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Routine "emergencies" ?

Last post 11-21-2010 4:22 PM by worstfriend. 18 replies.
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  • 11-10-2010 11:17 AM

    Routine "emergencies" ?

     Thinking back on all the hospital transports I've seen in the last 10 or so yrs. which do end in vaginal births....

    At every single one;

    1. the doc has his/her hands up in the vagina pulling and stretching vaginal tissue from transition on, why? That certainly doesn't help the woman relax, nor does it help prevent tears.

    2. as soon as the head is out, they start pulling, tugging, turning, & wiggling on the head until I know that poor baby will be in sore need of a chiropractic adjustment in short order! With no sx of distress, nor any "turtle" sign, why aren't they waiting on the next ctx?

    3. why do they think that being falt on your back brings a baby past the pubic bone better than being upright?

    4. why do they not see that holding ones breath to push (and being flat) is what is causing the decels?

    5. why do they have these wonderful birthing beds, and no one knows how to use them properly? Many times when I ask about the squat bar, has not been used in so long, no one can find it! or if they do, they can't figure out how to attach it! What happened to the great instructions that came with the beds, demonstrating all the different birthing options it not only allows, but facilitates?

    6. Why do they think "delayed cord clamping" means wait 30 seconds? Why do they think it's necessary at all?

    7. Is all this just local? How wide spread is this dicotomy between what midwives are taught & what ob's are taught as the undisputed physiology of the birth process?  

     

      

  • 11-11-2010 5:46 AM In reply to

    Re: Routine "emergencies" ?

    It is not local.

    I cannot for the life of me, get our hospital to do anything about #3.  I was just at a birth on Sunday and the RN--a woman who has used midwives and had homebirths herself--spouted the "When you're flat, you can get the baby under the curve of your pubic bone".  What do you think would help?  An inservice of some kind using ... ? a physical therapist?  It has to be someone in the medical/hospital realm as they won't listen to me.

    #5:  The overwhelming majority of women are birthing with epidurals. The squat bar gathers dust or is forever lost in a closet somewhere because they never get to use it.

    Let me know if you have the answers to any or all of the above!

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-12-2010 5:45 AM In reply to

    Re: Routine "emergencies" ?

     What you describe is exactly what led me to work at 7 different hospitals in 10 years as a nurse--I thought if I could find the right hospital that honored birth, I would enjoy being a nurse.  I finally learned that those kind of hospitals were rare (I've never found them in 10 years as a nurse or 11 years as a midwife.) The only answer I can come up with to your question about the dichotomy between OB's & midwives is the God complex.  Everything is done for the doc's convenience.  The doc thinks the stretching helps the baby come faster (doesn't matter if it bothers the woman).  Pulling the baby out by the head saves that pesky 2 minutes waiting for the next contraction.  If they saw the correlation between what they do and decels, they would have to stop doing most of the interventions they do (epidural, AROM, pit) and THAT ain't gonna happen. The birthing beds are a sales ploy (the salesmen can confirm that) they're not really meant to help the woman to "alternative" positions that may be uncomfortable for the doc!. About the delayed cord cutting, anything that takes more time isn't going to happen.  From the moment the doc comes in the room for a vaginal birth, his/her only thought is how soon can I get out of here?  One female OB asked me, "Why do the mennonite women prefer a midwife?"  I said, "Doctors believe pregnancy and birth is an accident waiting to happen."  She said, "Well, it is..."  I laughed and said, "Midwives think birth is 'as safe as it gets'.What I've found interesting in my time as a midwife to mennonite women is how many of them give birth lying flat on their back.  I come from the school of thought to let the woman choose her position to give birth and I'll intervene if needed. I've never seen a problem due to birthing flat on their back.  One woman asked, during a check up, if it is better to push sitting up?  I told her a lot of people think so.  She wanted to try it this time (#7).  We stacked the pillows, she took a breath, pushed approximately 2 seconds and then flung the pillows to the floor, layed flat and birthed her baby with the next contraction.  I guess I don't see the problem with pushing flat on your back since I see that so often.  p.s. I still have nightmares about my years as an OB nurse.  Thanks for letting me get this off my chest.

    Good article: "Women speak out about what's gone wrong with the US birthing system"

    http://www.huffingtonpost.com/tabby-biddle/women-speak-out-about-wha_b_781205.html?ir=Living

  • 11-12-2010 2:26 PM In reply to

    Re: Routine "emergencies" ?

