|Topic Review (Newest First)|
|08-25-2006 11:42 PM|
Speaking for myself, I believed it was necessary also. That belief did not make it any less distracting, inhibiting, emotionally unpleasant, and painful (again, as it was unnecessarily for this woman.) And yes, I regard that as harmful.
As for evidence that touching the genitals with the woman's consent is harmful, I know of no studies that have looked at its effect on the woman as far as distraction, inhibition, discomfort, etc. But do we really need studies to know that those things do occur to some degree or other with the exposure and handling of genitals by those who are not the woman's lover?
|08-25-2006 09:40 PM|
|08-25-2006 08:47 PM|
|08-25-2006 08:21 PM|
I don't know why I feel the need to jump in here since I certainly have enough aggravation IRL, but I feel the need to have a try at explaining why some folks viewing this have negative reactions to it - and why that is not necessarily the same as viewing the woman negatively, or as a victim, or as a stupid misguided consumer or whatever.
I do agree to some extent that respect and kindness are above all important. We know that women who feel respected and in control are in general happier with their birth experiences than women who feel control was taken from them and their wishes were not respected. Of course it's better to be spoken to gently, and to not have one's feelings discounted or worse.
On the other hand, it is important to pursue what is necessary and helpful in a birth, and what is not. There will always be differences of opinion on this, and gray areas where there isn't clear evidence of harm or benefit. Some people feel perineal massage is helpful - although really most comparative studies of even touching the perineum suggest that there is no benefit. (The one study I'm aware of looked at Hands on or Poised (HOOP) in which the attendant either did standard support/massage or didn't touch the baby until after delivery of the anterior shoulder. They found no difference in tearing or pain after birth to the mom.) Some studies show increased tearing with perineal massage, or increased pain. If something is a gray area like that, my personal belief is we ought to err on the side of doing less, unless we are sure it has benefit - unless it feels good to the mom (I have requests for hot compresses some for example.) Having a mom saying "Ow" or equivalent and the attendant apologizing for being mean don't suggest to me that the mom thought it felt good.
It is good that the mom is treated with respect and care - but is it enough? For example, there is an older OB at my hospital who truly believes that every 1st time mom needs an episiotomy. Now there are literally dozens of good studies that show this is absolutely wrong, but he believes it. He is a very gentle, kind man actually. If you asked him to not do one, he would "try" but he would see crowning as needing something done because that is what he believes and he would then tell you you needed that. He would even be respectful about it, and probably regretful, too, and his few mamas who even request no episiotomy (very uncommon around here) seem to feel that he was respectful and kind, and even asked their permission, and they are okay with him having done an episiotomy in the end because they "needed" it. Yet I can attend an equal number of births in the same population with a virtually zero percent episiotomy rate. So is it okay that he does so many, as long as he is kind about it?
I feel that we have to apply a critical eye to every birth intervention - from such invasive things as episiotomy, to such seemingly harmless things as asking mom to assume a certain position for birthing. Our we doing good by doing something? Are we doing good by promoting something because it is the standard and normal for our culture?
It is quite possible to think critically about interventions without thinking bad of the woman or her midwife. I am quite sure if that midwife thought she was harming her client, she wouldn't do what she does. I bet the woman felt she got great care, and she probably felt respected and cared for, and that the things her attendants did were needed. But it is important to have these kinds of discussions and keep hashing out what is good and helpful, and what is not. It is hard sometimes as a birth attendant to think critically about the things we do culturally and to step back and say - why am I doing this? Am I helping? Am I doing something necessary, or creating an unnecessary ritual? It is important as birthing women to understand also what is ritual and what is needed - or even just what you truly want versus what you feel you have to have. I don't think that is promoting snobbery or a sense of elitism in birth, it is simply seeking truth.
|08-25-2006 06:57 PM|
my sig line is my birth montage- it shows crowning.
My hospital birth a nurse pushed my dh out of the way- climbed up on a stool and started to push on my stomach- hard- to get ds to come out. - no one told me why- or what- it was scary, rude and uncalled for.
|08-25-2006 08:41 AM|
I say it was oxygen she has also. I had the same thing while having my first DS. I was nervous and hyperventalating (sp?). My fingers and lips were tingleing. . I'm glad I didn't see any videos of birth while pregnant or before becoming pregnant though. It would have scared me into not having kids. I don't do well with pain. I was really nervous about labor while pregnant. But everything turned out fine. Doctor told me it was one of his best labors he ever saw.
