How does a MW know when to suggest position changes vs. let mama be?

[MegBoz]

I have some concerns that the presence of my MW & her asst might be detrimental to my laboring - getting me all "in my head." What I'm really curious about is how a MW knows when it's best to offer position changes or give feedback like what type of sounds to make, vs. just let a mama do her thing & only check FHT?

My doula walked in a few minutes after I'd had the urge to push (Still at home! Needing to leave for the hospital!) I was VERY noisy and she said, "Keep it low, grunt," and made the sound herself. I remember thinking, "Oh, yeah, right, lower-pitched sounds are better. Ina May wrote that."

Seriously, I was having pushing contractions and that is exactly what went through my head. LOL, you see how the presence of professionals giving me such "feedback" could be detrimental? I'm very Type-A, analytical. My doula's suggestion got me thinking about "HOW TO DO IT RIGHT" - the PROPER and CORRECT WAY to labor. Whereas before, while alone, those thoughts had not popped in my head at all!! I had been rocking along "having my monkey do it" & in labor land, in the moment previously.

I remember one mama in my tribal area saying her MW (at the #1 best NCB-friendly hospital in Baltimore) suggested an epidural because she wasn't "coping well." Sorry, but What???? What does a mama who "is not coping well" even LOOK LIKE?! Obviously screaming shouldn't be considered a problem of some kind that needs "fixing," right?? So what could have possibly made the MW say that? Unless of course the mama was actually saying, "I can't deal with this! Gimme drugs, please!" But that was not the case.

This is certainly a question for my MW & I'll ask her, but would love input from others.

Thanks!

[NuzzleNudge]

Hmm Yes. I am going to have to talk to my midwife about this also. I am very much into letting my body do what it does. But it THAT MOMENT I am not sure how I will react and what sort of coaching or help I will require.

When I had both my kids in the hospital, BOTH times they would not let me up out of the bed or or off those belt monitor for a moment so the only way I could 'cope' was with drugs. Just Stadol the first time and both Stadol and an Epidural the 2nd. I was ultimately drunk when m son came out. And though I still felt that pain both times, I have no clue how I will cope fully clear-headed this time. Even though I am certain the ability to move about and be in water will help immensely. I just don't know.

Also with both my kids BOTH times they held the head in because the doctor wasn't there yet, and told me not to push and to breathe thru the urge. (Yeah Right!!!) But as a result I couldn't push at my will. Now this time without that interference...I don't want to push so hard and so fast that the head BURSTS out and rips me up badly! So I may need some coaching to remember to go slow and steady.

Also, I am a screamer. I remember them telling my sister not to scream because it was a waste of energy. BULL. I believe there must be a nerve or something in my birth canal directly linked to my voice box because it was so involuntary both times. I just SCREAMED as the head emerged. I WILL NOT BE SILENCED. Literally. Because I can't help it!

Point is. You never know what you'll need in that moment. But if you feel empowered and confident enough, tell your midwife to zip it unless you ask for help. Perhaps make a certain signal or signal word cuz expressing your needs during labor is never easy. As a rule I think most midwives are into being as hands off and letting you do your natural thing as possible so I am sure she will be cool with your wishes. Just be clear and open with her.

[plantnerd]

I really depended on my midwife to tell me things like "breathing this way is good; standing this way is good; heartrate weird in this position, move this way instead; try pushing this way; etc" 

That's what I hired her for, to help me birth safely, and she delivered (haha).

I was most comfortable standing against the wall, freaking out with pain.  For the most part I was allowed to do that, but after 15 hours you don't give a crap, you just want baby out. And for me, well, I was open to any and all suggestions from an experienced mother and midwife who had done this 1million times more than I had, KWIM?

[NuzzleNudge]

Originally Posted by plantnerd 

That's what I hired her for, to help me birth safely, and she delivered (haha).

I was open to any and all suggestions from an experienced mother and midwife who had done this 1million times more than I had, KWIM?

 

[MegBoz]

Originally Posted by NuzzleNudge 
I don't want to push so hard and so fast that the head BURSTS out and rips me up badly! So I may need some coaching to remember to go slow and steady.

Also, I am a screamer. I remember them telling my sister not to scream because it was a waste of energy. BULL.

<snip>

Perhaps make a certain signal or signal word cuz expressing your needs during labor is never easy.

