What can a birth atendant learn from UCers? - Page 2

[paloma]

I think the worst insult I was ever given about about a birth is that I was a hero and that I saved the day. It was an alternate presentation and they were way up in the mountains. I needed to reconcile that they needed someone there to feel safe. After the birth was the time to solidify that they did it all themselves.

[homemademomma]

Originally Posted by pamamidwife

Spending more time away from a woman's laboring space has also empowered partners. They do the labor together. In the end, when the six week visit is over, I'm history. The memory should be of THEM doing it together.

My views on perineal support and support during pushing has changed radically from my training. I no longer do much support, if at all. It's pretty quiet during second stage, except for encouraging words from me or my apprentice.

The immediate postpartum experience is different. I'm really working on the "don't wake the mother!" aspect after birth. No more baby hats, no putting a stethoscope between mom & baby. No bulb syringe. I am working towards more quiet, less light during this time. It's hard.

pam, i agree with you 100%. as a student midwife, i see and do so much that i feel is unnecessary. suctioning, stethescopes, perineal support- i really feel like we do that stuff because we want to feel useful and needed, kwim? its really really hard to let it go.


friday night/sat morning i went to abirth of a mother who has already had 12 children, including 2 UC births (one of which was a stillbirth). her last baby was born at the birth center, as was this baby, because she felt that with her high parity and history of PPH she wanted extra help, just in case.

anyway, her husband has caught almost all of theirc hildren, and her oldest daughter (who wants to be a midwife), was going to catch with the father. my precepter had me get my hands in there too, because, as she put it, " im the one who is going to have to suture if they mess up!"

sigh. i think the main thing UC'ers can teach us as birth assistants is to let go of our egos. stop doing so much at births. TRUST birth. give the experience back to the parents startig at the first prenatal visit.

[pamamidwife]

I hear you, homemademama. In my training, I was required to listen to baby right after it emerged (even though it was impossible to hear heartbeat because of the SCREAMING baby!!), suction and put a hat on the baby right away.

I found this great article by UK mw Sara Wickham (whom I love, love, love) that explains it so well...

From that article:

Yet, after thinking about all of this, I am left to ponder the question that bothers me the most. Whether or not we do things like this as a regular part of our personal practice, why do we feel we need research evidence to support the argument for not intervening? In a model of midwifery that assumes normality, I would assume that midwives would need to see evidence that something is useful before incorporating it into their practice, not the other way around. Have we become that uncomfortable with the physiology and normality of birth that we would rather intervene than not? Are we so fearful of litigation that we feel we need to “do” rather than “be with”? And are these practices really so ingrained in us that we feel compelled to continue them on a routine basis unless – or until - they can be proven unhelpful?

This, to me, is the biggest fault of modern midwifery care.

[rajahkat]

[QUOTE=
I'd love any ideas on how to encourage women to be more in control.

I'd love to know how to encourage everyone to know they have the ability to birth their baby, and to feel the power of doing something so momentous.
Any ideas?[/QUOTE]

Cool Thread!! I really wanted to respond to this. I think this is something that needs to happen throughout the woman's pregnancy. It's sure not going to happen in labor if she's been conditioned to believe the attendant is going to DO/FIX/CONTROL everything!

I think something as small as wording (emphasizing what SHE will be doing, not what the attendent will be doing TO her) transfers focus and power back to mama.

Stop talking And see what she has to say. Recommend books that emphasize mama-led birthing, whether attended or not.

If she comes to you with a problem, BEFORE you offer a suggestion, ask what she thinks she should do, how does she feel about it, etc.

Talk to her about births you have attended where mama WAS in control, caught her own baby, etc. So that she understands that those things are even possible. It's amazing how many women don't even consider the possibility.

I hope this helps a little. I don't really know what goes on in a birth attendant/mama relationship, as I've never had one. But I DO believe there is a place for you ladies, so keep up the good work!

