⁠

Shellie, Kemi and Dr Stuart Fischbein examine the forces shaping modern maternity care and what happens when we look beyond the intervention itself to the system that created the circumstances for it.We explore how birth care can be shaped by institutional incentives, liability and throughput as much as by evidence, and how time limits, induction, defensive caesareans, routine scanning and licensing can become mechanisms of control rather than genuinely individualised care.We look at how poor outcomes are often the end of a cascade rather than a single event. Instrumental birth, caesarean, NICU admission and difficulties with bonding may follow a chain that began much earlier with restricted movement, fear, continuous monitoring, coached pushing, early intervention or time pressure.We also examine deskilling. When practitioners lose confidence and experience in breech birth, twins, forceps or vacuum extraction, caesarean can become the default, not necessarily because alternatives are inherently unsafe, but because the skills to offer them are disappearing.What happens when the numbers we rely on aren't as universal as they appear? We explore how growth charts, labour curves and other obstetric thresholds can turn narrow reference populations into supposedly universal definitions of “normal”, potentially turning healthy variation into pathology.Consent is another key theme. We question when counselling becomes coercion, particularly when information is selectively framed, alternatives are minimised and a woman's “no” is repeatedly challenged.Finally, we discuss continuity of care, fear and professional culture. Continuity can create trust and accountability, while fragmented systems can encourage defensive practice. Much of the behaviour experienced as bullying or coercion may stem not from individual malice, but from clinicians working within a system that teaches them to fear uncertainty, blame and responsibility.This episode asks us to look beyond the final intervention and follow the signal back to its source: what assumptions underpin the evidence, who benefits from the way care is organised, and who ultimately carries the cost?Become an Untethered Rebel:https://birthuntethered.kit.com/products/untethered-rebel-subscriptionBook time with Shellie:https://www.theserenitydoula.co.uk/bookachatwithshellieBook time with Kemi:https://kemibirthjoyjohnson.com/work-with-meWebsite:https://www.theserenitydoula.co.uk/birthuntetheredPatreon:https://www.patreon.com/14193903/joinSpotify:https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjBApple Podcasts:https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735YouTube:https://www.youtube.com/@birthuntetheredInstagram:https://www.instagram.com/theserenitydoula/https://www.instagram.com/birth.untethered/https://www.instagram.com/kemibirthjoyjohnson/Support us with merch:https://www.theserenitydoula.co.uk/merchBuy us a coffee:https://buymeacoffee.com/shelliehttps://buymeacoffee.com/dujube

In this episode, join Shellie, Kemi and Dr Stuart Fischbein as we explore how birth outcomes can be shaped by system design, not just clinical skill, or lack thereof.We discuss how time pressure, immobility, fear, monitoring and routine intervention can create the very problems they are then used to solve. Epidurals, coached pushing, early admission and continuous monitoring can influence labour, malposition and intervention rates, while evidence is often focused on short-term outcomes and hospital-based measures rather than longer-term effects on bonding, breastfeeding, the microbiome, child development and future reproductive health.From breech caesareans and synthetic oxytocin to postpartum decision-making, we ask whether the outcomes we measure are always the outcomes that matter.We examine how induction thresholds, routine scans, escalation protocols and arbitrary time limits, such as the 24-hour waters-breaking and 42-week thresholds, have become rigid rules rather than prompts for individualised decision-making.We also explore continuity of care, responsibility and professional power. Trust and familiarity can influence decision-making, while fragmented responsibility can allow harmful practices to continue because everyone is simply “following the system”.Ultimately, this is a conversation about who owns birth knowledge: who controls the tools, who is allowed to learn and teach, and who gets to decide what is considered safe. From the historical secrecy surrounding forceps to the medicalisation of midwifery and restrictions on independent birth workers, we question when professional control becomes disguised as safety.Become an Untethered Rebel:https://birthuntethered.kit.com/products/untethered-rebel-subscriptionBook time with Shellie:https://www.theserenitydoula.co.uk/bookachatwithshellieBook time with Kemi:https://kemibirthjoyjohnson.com/work-with-meWebsite:https://www.theserenitydoula.co.uk/birthuntetheredPatreon:https://www.patreon.com/14193903/joinSpotify:https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjBApple Podcasts:https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735YouTube:https://www.youtube.com/@birthuntetheredInstagram:https://www.instagram.com/theserenitydoula/https://www.instagram.com/birth.untethered/https://www.instagram.com/kemibirthjoyjohnson/Support us with merch:https://www.theserenitydoula.co.uk/merchBuy us a coffee:https://buymeacoffee.com/shelliehttps://buymeacoffee.com/dujube

This episode continues the episiotomy discussion, focusing on what it is, why it’s used, the evidence against routine use, the risks and complications, and the importance of informed consent. Become an Untethered Rebel: https://birthuntethered.kit.com/products/untethered-rebel-subscription Book time with Shellie: https://www.theserenitydoula.co.uk/bookachatwithshellie Book time with Kemi: https://kemibirthjoyjohnson.com/work-with-me Website:⁠ https://www.theserenitydoula.co.uk/birthuntethered⁠ Patreon:⁠ https://www.patreon.com/14193903/join⁠ Spotify: ⁠https://open.spotify.com/show/1kKvf6pjLGDJ5nDBMKPCjB⁠ Apple Podcast:⁠ https://podcasts.apple.com/gb/podcast/birth-untethered/id1836371735⁠ Youtube:⁠ https://www.youtube.com/@birthuntethered ⁠Instagram:⁠ https://www.instagram.com/theserenitydoula/⁠ ⁠https://www.instagram.com/birth.untethered/⁠ ⁠https://www.instagram.com/kemibirthjoyjohnson/⁠ Support us by buying our merch: ⁠https://www.theserenitydoula.co.uk/merch ⁠ Buy us a coffee:⁠ https://buymeacoffee.com/shellie⁠ ⁠https://buymeacoffee.com/dujube⁠