“I Gotta Push. Please Let Me Push!” Social Interactions During the Change from First to Second Stage Labor


  • Linda Bergstrom CNM, PhD,

    1. Linda Bergstrom is an Assistant Professor in the nurse-midwifery program at East Carolina University, Greenville, North Carolina.,
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  • John Seidel PhD,

    1. John Seidel is a sociologist, author of the Ethnograph computer program, and president of Qualis Research Associates, Amherst, Massachusetts.,
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  • Leslie Skillman-Hull RNC, PhD,

    1. Leslie Skillman-Hull is a women's health nurse practitioner living in Morris Township, New Jersey.,
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  • Joyce Roberts CNM, PhD, FAAN, FACNM

    1. Joyce Roberts is Professor and Head, Department of Maternal-Child Nursing, College of Nursing and Clinical Chief, Parent-Child Health, University of Illinois at Chicago Medical Center, Chicago, Illinois.
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Linda Bergstrom CNM, PhD School of Nursing, East Carolina University, Greenville NC 27858.



Forms of social interaction may occur among the participants in medicalized births, in which a woman in labor is experiencing strong involuntary urges to push but has not yet been found to have a completely dilated cervix. This article examines the social events and communications that occur at the change between first and second stages of labor.


Three cases are described from videotapes of women in the second stage of labor and their caregivers.


Several social and interactive features occurred, in which (1) the caregiver, usually a nurse, by invoking the “no pushing rule,” insisted that the woman suppress her involuntary urges to push; (2) both the caregiver and the parturient displayed an orientation toward the future and the eventual certification of full cervical dilation by a designated authority, usually a physician, regardless of the actual state of the woman's cervix or her involuntary urges to push; and (3) the certification process marked a ritual transition to “official” second stage labor, in which the woman's involuntary urges were considered appropriate and actively encouraged.


A discrepancy between a laboring woman's sensations and caregivers' ideas about how labor should be conducted has implications for clinical care of women, wherein the goal should be to facilitate the woman's accomplishment rather than to direct the “delivery.” (BIRTH 24:3, September 1997)