Kat- mama to Alder(9/6/01-couplesUC) & Banyan(5/7/04-solobirth)

[harmonymama]

I haven't had a UC, but am considering it next time around. My input is: Recognize how much power your words have. Objectively speaking my MW for my last birth said very little. She is a good midwife, but... She arrived 5 minutes before the birth, but the words she did say are stark and fracturing in my memory. On the phone with my husband, they kept discussing how I needed to lengthen out my contractions, because they were short, and I was probably still in early labor. I, on the other hand, knew that I was in active labor and rapidly approaching transition, but they couldn't seem to get it. (I think timing, and trying assess where labor is at, when to come over, etc., is an underestimated way that attendants undermine the natural birth process and mother's innate wisdom. As much as I got out of Bradley, there is this sense that others outside need to assess where mama is at in labor, by emotional sign posts or whatever, as if she herself couldn't possibly know.) When she arrived, she said something about getting the pitocin ready, because things were going so fast. That comment really disturbed my focus and intruded into the sacred atmosphere. It put me on my guard and I said to her something about putting that away unless I really need it (I didn't). Then she suggested I labor on my back so things would go faster (things were already going fast enough!) I associate laboring on my back as very disempowering, even humiliating. I responded, "I'm not going to labor on my back!" Her comment made me mad enough that I summoned the energy to get up into a squat. She was wisely quiet after that, but her intrusion continued after the birth. She asked me three times to cut the cord, even though I kept telling her no, because it was still pulsing. She was also pushy about breastfeeding, made me feel like I was doing something wrong, because my baby was not interested in nursing for close to an hour, even though I was an experienced breastfeeding mother and La Leche League member. I don't write all this to badmouth my MW. She is not a bad person or a bad MW, and had no ill intentions. I just share in order to demonstrate how sensitive mama and baby are at a birth, and how seemingly innocuous intervention can really undermine the natural process. Next time, I think I'd rather not have to be on guard against intrustions.

[mum at home]

My second birth experience was a VBAC and I had all the usual hangups about whether I could do it or not. The hospital midwives were very concerned about following rules - after my waters broke they checked the heart beat after every contraction (I refused frequently) and were timing me as to how long they would let me labour for. This put such a lot of pressure on me. The thing I remember most about my private midwife (who in Australia has no authority in the birthing room and can be asked to leave like any support person) was looking at her when I was close to transition and saying "I don't know if I can do this", and having her look me straight in the eye and say "yes you can!". She knew what my fears were beforehand and how to respond during the labour in a way that would be positive for me - this was more important than the medical knowledge she brought along.

During my homebirth with her, she was mostly hands off, although she did check the heart beat a few times. This was quite annoying - baby was moving a LOT during the labour, and she couldn't get the heartbeat so I had to reassure HER that everything was fine. By the time baby arrived I was starting to get concerned because she was. The main issue was that she was worried about a breech birth (even though it ended up head first) and her fears transferred themselves to me. So I think as an attendant, you should really think about whether you should be in the room if you are worried about the choices the mother has made, as your insecurities can pass themselves to her.

[TRIBE]

Originally Posted by mum at home

So I think as an attendant, you should really think about whether you should be in the room if you are worried about the choices the mother has made, as your insecurities can pass themselves to her.

Exactly!! If you as an attendant do not trust the birth process or even the postpartum period immediatly after birth, GET OUT! Those fears and insecurities definetly transfer to the mama and mess with her energy and flow.

Pamamidwife--If you don't mind could I ask you a few questions as I see you are working really hard on stepping back even after the birth. I just need some of your insight/wisdom when I have a lenghty talk with my midwives about their behaviour after my birth.

In a waterbirth, do you strongly encourage (err command) the mama to get out of the water so baby doesn't get cold? Is there anything that says the baby has to get out of the warm water immediatley?

What are the benefits or repurcussions to strongly encouraging (err again commanding) mama to deliver her placenta even if she doesn't feel ready to?

All the baby procedures that are attached to the "standard of care" model, how important are they to perform immediatly after birth to protect your liscense? Couldn't you say delay all of those for the first hour or two and still be "safe"?

Thanks and sorry for somewhat going off topic, I just feel its important for me, as a previous UC-er, to pass on some wisdom to my medwives but in a way that wouldn't be confrontational (which I am feeling that I would be very confrontational right now)

[pamamidwife]

In a waterbirth, do you strongly encourage (err command) the mama to get out of the water so baby doesn't get cold? Is there anything that says the baby has to get out of the warm water immediatley?