Thanks for sharing the link though.
|08-25-2006 08:39 AM|
I think we ought to step back a bit here. We don't know this woman, and whether she considers the experience positive, negative or in-between. Inca is right, we are assumming the mw touching her is bad, when it might be just the tenderness she needed. None of us know.
However, most of us come to this forum because we have had a traumatic experience. Intentionally or not, we may bring a lot of extra baggage with us, which makes us hypersensitive to other peoples birth experiences. I know sometimes I see or hear things and think "how sad" when in reality it wasn't sad at all for that woman.
|08-25-2006 07:59 AM|
I like them both!!
I want to put my video on line
I would scare anyone away from a non-medicated birth.
I do not do"transsition" well.... I scream and curse a lot.
BTW, I gave birth to my last three children in that posistion. Well my second VBAC I was sitting up a bit more.
|08-25-2006 07:50 AM|
The way she touches the lady may not be evidence based but it is part of the birthculture and is seems to be percieved that way by the woman. She is not causing any harm but believing to do good - and if both the MW and the birthing women agree that something positive is going on (that is not harmfull as far as I know - you keep talking about evidencebased - well then show me that touching the perineum - with the womans consent and accept - is harmful or dangerous) then what is the problem? I know it doesnt correspond with YOUR image of the perfect birth - but maybe this is how this woman sees HER perfect birth?
There is no way you can know if the woman feels it is distracting without actually asking her. You are making assumptions on her behalf.
I agree that everything that is not safe practice or harmful in some way should be made better. I believe the hospitals can do a lot better in the care for pregnant and birthing women. But we can not set a universal standard for birthculture that goes beyond what is "evidencebased care" Sure we can demand that hospital staff are being respectful and caring towards the birthing women - but what is considered a kind gesture in one culture may not be considered the same way in another. And by culture I dont just mean the national cultures but also the culture that is different in each family. Such as how often we touch eachother. How close we allow others to our personal space etc. What you see as "distracting touch" may by another woman be seen as "comforting touch". I think that is where the core of this whole discussion is..
This could be turned around completely. Imagine this particular birthing woman see a video of your unassisted homebirth? What would she see? What assumptions would she make of your experience do you think? Would she be right in your opinion? Are you right about her birth when you make assumptions on her behalf? Just questions for thought..
|08-25-2006 03:57 AM|
|08-24-2006 09:51 PM|
I personally didn't care for that video much.
If my MW would have been messing with me like that I may have just flipped out on her. She was rubbing the babies head, pushing momma's belly, stretching her perineum.... I didn't even finish the video. My own video of ds crowning is much better. innocent Maybe I'm either super crunchy...or spoiled, but that would have made me mad. All my mw did was squirt warm oil on me (with permission) and hold an oily towel up to me. That was it. She never touched the baby before his body came out and only then because somebody had to catch him and I wouldn't let go of DH's hand.
|08-23-2006 11:53 AM|
to me yes when you say this reminds you of things you would have done differently- yes- but to be clear I think that critical thinking and criticism are different things.
also reasoning and reaction are different-- Many times I read and hear reactions coupled with criticism and most of the time it is like meeting a perfect stranger who just vents on you/to you --ok, maybe but not of much use to me--
give me a review respond to the information not just react-- it is even helpful to say this reminds me of my choices and things that occured at my birth... "I" felt....
lets not throw the baby out with the bath water... KWIM
Look I had a few of my own hellish births and I have been guilty of venting reactions myself-- but for me a goal is to be aware of what belongs to me and try to pull in my horns--this birth is not happening to me I am sharing someone else's experience , how do I respect that and still be honest.
|08-23-2006 11:22 AM|
I don't know. Some parts of the video made me happy, some parts made me sad. I thought, "well, she looks happy. And she is taking the laughing gas herself... and this is a lot better than it often is" but I also thought "why did the mw do this?"
I don't think many of the posts are condescending or feeling superiour, better.... It isn't pity either (which would victimize the woman). Maybe it is sorrow for some of the things? I feel sorry for myself for the way I was treated and the harmful interventions that were done to me. I feel sorry when I hear over and over that these things happen to other women. Maybe this woman doesn't feel sorry about it at all. We don't know. But can I not still feel sorrow myself, in watching it?
