My hands do not touch the woman or baby at birth. I do not check for nuchal cords. I think hands off is best for mom, baby.
wanted to add more because I'm not on my phone anymore, but actually on my laptop:
In nearly all the births I do, I don't usually see the mothers vagina until AFTER the birth. There are times where I don't see the baby's head emerge - the mother usually says, "oh, there's the head". I don't think there is a need for pressure on the occiput - women naturally do that themselves because they feel so much pressure by their clit. In fact, when we apply pressure anywhere on the vagina as the baby is crowning, we are creating more pressure (reducing slack) in other places that the body wouldn't normally allow. I think that women naturally will have their hands on their baby's head if they're left alone to their own devices.
I wrote an article on this topic and I feel pretty strongly about it. Here's the article: http://midwiferytoday.com/articles/h...ng+body+wisdom
In addition, I really think we need to get away from this belief that tearing is something horrible or to be avoided. Many times the body naturally "gives" in safe areas (like the upper inner labia) to prevent larger tears like on the perineum or clitoris. This idea that somehow midwives prevent tears is erroneous. The evidence shows that hands off is not likely to cause any more tearing than hands on. In fact, I think that hands-on perineal massage and stretching by a provider can cause tears that wouldn't have normally occurred. I rarely suture - but that doesn't mean I don't see small grazes or small tears. I just happen to think that whether my hands were there or not, those would have still happened.