No, the mom stays in as long as she wants. I don't monitor the temperature of the water, as I just suggest that the temp be what the mother feels comfortable in. We don't even put a hat on the baby. I trust that the mother's intution and care for her baby (she loves that baby more than I do!) will lead her to get out if she thinks the baby is too cold or ask for a towel/blanket.

Think about it this way: most babies are born into room air. In a typical hospital, that means about 70' if they're lucky, it's usually cooler. In a homebirth, many mws pump up the heat to near 78' or so (at least, it seems, until everyone there is sweating). Even water that is 78' is pretty cool. In fact, I'd venture to say that not many moms birth in water that is 78'. It's usually much warmer.

Babies don't seem like they're affected by the water temp much. One thing I notice is sometimes it's normal for waterborn babies to take awhile to breathe or to pink up. I think this is because of the warm water on the cord - there's no shock to start it constricting like it does when it's exposed to air. So, in turn, many mws could interpret this NATURAL slow-to-pink-up process as being abnormal, i.e., the baby is cold.

What are the benefits or repurcussions to strongly encouraging (err again commanding) mama to deliver her placenta even if she doesn't feel ready to?

Hemorrhage, partially separated placenta, retained placenta, retained placental pieces. Nature is not going to allow a woman to just "forget" about her placenta. It's only an emergency to get the placenta born when it is partially separated - that is, part of the placenta has come off the uterine wall and there is blood pouring out of the mom. Because part of the placenta is still attached, the uterus cannot contract to slow the bleeding from those vessels where it detached. This is an emergency situation that means the placenta must come out immediately.

Other than that, I cannot imagine why a woman would be rushed to birth her placenta...especially if she cannot feel it or doesn't want it hurried.

All the baby procedures that are attached to the "standard of care" model, how important are they to perform immediatly after birth to protect your liscense? Couldn't you say delay all of those for the first hour or two and still be "safe"?

What do you mean? Like listening to the heartbeat? I don't touch the baby for a good hour or so after the birth. Even then, it's usually just to hold the baby while we re-wrap it after mom gets out of the tub or gets up to shower. If a baby looks great, I'm not going to listen to the heartbeat with my stethoscope! There's no regulation that says I have to suction the baby or do everything right away.

We usually do the newborn exam as one of the last things before leaving - around an hour and a half after birth. By then, babies are getting sleepy and don't mind us doing silly things like measuring their heads, etc. I've also left without doing a complete exam, just check baby over in mom/dad's arms and did the exam the next day. Not ideal, but I don't want to disrupt what is going on if baby is awake and aware.

Thanks and sorry for somewhat going off topic, I just feel its important for me, as a previous UC-er, to pass on some wisdom to my medwives but in a way that wouldn't be confrontational (which I am feeling that I would be very confrontational right now)

Here's a great quote from wise UK midwife Sara Wickham that I recently found so true - and every mw should read it:

Yet, after thinking about all of this, I am left to ponder the question
that bothers me the most. Whether or not we do things like this as a
regular part of our personal practice, why do we feel we need research
evidence to support the argument for not intervening? In a model of
midwifery that assumes normality, I would assume that midwives would
need to see evidence that something is useful before incorporating it
into their practice, not the other way around. Have we become that
uncomfortable with the physiology and normality of birth that we would
rather intervene than not? Are we so fearful of litigation that we feel
we need to “do” rather than “be with”? And are these practices really
so ingrained in us that we feel compelled to continue them on a routine
basis unless – or until - they can be proven unhelpful?


Yes, yes, yes, yes. It's time for a revolution in midwifery. I'm hopeful that we can do it.

[TRIBE]

Think you Pam! You answered me with what I needed. Just one more question, are there any links to help support that mom can safely stay in the water with baby as long as they are comfortable? My water temp was 98-99 F so I know it was plenty warm in there. As well as links on allowing the mom to birth the placenta in her own time, unless in the event of an emergency? I think having something to back me up other than just my say so would help out when I talk to the midwives this week.

I love that qoute and I am now reading all over her site. Thank you so much!