Oh yeah, when I had my DS, I totally forgot about the whole "don't push through crowning" thing - I just didn't even think about it & no one reminded me, so I pushed with each contraction as I had been. I had both a small 1st degree tear and a skid mark (which was worse), so I WOULD appreciate reminders not to push at that time. On the whole, I'm not nearly as concerned about "hands-on" help for 2nd stage as I am with interference for 1st stage. I also want very frequent FHT monitoring for 2nd stage.

That reminds me, I remember my MW once saying, "Sometimes women just need to scream their babies out. Sometimes I'm there ready to catch and they're screaming right in my ear the whole time." With a shrug & a smile like, "That's the way it is. That's what some women need - so that is what they should do." :) So it's nice to hear she doesn't think screaming is a sign you're "not coping well."

I like the idea of a code word or signal, maybe I won't feel as rude saying the code word as opposed to saying, "Shhh." or "Quiet." Because the thought of saying those things feels rude.

Quote:

Originally Posted by plantnerd 

I really depended on my midwife to tell me things like "breathing this way is good; standing this way is good; heartrate weird in this position, move this way instead; try pushing this way; etc"

Well, yeah, if FHT are non-reassuring, that's a medical problem and of course I want her to step in & act. & I guess if she could tell progress wasn't being made after pushing for a while, I'd appreciate her suggestion for a position change.

But all through out 1st stage? If FHT & my BP are good? Then what would make her suggest position changes, suggest different vocalizations, suggest breathing a different way? That's what I really want to know.

I'm not looking for a MW to "guide" me through birth. I'm looking for her to stand back, monitor for medical problems and if there are no problems, let me do my thing. I'm not depending on her to guide me, or even reassure me that I'm breathing & pushing correctly.

Of course, if I was in intense pain for many many hours, yes, I'm sure I'd feel differently & I'd be happy to tell her, "HELP!" & let her 'guide' me.

On the whole though, I do respect her judgment & experience. That's why I hired her! So if she really & truly thinks things would be better if she makes a suggestion, I'm comfortable with her doing so. I'm just curious how she makes that judgment call when "interfering" with a suggestion is better than staying quiet. WHAT specifically [in the absence of medical problems] is it that makes her act vs. observe?

[emily11megan]

On a side note, I find it very interesting that most threads on MDC generalize midwives and homebirth care, much more so than MDs.  There are SO many different kinds of people working as midwives, and this exact question can only be answered by the one you have hired.  That said, I'll tell you what would make me (birth assistant and student midwife) think a woman "needed" some coaching.

If she looked or acted scared, very high pitched screaming, thrashing, scared look in her eyes, crying.

If she was in the same position for a very long period of time during 2nd stage with little or no progress.

If she was in a great deal of pain, for example her hips or back hurt in a certain position.

If the baby was not tolerating a position well (due to FHR)

If she asked me what to do

You might want to screech and thrash, and so what about your back pain.  That's totally up to you.  You'll have to talk with your midwife and let her know that you are getting good info about labor coping techniques, and would only like her to interfere if there is a safety concern (if that's how you feel)  If you've hired the right midwife, she'll agree with your wishes, and you will screech and thrash yourself into a lovely birth!  Good luck!

[MegBoz]

Originally Posted by emily11megan 

On a side note, I find it very interesting that most threads on MDC generalize midwives and homebirth care, much more so than MDs.  There are SO many different kinds of people working as midwives, and this exact question can only be answered by the one you have hired

Excellent point! I guess what I meant, "For those MWs who are more hands-off, what makes them decide to get more hands-on?"

Thanks for your list. Interesting & that makes sense to me.

[636Jen]

Speaking as a midwife, when I notice a mom squinching (is that a word?) up her face, raising her shoulders, tightening her fists and using a high-pitched voice, I feel theI need to remind her to relax her face, drop her shoulders and get her voice lower....like a primal growl almost.  (I too make the noise.)  The things I mentioned first are signs that the mom is feeling out of control in her labor.  She is tense and as we all know, tension stems from fear and can create harder contractions and more pain.  Maybe she is nearing transition.  Talking in a low soothing voice, I may tell the mom to let the contraction move through her and remind her that each one opens the cervix, making it possible for the baby to be born.  I tell her to use the energy to visualize her cervix opening, not use the energy to tighten her face and clench her body.  I've always heard possitive responses to this sort of guidence....never that I was "telling" someone how to birth.  Everyone births their own way and a midwife (if she's good at her work) can get to know a mom during prenatals and adjust her care accordingly.  If you are a take-charge kind of person, your midwife would do best to offer gentle encouragement and not too many suggestions.  Some will need more hands-on care and be more receptive to suggestions.  What's so awesome about homebirth is that YOU (the client) tells US (the midwife) exaclty how you want to birth...and we are there to facilitate that.  :)

