Perineal tearing: the controversy of hands on vs hands off

[Emilie]

Great article.
Lots to think about.
my mw was relatively hands off-- she did not touch me while i was pushing and i caught and pulled up my own baby. Cord around the neck and all.
If I was to do it again- I do wish she had checked for a cord for me- I was not aware to look for that- and I pulled her up out of the water with the cord around her neck.
But next time I could also check myself- now with what I know.
I tore a little- my mw rarely has tears- even with breech- huge babies- etc.
She does this puh puh puh technique. are you familiar- why does this work so well?
One of the main reasons she tries to leave the peri in tact is that she does not suture.... so therefore- if there was a tear that needed stiching- it would be off to the hospital- with no baby- not what we want!
i am glad that i did not tear much- my recovery was very easy.


nak- sorry!lol

[Kathryn]

I believe in hands off. My midwife did massage, but I honestly was a bit annoyed by it even though it didn't hurt and if I wasn't busy contracting, I would've told her to keep her hands off.

[pamamidwife]

I think that any woman will naturally slow down when crowning because of that "ring of fire" - women don't need to be directed to breathe a certain way or anything. Women just know. It works perfectly.

I think checking for cords as the head emerges is VERY painful for women and totally not necessary. Most women do like you do and just unwrap their babies as they bring them up. No harm!

[Emilie]

oops - I did not unwrap it! I pulled her up- and knew things were not ok- but I would not let her go- so dh grabbed it off. She had a bit of a rough patch at first- but fared much better at home than she would have at the hospital!

[Kathryn]

You know, I had no ring of fire. I slowed down horribly because the sensation of my bones moving to let the baby pass was overwhelming. The actual crowning didn't hurt at all. It was just the moving bones. It was scary because I had no idea to expect that, they'd never touched on it in prenatals or class. It was always only about the "ring of fire" which I never had.

[pamamidwife]

Perineal tearing: the controversy of hands on vs hands off

I'll tell you right up front that I'm a pretty-hands off midwife, but I'm most hands-off when a woman is pushing her baby out. I'm including this article I recently wrote for Midiwfery Today for the mamas here - your birth belongs in YOUR hands, not your midwife's - not your doctor's. We are made perfectly to birth babies without too much perineal trauma and this is best done when those we are not intimately involved with keep their hands off our sexual organs during birth.

http://www.midwifemama.com/honoring.html


I welcome some discussion on this article, as there are still many women out there who believe a midwife/doctor can "save" them from tearing, as well as the general idea that small tears are to be avoided at all costs (and the resulting feeling that it's "bad" if we do tear).

[sapphire_chan]

Okay I'm totally biased here, but your article is yet another reason you're my ideal standard of a midwife. When the time comes, my goal in interviewing midwives will be to find one that is as much like you as possible.

[Emilie]

Smile. Smile Smile....
I am so sorry that not all midwifes are not like Pamamidwife.
I can not believe the things I hear on here.

[crazyeight]

My Peri Cut

I had my ds in the hospital and am now prego. I can tell that i am VERY different down there since giving birth to a big boy. He was only 8 lbs but I was only 6 lbs 2 oz and his father was only 6 lbs 3 oz AND i was TINY when i got pregnant plus his head seemed large but i don't remember. Anyways when it reached the point of ring of fire, which actually was SOOO much LESS painful than contractions now that i think about it, i had to push about an hour to finally get him out. My OB was known for being a good one for natural births and the like and was actually transferred to her by my first OB my VERY last week of prego, so when ds wouldn't come out after pushing and the like she massaged, lubed and something else i think. finally she told me that i was going to tear up into the urethrea and down in a star shape quite badly. I believe that it wasn't pretty but have you heard of it being that badly stretched? She did finally make a cut and i think i got 2 or 3 stiches and i am totally ok with the fact that she made the cut, she didn't do it right away, and i was almost ready to suggest it even though I NEVER wanted to be cut down there and even put it in my birth plan. I am hoping that this child will not have that problem but i also wonder if was sewed up tighter or looser or if the stiches will affect what my body sees as the limit for birth.
So basically the questions are: Can previous peri cut influence other births and likelyhoods of cuts? Have you ever heard/read/seen a stretching and/or possible tearing to the extent she described?
I will be birthing at a free standing birth center this time.

[DreamsInDigital]

I think Pam is a great midwife.