    I agree that women should assume the position most comfortable to them. However, I also agree with Ina May when she talks about "getting something big out" and when I'm trying to "get something big out,"--or at least what feels like something big--I don't lie on my back.  It seems that gravity is working against the uterus.  But ... if it works, you do it and if it doesn't, you don't.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-12-2010 4:01 PM In reply to

    Re: Routine "emergencies" ?

    Marlene, Susan, Joy,

    Thanx for starting this type of thread, Marlene.  Tell you truth I'm not even one bit surpised at all of observations that were pointed out.  Not just your posts, but the others as well.  To me its not just local (your area), but its widespread and really don't any additional details.  Since I was only a volunteer and a clerical one as well, so I really don't that much go on.

  • 11-13-2010 12:42 PM In reply to

    Re: Routine "emergencies" ?

     I noticed the thing with fingers up in the vagina throughout pushing at the last birth I attended. Why do they do that?

    Apprentice Midwife.
    Homeschooling mom of four with another on the way.
  • 11-13-2010 5:04 PM In reply to

    Re: Routine "emergencies" ?

    re: fingers in vagina - a hospital mw once told me a doctor told HER it was done to help women "aim" - so many were numb or partially numb during pushing from an epidural that they genuinely struggled to "direct" the pushing, and, apparently, the fingers in the vagina helped them...  I have never had an epidural, but i have to say that i would kick the face of anyone, ANYONE, who tried it on me.

    re: pushing - it strikes me that the sort of pushing involved in childbirth is most similar (in terms of the experiences of those giving birth) to moving one's bowels.  One does not normally move one's bowels in mixed company, in unfamiliar surroundings, under bright lights, flat on one's back while strangers scrutinise/manually manipulate the progress!  Given the company, lights, surroundings and strangers seem to be a given for so many people, position might be one of the few things which might make a difference to the woman, given we are trained from early toddlerhood to "leg go" of our bowel/bladder muscles in an upright position.  So many people have to fight hard once they see the toilet to hold back the urine they were managing perfectly well to hold when walking to the bathroom, it makes sense to me that being upright (or even, if possible, alone and on the toilet!) would, purely for those reasons, greatly assist in delivery.  That's not to mention the effects of gravity, which would assist far more in the upright position than the flat-on-back one.

    I do know one woman who had all 6 of her babies, including a brow presenting daughter, flat on her back.  She said it was her preferred position.  But when i talked to her more her whole view of labour is one of suffering to be endured - she would "time" her contractions by "tapping" her thighs and had massive bruising on both thighs after the births from doing so.  It sort of made sense to me that she'd want to be on her back, for her labouring was about submitting to something, rather than doing something.  She did not enjoy her births but seemed to enjoy that she had suffered so much (if that makes sense?  Like coming at it from the point of view that it SHOULD be agonising and horrendous and that if it isn't you did it wrong in some way).  Each to their own of course.  I see birth as an ocean to float and swim in, and she saw it as a potential drowning she may or may not survive but mustn't resist either way.  I realise that's a tiny sample size but she is literally the only woman i know who CHOSE to give birth on her back, though many many more (including me with #1) were forced to do so by those attending the birth.

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 11-14-2010 4:56 AM In reply to

    Re: Routine "emergencies" ?

     Aaaah, hospital pushing, always gives me sympathy hemorrhoids. All that frantic coached pushing makes me involuntarily bear down meself.

     

    re; pushing supine. I see a LOT of women choose this position on their own. Usually, if they're not in water, they walk, rock, sway, sit on the toilet, hands and knees, whatever, and then say, "I'm tired, I want to lay down!" They lay down, usually on their sides, fall asleep for a few minutes (or even a few hours!) and wake up, roll onto their backs, (or, less frequently, onto hands and knees) and push the baby out within minutes.

    I don't really think pushing while laying supine is a problem, clearly the overwhelming majority of women world wide do push babies out while lying on their backs, whether or not it's by choice or by protocol. I think it's the forced, coached pushing that starts as soon as she's complete that makes pushing difficult and prolonged. We all know there's a whole lot of molding, rotating and repositioning (as well as a well-deserved break from contractions) that happens after she reaches fully, and if she's not ready to push then no amount of coaching, counting, holding breath, tugging, or stretching is going to make it happen. What's the big rush to bring the baby down?

    I was trained to coach pushing as soon as the woman was complete (and yes that meant lots of VE's) but since I stopped checking for dilation and stopped coaching, I rarely have a second stage that lasts more than 20 minutes in primips and 2-3 contractions in multips. Usually, the baby's head appears without warning or fuss and Dad has to scramble to receive the baby!

