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Question from reading Ina Mays Guide to Childbirth

1272 Views 22 Replies 15 Participants Last post by  Smithie
Based on your book recomendations, I purchased Ina May Childbirth book last night. I was going to get a few more, but this was the only one they had from the list. I will have to order the rest online.

Anyway, I have only read the first 50 pages or so, but had a few questions about this farm and the births there.

The first is about water birth, I have noticed in the birth stories so far there are none. The women often labor in water, but always seem to be told to get out before delivering. Anyone know why? I am planning a water birth, and was hoping to read some birth stories where babies were born in water. Maybe I just have not come to them in the book yet.

The second question that I had is why to the MW's always brake the bag of water if it has not on it's own. I was under the impression that is labor is progressing nicley, there is no need to purposefully rupture it.

Thanks for your help!
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I can't answer your questions, but I'm posting because perhaps you're noticing a difference of birthing philosophies.

For example, I noticed I have a different philosophy from Ina May, as I feel that cervical checks might not be neccessary at every birth. It seems that the Farm midwives do quite a bit of checking, despite their crunchy ways.

I was quite shocked when I began to realize that in certain areas, it may be possible that I may be more Earthy Birthy than the Farm folk, but I don't know how that can be true....but maybe it is. And despite my differing opinions in some areas, I do admire Ina May and agree with many of her tenants.
I will just say that I find the Ina May school-of-thought to be *extremely* interventive. Her message seems to be your body's not a lemon, but you certainly need a mw to help it work.....I realize in some circles, this opinion is very unpopular, but after meeting her, listening to her, reading her books, watching Farm birth videos (I can't even make myself watch these anymore), and meeting a few mws/apprentices from the Farm, my opinion stands firm


I
the book Choosing Waterbirth by Lakshmi Bertram (sp?) Very nice!
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I got hauled out of the tub at my hospital by the nurse and my DP when I my water broke. I was not happy to say the least. DS was born within 5 minutes. If I had stayed in the water, I would not have had incredible hip pain come back with a vengence.

They say its for sterility. Or because there isn't enough room for the doc... or or or or..

More like they don't want to do anything that actually benefits the mom.
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"The first is about water birth, I have noticed in the birth stories so far there are none. The women often labor in water, but always seem to be told to get out before delivering. Anyone know why?"

This is just a guess, but it may be so that the midwife has easier access to do her thing. I haven't read the new book, but in Spiritual Midwifery the midwife is always VERY involved in second stage, stretching and supporting the perineum, suctioning as soon as the head is out, and catching the baby. (Personal opinion about that:
: )

"The second question that I had is why to the MW's always brake the bag of water if it has not on it's own."

They want to speed up the labor. As Georgia and Tinyshoes noted, Ina May may be crunchy, but her approach to birth is nonetheless pretty interventive.
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If you read Spiritual Midwifery it might help understand where she is coming from. She is crunchy, but she still learned everything from ob's or just by flying by the seat of her pants. Her approach is a lot less interventive than the environment in which she became a mw. I don't know what the situation is like on the Farm now, but in Spiritual Midwifery the water they used to bathe in was not treated so that could be an issue with the waterbirth. Nothing like giardia in a newborn...

As far as breaking water, I don't remember from the book, but sometimes labor does stall and they do it to get it going again. A friend of mine gave birth a few days ago and she stalled at 7-8 cm for hours. She was getting really tired and discouraged and she was in pain so they (her HCP, herself, her dso) decided to go ahead and break her water. This got her going again and she gave birth a couple hours later. Sometimes women need the pressure of the head on the cervix to finish dilating and sometimes the bag of water is really strong and won't break on it's own. I don't think it is for everyone, but speaking as a person who was there, we all were getting concerned she would be too tired to push if she didn't start progressing. At 7-8 cm there is not the usual concerns that accompany AROM like infection or labor still not starting or fetal distress. So I think there is a time and a place for it. Being able to tell my friend that mw's do it in homebirths helped her be okay with the process. I talked to her the next day and asked her how she felt now about it and she thinks it was still the best choice for the situation. Of course we both wondered if the baby would have been born in the caul if they hadn't done it, but we also wondered if she wouldn't have ended up in a downward spiral of interventions as well.

IMO, I really liked the book but at the same time I have a less interventive mw. Towards the back of the book it talks about how state of mind affects labor and gbs testing, etc. That was the part of the book I liked the most.
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Ina May and The Farm midwives are indeed a bit closer to the medical model than some other midwives. But ultimitely, it is always the woman's choice to agree or decline anything, and they never pressure anyone into something she is not comfortable with. At least that was my experience with them. Nobody broke my water, or even suggested it, it broke on its own when baby crowned. Nobody did any internal checks that I didn't ask for myself. Waterbirth wasn't my thing, but I'm sure that if a woman wanted to deliver in the tub, they wouldn't do anything to stop her from doing just that.

they do have to maintain a certain amount of respect with their backup doctors in order to do what they do there. And that is the biggest reason I went with them instead of the *only* semi-local homebirth midwife. I knew that if I had to be transferred, I wanted to be with a midwife who could talk to the doctors as an equal. The hb-midwife here has alienated the doctors and hospital staff already, and they have no respect for her. That would put me at a disadvantage from the get-go in dealing with them, and would make my hospital experience that much worse.

At the same time, that deference to the almighty doctors turns so many against them, and does bother me a little bit too. But the things I disagreed with them were small compared to how much I love them and what they have done for midwifery on the whole. So I agreed to things like GBS testing, just to keep the doctors happy, just in case I had to go to the hospital. It's a delicate balancing act, and each midwife has to choose just where she wants to be, and each woman must be able to choose the right midwife for her, given her unique situation.