|08-23-2006 10:18 AM|
|Seie||Mvherbs: Thanks That is how I experience it too.. Even though I do recognize that some things can still be different. But thanks anyway|
|08-21-2006 08:12 PM|
yes the sounds
I went back and watched again just to see and hear- and it is such a calmer birth than I have ever seen or heard in any US hospital. and the baby right onto mom not moved or futzed with no quick clamping of the cord no big move to a table/warmer - as far a suctioning goes- studies and standards change it seems every year- but we do not know the "whole" birth story and there is some evidence for suctioning
what I see is a mom who is not being shouted at- and she is being spoken to and I hear things like acknowledgment of burning- when the baby crowned and even though it seems that the hands on moving mom's tissues is being done I don't see or hear mom reacting to that in a negative way- mom does move a bit when the head is born and her reaction to that is noticeable and that wonderful new baby cry...
even if we were to have a critical review of the birth movies we see it is good to point out all of it the compliments as well as the problems -- what is going right here - and we don't know how this attendant would have reacted if a woman did not want to be touched or if it was obvious that it was not ok-- compare this to any of the cable TV birth shows- far better birth than any I have seen - if this were a standard hospital birth here how much better would birth be?
there is also something else I see in this birth and that is mom has her legs at rest open but at rest and she seems very relaxed even when there is intensity she does not seem fearful- yes she reacts to the sensations and responds to the contractions but does not seem to be frightened or for that matter disassociated either.
|08-21-2006 07:39 PM|
|Seie||Hmm just thought I would get a bit back to the "beginning" and add that one of the reasons I really like this birth video (nomatter the surroundings) is the way that her sounds are not censored. Most of the birthvideos outthere on the net that I have seen have the sound taken away or replaced with gossip or music. But IMO the sound is an importent part of birthing and it is what really makes you feel what that birthing woman is feeling. It makes it all very real I think ..|
|08-21-2006 05:11 PM|
|caricandothis||Amazing, thanks for sharing!|
|08-21-2006 03:15 PM|
having someone do something because it feels good to you - and I must say warm compresses on your bum are hardly the same as perineal ironing or massaging in terms of evidence and intervention! - is vastly different than doing things because you were taught that this is best for every woman.
I think you're just missing what I'm saying. It's ok, it's just words are getting confused.
In no way do I victimize these women or call them victims. If anything, I think it's the providers that are the victims here. They've been taught to swallow a belief system that is not working or helpful most of the time...yet they feel in their hearts that they are helping.
And, it's true that I don't sugarcoat much. This is because I did so for so long and I think providers do not need any more handholding or sugarcoating. Truth is, most are not listening! Radical change needs to happen and it doesn't happen in a cupcake.
The point is, I'm not really trying to win friends. I'm just speaking about normal physiology of a woman's body and choice. This is the heart of it. If that makes it offensive, then obviously they're not in it for the right reasons.
|08-21-2006 03:09 PM|
|08-21-2006 05:11 AM|
so there is a study done in New Mexico that showed doing or not doing support to be equivocal -and it could be that in some places or for some culture groups it is more helpful than others-- I would like to see a study done in Jamacia where I have been told that tearing is rare...evidence based practices all rely on someone actually doing a meaningful study
personally I don't do much perineal support but I have been with midwives who always do and some have almost never had a mom tear- and I certainly cannot make that claim-
J Midwifery Womens Health. 2005 Sep-Oct;50(5):365-72.
Midwifery care measures in the second stage of labor and reduction of genital
tract trauma at birth: a randomized trial.
Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P.
University of New Mexico College of Nursing, Albuquerque, NM 87131-5688, USA.
This study randomized 1211 healthy women in midwifery
care at the University of New Mexico teaching hospital to 1 of 3 care measures
late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. (snip>>>>>)
The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations.
PMID: 16154062 [PubMed - indexed for MEDLINE]
|08-20-2006 07:43 PM|
Pamamidwife: I do not disagree with you actually (even if you may see it that way) but I like to see a cup half full rather than half empty.
Sure there are things in this birth that could be done differently and probably better. But as the pp here mentions then this is a heck of a lot better than it could have been. It seems to me that some of you are actually offended on this womans behalf and that is not fair - is all I am saying. That is patronising her - like saying she is not clever enough or educated enough to choose a better way to give birth than in a hospital - where the things in the video are pretty much the standard around here (apart from the internal monitor). This woman is obviously informed and consenting and I am sure she would not appreciate being seen as a victim of the terrible hospital system.
I do not say that standard cannot be improved - I am sure it can. But the negative way that I feel it is being approached by some of you is not constructive IMO.
To educate hospital staff better and birthing women too you need to respect an effort to do good even if it can be better - and you need to ACTUALLY respect birthing womens experiences and wishes for birth - even when they are not into homebirth or even if they do not wish for the midwifes to leave them to do their own birthing because evidence doesnt show midwifes hands on the perineum to be better than her not having them there.
