The “Rule of 10” Versus Women’s Primal Wisdom

by Lydi Owen

© 2008 Midwifery Today, Inc. All rights reserved.

[Editor's note: This is an excerpt of an article which appears in Midwifery Today Issue 86, Summer 2008. View other great articles and columns in the table of contents. To read the rest of this article, order your copy of Midwifery Today Issue 86.]

There is a rule of labor that forbids a woman to push with contractions until her cervix is completely dilated to 10 cm. Women are warned that to push before this doorway is completely open and out of the way will result in a swollen and/or torn cervix.

What will supposedly happen if the cervix swells?

Doctors, nurses, midwives, doulas and childbirth educators all warn that a swollen cervix will impede labor and increase the chances of tearing the cervix, thus causing hemorrhage. They have been taught that a swollen cervix is easily broken or pulverized. If this is indeed the truth, then why do most women during labor have an irresistible urge to begin bearing down before dilation is complete?

Could it be that the instinctual wisdom of our bodies has become our enemy? Is Spirit trying to destroy us instead of guiding us? Why would we feel the need to begin bearing down at 5–6 cm (or sooner) if it would shatter the gateway to the baby’s outer world?

These were questions that I pondered as a midwife, as I watched woman after woman give birth in the 1970s. Each of us struggled through the phase of labor when we wanted to push, but we knew that we had to refrain from doing so because that was what we had been taught in childbirth education classes. We had learned this from previous births in the hospital.

By what authority should we doubt the information given to us by the learned men and women of science?

Collectively, women decided that remaining passive during labor was better than risking injury or death of themselves and/or their unborn babies by obeying “outdated” promptings of their bodies, whose wisdom hadn’t kept up with science.

Could professionals be mistaken about when women can begin bearing down during labor, because they forgot one simple part of the equation—that of observing non-medicated women in labor in their natural habitats?

Remember this: People at one time believed that the world was flat. Dr. Ignaz Semmelweiss was ridiculed until his death in 1865 for suggesting that germs were responsible for the widespread child bed fever that killed an epidemic number of women simply because doctors didn’t wash their hands.(1)

How did this “Rule of Ten” come about?

In 1951 doctors Greenhill and DeLee wrote “During the first stage of labor no abdominal pushing is allowed because the cervix will tear.”(2)

We can safely assume that the women being studied by Greenhill and DeLee were under the influence of drugs, because in the mid-20th century the orgy of drug interference during labor and birth was at its height of glory. Almost no women were informed enough to withstand the onslaught of drugs given to them during birth in the hospital. Unfortunately, the situation has not changed in the sixty years since.

Therefore, these doctors were scientifically incorrect in concluding that the “Rule of Ten” was valid, without simultaneously observing a control group of drug-free laboring women in the upright position (as opposed to being drugged and lying down in beds).

The only place that they would have been able to make these observations by comparison would have been at homebirths. In the 1950s, homebirths were almost non-existent.

In the early part of the 1970s many American women, tired of being dominated by wrong medical thinking, left the system and went home to birth their children. I was one of these women. That birth led to my becoming a midwife.

The first time I witnessed the cervix miraculously responding to being pushed on at 6 cm dilation was when a woman was giving birth to her third baby. Susan had a quick and easy labor. When she reached 6 cm, she could not hold back from pushing. Her body gave her clear signals that it was time for her to aid the uterus in the expulsion of her unborn child, himself pushing to be born. She began to grunt and bear down involuntarily, making primitive animal sounds that emanated from deep inside her throat.

I, supposedly the learned one, watched her break the cardinal rule in obstetrics. Aloud, I recited, “You must not push. You’re not fully dilated. You can tear or injure your cervix. Pant like a puppy!”

I was attending a lady in birth who had previously given birth to five children in the hospital. She wanted very much to try a homebirth this time. I spent hours with her explaining why it was okay for her to push before ten. She was afraid of birth because her other labors had taken such a long time and were very painful, yet some part of her believed that she could do it and do it well. Despite her fear of pain, she called me when her labor started and I drove to her home in the middle of the night. She dilated quickly to 5 cm, at which time she wanted to get in the bathtub in warm water. She seemed to be handling the contractions very well, just breathing in and blowing out. I could tell by observing her that she felt like bearing down, but she held back. I told her it was okay to push a little if she felt like it, but I could also sense that she didn’t trust that it was really okay. She had consistently been taught otherwise by her doctor, the nurses and previous childbirth educators. After an hour in the tub, Cathy asked me if I would check her dilation, which I did. She was still at 5 cm. Cathy moaned with disappointment, but got back in the water and continued with her breathing in, blowing out for another hour. She asked me to check her again, certain that she must surely be 10 cm by now. The look on her face when I told her that she was still 5 cm was one of discouragement and hopelessness. “Tell me what to do!” she cried, ready to let go of the old rules and try something different. “Are you ready to trust in yourself, Cathy?” I asked her. “Yes! Just help me please!” I set up the birthing area on the floor (all the women I help give birth on the floor) and propped fat pillows next to the wall for shoulder and back support. I laid out a plastic shower curtain and plastic bed pads on top of it and then asked Cathy to position herself on the floor. Her husband held one leg and her sister helped hold her other leg up while she grabbed underneath her legs as the contraction started. I told her to go ahead and push is she felt like it (she had felt like doing so for two hours already, but didn’t because of fear). She began to grunt with the force of the contraction and then back off a little to catch her breath. She then grunted again, this time a little harder, and then relaxed for another breath. She did this three times during that one contraction. When it was over, she smiled and said, “You’re right. It doesn’t hurt as much when I push.” She naturally pushed harder with the next contraction as the baby began to rotate and move down, the cervix yielding and slipping over the baby’s descending head a little more with each successive contraction. She gave birth in twenty minutes to a healthy baby boy. She cried out joyfully with tears of gratitude that it was over and that she had done it so fast. I spoke with her recently, ten years later after her son’s birth, and she still enjoys talking about how empowered that birth made her feel.