After a certain other thread about Ina May, I contacted her and she told me that anyone should feel free to personally ask her any questions they might have, and it might take her a while to respond because she is a very busy person, but that she would personally answer your emails.
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I don't know enough about her to know the reasons, althought I wondered some of the same stuff. However, her outcomes have certainly not been compromised -- she doesn't "risk out" twins, breech presentations, VBACs, GD, etc., like many midwives do, and her C-section rate is 1.4%. Nearly 70% of the moms had intact perineums, and an additional 19% had only 1st degree tearing. 95% of the births were completed at home. Etc. I'm not saying she's right and you're wrong, just that her ideas have not seemed to hurt her mothers or babies.
Statistics will only tell you so much. On paper my first birth looked very good: homebirth, no complications, intact perineum, healthy baby. Yet my midwife's style of management was intrusive and interventive enough that my body took a long time to recover, and I had severe postpartum depression, partly due to the way I had been treated. From what I've read, Ina May practices in very much the same way that my midwife did. That is not to say that she is not a good midwife for some people -- everyone has different needs.
I just thought that I would interject that I took the approach Ian May uses in her books that birth happens naturally and that the mother knows how to birth without taking a class on birthing. While I agree that she takes a more invasive approach to mw, the birth stories are great and empowering. I read that book 3 times in 6 weeks before I had my dd at home.
Best to you,
I think that Ina May said something like "birth in water is for fish"? Someone can correct me if I'm wrong. That would probably explain moms getting out of the tub in the stories in the books.
i think that the ina may midwife team seems to take each individual birth as it unfolds, and they make decisions with the mother as it goes along. i don't think they do AROM unless they feel that it will benefit the mother.

i agree about the lack of waterbirth stories, and suggest looking for other books specifically about waterbirth.
Electra, I love the birth stories too! In fact, although I have a library of probably a couple dozen (mostly alternative) books on birth, Spiritual Midwifery is the only one I wanted to look at in the last weeks of my last pregnancy. I think the people of The Farm (the birthing women themselves) hit on something really wonderful and true about the nature of birth, and I just focus on that.
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I agree that the birth stories are awesome! I believe, too, that everyone has different needs. Several mothers I know who have gone to The Farm have expressed that their expectations of "hands-off" care were not the reality. The Farm's stats are wonderful to behold
.....and that mwery has become so much more visible as an alternative to the medical model is also such a positive outcome. The mws who are working to ensure that birth is a spiritual, personal journey deserve nothing but respect. still, that doesn't mean that I can't personally believe that many do much, much more at births than *I* would be happy with
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I also read Spiritual Midwifery in the weeks before I had my homebirth.

I had my baby in the water. My midwife was very non-interventionist and basically let me do my thing. It would have been tremendously difficult to get up out of the nice warm water to deliver the baby, and I wouldn't have done it anyway. I'm sure there are a lot of good waterbirth books out there. Strangely enough, although I wanted and planned and had a waterbirth, I never really read any books on the topic!

cmd
DD 10-03, at home
DS 11-98
My mw was not very hands-on, but since I delivered 1.5 hours after we arrived at the birth center, it's not like I gave her much chance to do anything but fill the tub!

Based on Ina May's writing as well as what my mw said after the birth, I think it's very possible that I could have avoided tearing if I'd gotten out of the tib and given my mw easier access so she could support me better. If I have another Indy 500 labor next time, I will certainly keep that in mind. But tearing aside, I loved my waterbirth and I think my ds liked it too.
I'd never read anything about waterbirth before mine... I had the tub because I wanted to labor in the water, and it felt so wonderful! We didn't call the midwife until I was in transition (hindsight), which was when I felt I needed her there. She got stuck in traffic, and when she got to my house, I asked her to check me, for which I got out of the tub. I was fully dilated, and she said if I gave a good push the water would break and I'd have me a baby! So I gave a mighty push, and she, standing at the foot of the bed, got doused. The dresser got doused. I think I nailed the wall, too!

Anyway, I realized, pushing on the bed, that the water was working better for me, so I got back in the tub. It afforded me the extra maneuverability so that I could move about freely to find the position that worked to get the baby where she needed to be. No way was I getting out of that water! It also helped, imho, to enable me to ease her out, pushing between contractions, not with them, as she crowned, which I think protected my episiotomy scar. I had no tearing. I was also able to catch her myself, which I don't know if I would have been able to, if I was out of the water. It would have been trickier, position-wise, anyway.

So, this is my long way of saying that I didn't know much about it, hadn't read about it, but that it just felt right to me. And it WAS right. For me, anyway.
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Originally Posted by reader
I don't know enough about her to know the reasons, althought I wondered some of the same stuff. However, her outcomes have certainly not been compromised -- she doesn't "risk out" twins, breech presentations, VBACs, GD, etc., like many midwives do, and her C-section rate is 1.4%. Nearly 70% of the moms had intact perineums, and an additional 19% had only 1st degree tearing. 95% of the births were completed at home. Etc. I'm not saying she's right and you're wrong, just that her ideas have not seemed to hurt her mothers or babies.
In the archives, there was a woman who Ina May turned down because her baby was breech.
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Originally Posted by rose angel
In the archives, there was a woman who Ina May turned down because her baby was breech.
Must have had to do with the presentation or something, b/c they do deliver breechs and some are ones that other caregivers have rejected for having a too large baby or other issue.
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Originally Posted by Mom2six
Must have had to do with the presentation or something, b/c they do deliver breechs and some are ones that other caregivers have rejected for having a too large baby or other issue.
She said it was because it was her first baby
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