Understanding Delayed Pushing During Labor: Safety & Baby's Well-being

Question
hi, my midwife uses this approach where when it's time to push the baby out and the baby is right there in the birth canal about to exit, you don't push for quite a while through the contractions, to prevent tearing.  my question is, isn't this traumatic for the babies head?  also can't this cause a hematoma(sorry not sure if that is the right word).  thanks, lisa

Answer
Dear Lisa,
I'm sorry I took so long to respond; I was without a computer for a few days.

When the baby is crowning, that is, right at the exit to the birth canal, and the widest part of the head is just there, it is very possible that the skin of the perineum, or even parts of the inside of the birth canal, can tear from the amount of stretching. To prevent that, a midwife or doctor can provide gentle counter-pressure on the baby's head, and ask the mother not to push with the next contraction.
Instead, the mother will let the power of the contraction be the only force pushing the baby down and out, so that the baby slides slowly out, instead of too fast.
Usually, this only lasts one contraction, which is about one or two minutes.

After the baby's head is out, there is minimal chance of tearing, unless the birth of the shoulders is handled incorrectly.

The reason this is not traumatic for the baby's head is because the baby's skull is not a solid sphere at the time of birth.
The soft spots a the top and back of the baby's head, called fontanels, are where the baby's skull is not fused yet, allowing for overlapping of the plates of the skull during birth. This process is called molding, is perfectly natural, and happens to all babies during a vaginal birth.

Also, the muscles and ligaments that connect the bones of the mother's pelvic outlet, having been bathed with a hormone called 'relaxin' during the nine months of her pregnancy, are extremely pliable and stretchy, so that her pelvis will expand to accomodate the baby's head, especially if she is not lying on her back and compressing the back of her pelvis against the bed.

I have never heard of a hematoma happening in a normal vaginal birth.
After reading up on it for you, I found that is is very uncommon, and that in the rare cases where it does happen it is either because the baby is breech, that is, feet or bottom first, with the head coming last, or when the baby is pulled out with forceps or a vaccuum.

Please let me know if you want clarification on any of these points, or if you have any other questions.

I wish you the very best of luck,
Sheva