She obeyed with difficulty.

After thirty minutes of this ridiculous scenario, I checked her dilation again, hoping that she would now be dilated to 10 cm so that I could release her from her agony by giving her “permission” to push. Horror upon horrors greeted my fingers as I discovered that she was still only 6 cm, but now her cervix was swollen from not pushing.

She had several more contractions while I was on the telephone (I was new at midwifery), frantically calling midwives in another state because there weren’t any in Las Vegas, for advice on what to do about this “problem.” The midwife I spoke to wasn’t any more experienced than I was and apologized for not knowing what to tell me.

While I was on the phone, Susan, tired of panting like the puppy she wasn’t, finally just went ahead and began pushing without my “permission.” I threw down the telephone, rushed over and quickly slipped on a sterile glove. As she pushed, I felt her very puffy cervix, now 7 cm, slip over the baby’s head. Out popped his little head, all in one contraction.

Her cervix didn’t tear, the swelling subsided immediately, and mother and baby were both fine. Mom was no doubt relieved that she had survived her well-meaning, but ignorant, midwife.

I went home thinking about that one, convinced that we were just lucky that everything turned out okay in spite of the fact that this woman ignored science in favor of primal wisdom.

The next time I encountered a “defiant” woman was soon after, when another woman went into labor. Carol was expecting her second baby. During active labor, at 4 cm—when her cervix was soft and stretchy—Carol squatted by her bedroom door and hung onto the doorknob with both hands. She then began to bear down with each very strong contraction.

“Oh, great, here we go again,” I thought as I advised her to desist from pushing.

Carol was less “obedient” than Susan had been and didn’t give ear to my dire warning. She just grunted and pushed like an empowered woman, completely unafraid, and within 30 minutes dilated to 10 cm.

Her baby was fine, her cervix was fine, and this time I was fine. I now understood the power of fearless women and the primal (of first importance) wisdom of our bodies.

As I attended more and more births, I learned that women could safely push during labor sooner than what the textbooks claimed. However, the question wasn’t whether a woman pushed, but how and when.

In my quest to “help” the next woman in labor with my newly discovered information, I wrongly decided to “assist” her to dilate faster by massaging and stretching her cervix when she was 4 cm dilated. What I didn’t yet understand was that the cervix has to be thin, soft and stretchy for this to work and the woman has to be getting the signal to bear down of her own accord, not my good intentions to help her get labor over with faster.

I ended up sending her into the hospital for “failure to progress,” when I caused the failure to progress. I was embarrassed that I had prevented her from having a good homebirth just because I was ignorant. I came to realize that I had much to learn about the different stages of labor from observation of women in their natural habitats. What we have been taught about labor and birth in medical textbooks comes from observation of medicated women in “laboratories” (hospitals), like mice in cages. Observations of women lying in beds, laboring under the influence of analgesics and anesthetics provide no real clue to the workings of the human body during labor and birth.

Lydi Owen is the mother of six, grandmother of six (another on the way) and great-grandmother of four. She has practiced midwifery for 36 years and helped over 2600 babies into the world. She has written three books, produced a DVD and is founder of the nonprofit Association for the Prevention of Maternal Attachment Disorders. Her Web site is www.powerbirth.com.

References:

1. www.cdc.gov/ncidod/EID/vol7no2/cover.htm. Accessed 13 Feb 2008.
2. Greenhill, J.P., and J. DeLee. 1951. The Principles and Practice of Obstetrics, 10th ed. Philadelphia: WB Saunders.
3. McGarey, G. 2007. Venture Inward. Virginia Beach, Virginia: Association for Research and Enlightenment, Inc., November/December.
4. “Achievements in Public Health, 1900–1999: Healthier Mothers and Babies,” MMWR, 1 Oct 1999.
5. Varney, H. 1980. Nurse Midwifery. Boston: Blackwell Scientific Publications.
6. Friedman, E.A. 1955. Primipara Labor Curve. Obstet Gynecol 6: 569. Cited in Varney, p. 170.
7. Varney, p. 171.
8. Buhimschi, C.S., et al. Myometrial thickness during human labor and immediately post partum. Am J Obstet Gynecol 188: 553–59; Myles, M. 1981. Textbook for Midwives, 9th ed. New York: Churchill Livingstone.

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