If your approach to this makes ME defensive - who is not even a birth professional but a regular birthing woman who has been in contact with this particular hospital system more than once - then how will it affect actual midwifes and doctors who are already in a completely different camp from yours? Will it make them want to change their methods - I doubt it to be honest.
I remember my midwife supporting my perineum and rectum with a damp warm cloth when I had my first baby - and evidence based or not it was a great relief and it made me feel like she was taking care of me - that I was in good hands. Was I a victim for believing that to be good. Heck no! Did I feel violeted? NO I did not. Was it evidence based? I ask you.. It sure didnt do any harm..
How you make birthing women feel safe may be different - but if something the midwife does makes the woman feel that way then it cant be all bad?
I am NOT defencing docs to do routine episiotomies. I am NOT supporting routine laughing gas for all women - but it still IMO is a heck of a lot better than routine epidural the way it is used in many countries (and Denmark is not one of those as of yet at least). I do NOT support routine internals or women flat on thier back during pushing for that matter. I am all for natural birthing and choose homebirth myself because for me that is the right choice. But that does not give me the right to judge wether someone who choose differently has a valid good experience or not. Or to judge them victims for "not knowing any better" than to choose a hospital delivery.
|08-20-2006 03:35 AM|
this is not a typical hospital birth in this region this is far better than the typical hospital birth- I would say in contrast that mom would be yelled at to push push push instead of waiting at all- and if the midwife's or doctors hand went to the fundus it would be to do fundal pressure- so for an institutional birth it is better than I have seen-- since it is not where I live I have no idea what the expectations are for massage and vaginal stretching-
I have talked to women who were mad at their care provider because the provider did not do a episotomy and so they felt that their tissues were stretched out too far and that they had lost something- so to each their own.. I appreciate that families have shared their birthing experiences . thank you again
|08-19-2006 08:55 PM|
I agree with pamamidwife. There is so much that made me cringe. It is not birth snobbery. Some things are not evidence -based but done based on fear or how someone was taught...and they can actually cause problems. Interference is interference.
I am pretty sure that's etonox this mom's taking - she places it over her own face - it's not given to her: first she looks down at her baby's head and then reaches for it.
Also, it takes less than a minute after the baby's head for the body to follow. Not long at all.
I was at a birth where it took six minutes. I was assisting another midwife and we just waited, and waited, and waited (i kept track of time because as her assistant that's my job). Then the mother hoped up out of bed and the babe plopped out.
But I remember the midwife looking up at me after a minute with a look on her face, and I said, "ooo look at how pink and healthy baby's head is" - this was not shoulder dystocia, just more waiting for the next contraction.
Like Pamamidwife says, babe is still getting oxygen from the mother via the umbilical cord.
|08-19-2006 06:12 PM|
wow- hearing that baby's squalls made tears well up in my eyes. Nothing like a newborn's cry! Pretty cool.
|08-18-2006 08:22 PM|
|08-18-2006 08:17 PM|
I finally got to watch it! My 3-yr-old loved it (thogh he couldn't figure out why they were suctioning the baby) Beautiful! (now I have to go watch it again because he's begging and crying for it!)
(ETA: I didn't like the mw yanking on the baby's head or cutting the cord right away..but I love birth and thought it was beuatiful that she was making lots of wonderful noises and the camera caught the crowning and birth itself very nicely)!
|08-15-2006 09:49 PM|
Thanks for sharing the link, inca =) I understand how you would take an attack on the video or the way the birth was managed as personal since you posted it. But please don't. I would hate for you to feel alienated over this.
Not to join in any brewing debate, really that is not my intention, but I had to turn it off. I understand how a first time mom really wants to see the mechanics of the process. I know when I was expecting my first I wanted to see it ALL And I was truly horrified at what I perceived to be possibly overwhelming trauma to my clitoris
But now, after three births, unassisted, it really HURTS to watch a video like that! I mentally put myself in that position......and I just can't do it. I would be screaming if someone had their hands all over me like that........anything that looks like stretching or "helping" on the part of the midwife makes me cross my legs and cringe. And I'm constantly asking myself WHY?!? What bizarre joke has been played on human kind that the majority of women believe THAT is a NORMAL birth?!?
It isn't a case of birth snobbery exactly, I don't think I'm BETTER for giving birth the way I do, but I think it would better serve ALL WOMEN regardless of how they plan to give birth to see more unmeddled-with birth. Videos like this just perpetuate the myth that "help" or even a "watchful eye" is NECCESSARY.