[CBEmomma]

My MW just kind of knew with what my face looked like or my actions. For the most part I labored like I wasn't even in labor. I held normal and good conversations, I went on some walks, took a shower, took a nap, ate, etc. It was more like a get together with some close family members and my MW rather than I was in labor. Once transition hit she knew when to offer support like saying "yes you're doing good, everything is going fine and baby sounds good too". Most of transition was silent, I really enjoyed that. There was a thunderstorm happening, so it was nice to listen to it as thunderstorms are my fav. sound. During pushing she would say "oh yes you are having nice involuntary pushes, things look great". It was very helpful to hear these things. I basically did what my body felt like doing, with her reassurance that everything was going ok.

If your MW is talking too much or offering unhelpful adivce you should tell her. I'm sure most MW's are find with hearing those things.

[jgale]

My 3rd baby was direct OP and a much harder labor for me than my previous 2.  I don't remember receiving much direction at all in my first 2 births, which was fine.  With the third there were definitely a few moments where the midwives seemed to read my mind and offer a suggestion that was helpful.  In the tub, at about 8 cms, when I started freaking out in between contractions about the next one instead of relaxing and enjoying the break--they suggested a walk to the toilet might help me get those last 2 cms done.  It was the right thing to do because the birth pool was starting to feel like a prison.  And when I was pushing, I had been thinking 'the harder I push, the sooner this will be over', but when she started crowning, I just felt like I was losing my mind.  I remember thinking 'it hurts to much to push hard anymore, but I can't get the baby back inside."  I was genuinely at a loss and felt stuck and terrified.  This must have all showed on my face because I remember one of the midwves saying "little pushes" and it was like this light at the end of the tunnel.  What a brilliant idea! Little pushes!  I seriously felt like she saved me in that moment.  How many times have I said that to a woman?  I can't even count--but it was way beyond me to come up with it myself in that moment.

Aside from my personal story, as a midwife, I agree with the above poster who said this:

If she looked or acted scared, very high pitched screaming, thrashing, scared look in her eyes, crying.

If she was in the same position for a very long period of time during 2nd stage with little or no progress.

If she was in a great deal of pain, for example her hips or back hurt in a certain position.

If the baby was not tolerating a position well (due to FHR)

If she asked me what to do

Those seem like good reasons to offer a change.  I think as I have gotten more experienced as a midwife, I have become less directive and more comfortable with positions and sounds that maybe don't fit with our ideas about how a nice birth should be.

Definitely talk to your midwife about this stuff ahead of time...

Jessi

[NYC_CNM]

As a midwife, I too agree with Emily11Megan's assessment of when a woman isn't coping well. Screaming is a part of labor, but usually it's a focused scream, or a determined scream, or a scream-through-contractions scream and then a return to rest and relaxation afterwards.  If she's screaming in a high-pitched distressed scream because she's frightened, or suffering, or feels out of control, that to me seems to be someone who isn't coping well.  Not that a little screaming is a bad thing, and can actually be normal during transition/ pushing/ crowning, but if it is that distressed high-pitch scream and it's going on and on and on, it's sure to exhaust the mama and not help her relax and dilate.  I attended a homebirth once where the mama screamed her way through every contraction--she put her hands over her face and just howled, but as soon as it was over, she was practically asleep with relaxation in between the contractions.  It seemed to be working well for her.  So it's just a judgement call.  Usually I think the philosophy of midwifery says you leave the woman be until you notice she needs help or assistance, and then very gentle suggestions usually do the trick.  If all is unfolding well, there's no need to say or do anything, so I'm not sure your midwife will even suggest position changes unless it looks like you need it, or the baby isn't liking a certain position.  But again, definitely talk to your midwife about this so you're on the same page.

[emily11megan]

NYC CNM, that's funny that you relate that story.  I myself was a "screamer" at my birth.  I guess I'd really call it a bellow, though.  It was throaty and almost masculine in sound.  But it was LOUD!  Now my preceptor (who attended that birth) and I tease women that they can be as loud as they want, especially with me at the birth.  Only one girl has beaten me and been louder. LOL  Sometimes, I demonstrate my noises during a late prenatal session, just to show them that really, anything  you need to do to cope  with labor is ok, and it's ok with us.  I think loud noises helped me let the energy flow better, my labor was fast and furious, and what energy came out downward, came out upward, too.