    Rarely do I see a woman choose to squat on her own, or stay squatting if she does choose it, it's tiring and the pressure is overwhelming. I rarely see women choose to stay on the birth stool or toilet for pushing, either, they usually jump up and stand or lean forward onto hands and knees or more often the runner's starting pose.   

    I guess I don't see any birth position as inherently better or worse than another, but I do believe forced, coached pushing is counter-productive, exhausting, and painful. A whole lot of work that does nothing to hasten the process and makes mama/baby tired and stressed.  

    I don't think pushing a baby out is like moving your bowels at all. I tell women pushing is like throwing up, in reverse. Once the urge strikes, nothing or nobody is going to stop it. You can usually hang on to your poop, but when you gotta puke, it doesn't matter if you're alone in the woods or on stage at Carnegie Hall, you're gonna puke.       

  • 11-16-2010 9:53 AM In reply to

    Re: Routine "emergencies" ?

    I did not push through a 90minute seconds stage with DD1 as i was told not to, so i disagree that once the urge is there you will push regardless.  My 2nd stage was written up as 5mins, that is the time from her ears being out (which is when the midwives noticed i must be fully and said i could push) and the next contraction, when she was born.  It was a terrifyingly hard 90minutes, but i didn't push.

    DO the majority of women worldwide give birth on their backs?  Do women in other cultures with less medical intervention choose this position?  I have no idea, i only have (old) anthropology accounts to go on, most of which were written by men (who usually had to sneak about to get the information).

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 11-16-2010 4:31 PM In reply to

    Re: Routine "emergencies" ?

    Michel Odent says that if left to their own devices, women will assume a standing, squatting or kneeling posture for birth. ??

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-17-2010 4:56 PM In reply to

    Re: Routine "emergencies" ?

    Brlnbabies:

    "Michel Odent says that if left to their own devices, women will assume a standing, squatting or kneeling posture for birth. ??"

    I've heard that, but I find, if un-directed, a lot of women, esp. "Plain" will get flat on their back! So I usually go over all possible positions, and their pros & cons prenatally, & still get a lot on their back!?!? 2nd most common is semi-sitting, 3rd, kneeling forward, leaning on birth ball, side of pool, or headboard. my pers fav is side lying, so wonder why more women don't chose it.

     

     

  • 11-18-2010 7:05 AM In reply to

    Re: Routine "emergencies" ?

     One lady told her sister she had her baby on her hands and knees.  The sister said, "I'll bet that was a great view for Joyce" (the midwife).  These plain ladies still think of modesty even when they're pushing a baby out.  I have some that prefer being covered while they are pushing--one day I'm going to miss the birth and be right in the room!  I think this plays a part in the plain womens' thinking about pushing.

  • 11-18-2010 10:07 AM In reply to

    Re: Routine "emergencies" ?

     if Plain ladies are thinking of modesty, flat on their back w legs splayed open is the least modest position, I can think of, so I doubt if that is why they choose it. The most modest position is in a tub w their dress floating around them. Then they just reach down and guide baby to surface w/o ever exposing their nether parts.

  • 11-18-2010 11:40 AM In reply to

    Re: Routine "emergencies" ?

    Perhaps it's more of an unconscious return to a sexual position?  ??

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 11-19-2010 3:19 AM In reply to

    Re: Routine "emergencies" ?

    Are "plain" women, women who would have been told "how" to give birth by someone and would follow that instruction?  I know most women here go to hospital and lie on their back unquestioningly because that's how you give birth.  They've seen it on a million tv shows, heard about it from relatives and friends (often with mention of the stirrups so specific that i had one woman say to me "i was so relieved when they fastened me into the stirrups and i knew the baby was coming"!).  But i don't know if that would be the norm.  I was flat on my back for #1 (made to lie that way for a VE which revealed a crowned head, then stayed there and pushed once for the rest of her - it was AGONY having to lie down that way, but once i was down it wasn't terrible pushing her out like that, it was only one more contraction after all, though i did get a 2nd degree tear despite her head sitting in the birth canal for about an hour before i pushed her out) and on all fours for #2, which was much much quicker (at-spines to birth in 6mins and no restitution) and i did tear, but just a 1st degree along the scar of my 2nd degree.  Wasn't stitched either time, so it could just have been i had more room 2nd time as it'd healed "open".

    Anthropological reports usually describe squats or hands and knees, but a lot depends on the context - men are often not around/allowed at births so it's hard for anthropologists (who were almost all male) to get a good handle on it all, some of them were run out of places for even asking about birth!

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
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