If you want someone there, GREAT. More power to you, but don't be hoodwinked into believing that the birth won't progress smoothly and safely without someone mercilessly "helping" the baby be born.
|08-15-2006 07:30 PM|
Oh, gracious. Well, that was hard to watch. The quality of the video wasn't good enough (or my connection wasn't good enough) for me to see the details, but at the very least I could see that the midwife's hands were constantly on the woman's tissues and baby's head. I feel sick that women are still led to believe that this is necessary.
For someone to accuse me of snobbery for acknowledging that -- well, there's got to be an assumption there about my motivations. I assure you that I'm not sitting here thinking how much better I am than this woman because I know something she doesn't, or that I'm somehow better than her. I find that extremely offensive. Why would anyone assume that?
The truth is that these things need to be spoken out against or they're not going to change. Every time we see something wrong and say "oh, that's great, perfect," for fear of hurting someone's feelings or being "disrespectful", we perpetuate the myth that these things are necessary and okay to do to women.
I think we can safely assume that the reaming the midwife gives the mother is not a good experience. Whether or not the mother feels it was overall a good experience is impossible to know -- we certainly can't know that based on the tone of voices after the birth and whether or not the mother is smiling. In almost all cases, no matter how awful the birth experience, there's going to be a positive response to the fact that a baby has been born and is healthy.
It's moot anyway, as far as whether or not we should comment on the midwife's actions. I don't have to make any judgement about the mother whatsoever in order to judge the practices employed and the things done to her.
|08-15-2006 05:47 PM|
I think that being sweet to someone while you are cutting their vagina open is no more respectful just because of the attitude towards the mother. The point is, for instance using episiotomy, the act itself is unnecessary and not beneficial to the motherbaby unit.
This is MY point.
That we need to stop thinking of "well, this is better than she would have received elsewhere" or "this is better than a cesarean" or "at least she's being treated well".
Evidence-based medicine is what we should strive for. Many midwives and doctors are still in the same routine of doing things because it's what they've been taught is "better", never mind what the research shows. This list includes things that are vitally disruptive to the mother - and if we look at doing away with them, our babies - and our mothers - would have a more gentle, beautiful experience. Isn't that the point of all this?
Why would I want my baby to have a tube shoved down its nose and throat as it's making his/her emergence into the world just BECAUSE?
It's not evidence-based. Meconium or no, it's just not.
Why would I want my baby's oxygen supply cut immediately after birth - even before the baby is in my arms - just because of some silly reasoning?
Why would I want my baby's head and neck forcefully pulled and pushed by someone as it is being born?
Why would I want my baby to be handled by other people for the first hour of life?
Why would I want my placenta rushed and risk bleeding and therefore needing medication?
Why would I want to be hurried in labor - and risk my child's well-being because of someone else's idea that this is how it "should" be?
I hope this makes sense. I'm not on a voyage of home vs hospital. I'm on a voyage of GENTLE BIRTH that is motherbaby centered. Why is this threatening? Why does that have to be victimizing women?
|08-15-2006 07:15 AM|
When talking about giving birthing women better births then there are two different aspects I think. One thing is the actual stuff that they do - how they "manage" birth/the "medical" side of it so to speak. - Another thing is how they treat the birthing mom. When reading birthstories I often read of women who are being treated with contempt, disrespect and arrogance - this almost ensures the woman a terrible traumatic experience.
Another thing is friendly wellmeaning docs and midwifes - who are just not well educated or up to date but who at least treat the birthing woman with respect and let her have a say about her birth (even if she is poorly informed). That woman has a good chance of having a good birthexperience - even if it is not as safe as it could be or if she doesnt recieve the evidence based care that you are talking about.
Ideally a birthing woman should recieve both though - I agree with that.
Guess my point is that a woman can feel her birth is wonderful even if it is not up to the standards that she should ideally be able to expect. Just as a woman going through a natural birth where she is given all the best support and circumstances for a safe birth does not necessarily have a good experience. Maybe the lvl of pain is greater than she expected or she panics despite the best of circumstances?
Birth is both a physical event - but also very much a personal, psychological experience. And I dont think it is fair to make judgements or assumptions about the latter based on what we know about the first. Do I make any sense?
I also dont think it is fair to victimise a woman if she doesnt at all feel like a victim but rather like she is in good hands. IMO it is not up to others to decide if someone is a victim or not..
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