[Brown Lioness]

WOOOOOOOOW.

omg, i learn SOOOO much on this site!

*scribbling notes*

[littleteapot]

Wow, PAm. That was a fantastic article. I read it out loud to my husband, and when I told him it was written by a midwife he was incredibly impressed.

I'm UC/UP, and the midwife I had with my first baby was very much like you. I consider her (and your) style of midwifery to be as close to true midwives as is possible in today's society. Certainly women have always had 'midwives' with them, but not all carried oxygen and needles: they were wise women, herbalists, support people, what today we'd consider a doula.

You're the kind of midwife I wouldn't mind seeing. Way to go: absolutely awesome article. I'm going to bookmark it.

[Stayathomemommy]

i just talked to my midwife about this at my 37 week appt because i had her for my last birth and while i was pushing i remember yelling, "how can i push with your finger down there!!" she didnt remove her finger, and though it wasnt the reason for my c/section it was definately a tense time where my body was unable to be completely efficiant.

anyway when i told her that last time i didnt like her finger down there she just told me that she was helping the perinium strech. and that was the end of that!! like i was silly and she had been doing me a favor. how do i tell her nicely that i dont want her doing it for this birth PERIOD!!

[pamamidwife]

I swear the goal here is NOT to give myself kudos - believe me, I still have plenty to learn in midwifery. I really wanted to let women know that the idea that somehow someone else can "prevent" tears for them may not always - or most times - be true.

I remember what an OB once told me....he said, "if you put two sides of a vagina together in a forest, apart, they will always find each other!" - meaning that our body does a beautiful job healing any sort of tears in this part of our body. Evolutionarily this makes sense - to not heal well means that we risk reproductive and hygeine issues. I think even urine has healing properties when it comes to tears postpartum.

Plus, I think there is some benefit to being a bit tender down south after birth - we're more likely to take it easy for the first week or so (important when we're establishing a milk supply and recovering from birth).

Suturing should only be reserved for when the sides of a tear do not come together well - or if the tear (which is not as common) extends beyond the superficial surface or underlying fascia.

[DreamsInDigital]

My most recent birth where I did not tear I found it quite difficult to stay in bed. It didn't cause me any problems but I certainly could have taken it a lot easier. I bet I would have if I'd had any trauma. Kind of scary that a 10 lb. baby came out and didn't hurt

[Jade2561]

I had the OB that was on call when my daughter was born and as I was pushing he told me that he is bad at cutting epis and doesn't do them. He did perineal massage and I only had a minor surface tear (I was birthing in the traditional lithotomy position ). My roomie at the hospital had a 4th degree epi (4th degree) and was miserable. I was carrying my baby and able to shower - no need for meds and she could barely walk and was taking pretty heavy pain killers. After spending time with her I was so greatful I had been spared.

I'm homebirthing this time and MW is hand off about almost everything.

[mezzaluna]

thank you pam!

i've been reading and admiring your posts for a long time now, and this article nearly made me cry it's so beautiful and respectful - and hits close to home for me. makes me want to print off a copy and mail it to the OB who "delivered" me. i guess i should!

[sapphire_chan]

Originally Posted by Stayathomemommy

anyway when i told her that last time i didnt like her finger down there she just told me that she was helping the perinium strech. and that was the end of that!! like i was silly and she had been doing me a favor. how do i tell her nicely that i dont want her doing it for this birth PERIOD!!

"I need your help to be completely confident in this birth, when you dismiss my concerns it worries me. I like you in all other ways, but I do not like how you are handling my concerns about you touching me during labor."

She probably doesn't even realize she was being dismissive she probably thinks "oh well, I explained it, so she understands now and is fine." And probably also thinks that you're fine with a repeat performance.

[LavenderMae]

Pamela, that was beautiful and full of so much truth. You are what midwives should be and I wish there were more like you!!!!!

[InochiZo]

Posting from a birthing experience; no midwifery experience. I agree with the hands off completely but I don't think that it was natural for me to slow and take it easy even though I had a lot of burning. I ended up with a 2nd degree tear, almost 3rd. My MW was very handsoff since it was a breech, but me and baby surprised everybody by coming out all at once on the push after the butt crowned. I think, if I ever have another baby that I will have someone cue me to slowdown and not push too hard and/or birth in a different position. Handsoff but some direction would be good.