I was having one when a contraction hit.....middy went to move her hand and i screamed at her to leave it as it helped with the pain! LOL
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I was having one when a contraction hit.....middy went to move her hand and i screamed at her to leave it as it helped with the pain! LOL
As an RN, I sometimes had to do some pretty mean things to patients in the course of their care - like, injections, wound dressings, manual evacuations ....
We were taught that if we take hold of a peron's wrist to take their pulse, without explaining what we're about to do or obtaining their consent, it is assault.
For procedures more painful and personal than that, it's even more important that there is respect, gentleness and patience, and that you don't push beyond the patient's consent, willingness or endurance.
It's good to hear about VEs done with this sort of professionalism. But I'm so sorry about the situations in which this has been lacking. Especially if they were completely avoidable in the first place.
It's procedure / I'll get into trouble with the Consultant if I don't / It's been a while since the last one / I have to write it in the notes that I've done it / I have to follow protocol so I don't get into trouble professionally etc - are not valid reasons to do a VE, especially if the mother is averse to it.
There are, of course, times and reasons when a VE is advisable. (Even then, if the woman says no, no means NO, and to push and push her to accept the VE is coercion and assault.) Time will tell.
I remember one (hospital) midwife who said, "You can tell how dilated she is soon enough - when you see head on view. Then you know how far she is dilated."
Julie - I don't doubt those mean things are as hard for you as they are for the patients. I have had problems with VEs since my PPH. They did manual removal and while I can cope with the absolute necessity of it at the time - I have still never felt so horribly violated in my entire life.
Do you think that if I mention this to my eventual MW that it might make it easier to express no means no without the guilt trips?
I haven't read through responses so I apologise in advance if I am repeating myself.
When you sit and watch and listen to a woman in labour she will "tell" you how far dilated she is. Unless for a medical reason there really isn't any good reason to be thrusting gloved fingers into a womans vagina during labour.
Having said that - when there is a lip this can be flipped over during a contraction and can save more invasive procedures. So there is a place for it if an anterior lip is believed to have happened.
I have only ever had one VE during labour with my fourth and it hurt like hell! I asked for it as I wasn't progressing as quickly as I thought I should... Anyway I was 7cms - very depressing for me. With the next contraction Eva was born. Soooo...
Anyway - I believe watching and listening are the best "crystal balls" to how a labour is progressing.
What - a manual removal without a GA??? How traumatic! I'm so very sorry for what you went through. I do wonder about what led up to the manual removal, I wonder if mis-managing or rushing the third stage led to the manual removal being necessary.:
I recently heard of a birth (VBAC) in which they calmly waited for 7 hours before the placenta was gently born. (Obviously when a placenta is taking a while, you keep checking the mother's uterus, bladder and vital signs to make sure all is well).
This is definitely something to discuss with your midwife when you interview her. If she is a good independent midwife, it's likely that she would do VEs very rarely anyway. And discussing how you want third stage managed is vital. The right midwife for you is the one who understands how traumatic these events were for you, and will do all she can to avoid VEs or messing with a natural third stage.
There are some important things that are necessary to make third stage as safe as possible for a mother. It all comes back to how the birth hormones work. You need the things that will promote the optimal flow of oxytocin, so that the placenta will detach and the uterus will involute.
They are:
* naked baby placed on mother's bare chest, between her breasts, skin to skin.
* breast crawl - baby's kicking actually stimulates the uterus to involute. Baby's suckling stimuates the mother's pituitary to release oxytocin, which causes the uterus to involute
* quiet in the room - no loud voices
* privacy for mother, father and baby to bond, again, this enhances her hormonal flow
* the room should be warm. Cool temps inhibit the flow of oxytocin. Make sure if the mother moves to another room (such as the toilet), that that room is warm too.
* the lighting should be dim.
* mother's bladder should be empty or nearly empty
Arbitrary time limits can cause much mischief. Once, at a birth centre, the midwives were getting nervous and talking about the injection because an hour after the birth, there was still no placenta. I gave my client the heads up about the way the midwives were talking, and suggested they have a cuddle together, with her sitting on the toiler, with the lights off (she liked the dark, and had given birth in near total darkness.) 5 minutes later we had a placenta, and she just dodged the injection. Sometimes just some peace and quiet is all it takes - the natural birth hormones get a chance to do their thing.
Sometimes there is so much angst about getting the placenta out that it's counterproductive. If you 'reverse the energy' and stop focussing on getting the placenta born, and give the couple time to cuddle with their baby in quiet, warmth and darkness, it often all happens. This is assuming there are no signs of excessive bleeding.
Sometimes movement and gravity (such as getting out of the birth pool, or moving to sit on the toilet (with a basin in it to catch the placenta)) can be all it takes to get some action. Other times, patience and time are needed. You don't always get that in some institutions and this can create problems.
I've had two interesting placenta adventures at recent births. At one, the mama shut herself in her toilet, and firmly spoke to herself for about 10 minutes, telling herself that the birth was over and she could release her placenta now. She told her body to stop bleeding and release the placenta - and it did! She had had a traumatic birth the last time, so this was part of her overcoming those old fears and tensions.
At another birth, the mother had had a very traumatic c/s the last time, and her homebirth was a huge triumph over many emotional issues. She had pretty painful afterpains and was getting quite distressed. The pain kept taking her back to the trauma of the last birth, and she was feeling guilty that she was in too much pain to be bonding with her newborn. I had a little chat with her and her dh, and we actually prayed together. Then the midwife came in and was able to gently persuade her to roll over onto her back. That's all it took. A little bleed (which is a sign that the placenta is coming) - and out it came. The midwives had been bringing up the subject of transferring to hospital for a manual removal by this time! But more time, and extra reassurance, and a gentle approach, was all that was needed.
(I realise that there are times when synto and obstetric help ARE needed - but if these other techniques can be employed and more drastic measures avoided - that's good, right?)
Have you noticed that when the birth is pushed and rushed, it seems more likely that there will be PPH and placenta problems? An unhindered birth usually (not always, granted) yields a safe third stage, because the birth hormones that are flowing in an unhindered birth continue to provide for a safer third stage.
With DS1 I had a VE to check what was going on after I'd been pushing for quite a while. It turned out there was a lip of cervix still so the OB held it while I pushed through the next contraction and his head moved through. I must say I didn't feel a thing!
Its a bit of a story. I had her at change over. It had been 4 and a half hours since anyone had come to check on me and they had ruled my labour stalled at the last check. For change over, they were all outside "discussing what to do with me" as the ob so casually said when he came in to watch her delivery in disbelief. Anyway - I buzzed them when I felt the head on its way out and the middies I had had all night came in to finish the birthing. They the did rush through the third stage using cord traction to get the placenta out. Then they vanished again.
Over an hour and a half later, my older sister who was an AIN at the time went searching for help for me because she knew there was something seriously wrong. When they got in the bluey weighed for something like 2.8l and that was before they went in after the clots and my bp was something like 50/30. I figured they wouldnt have been elbow deep in my uterus pulling out clots and looking for placenta bits if it wasnt absolutely necessary by then. I mean, they didn't do anything else such as an episiotimy or offer any form of pain killer. It just all happened and I remember all that going on, them telling me to stay awake and me not wanting to (thus not really trying to) because this is not a memory I wanted.
They did give me DD when she was born but then went and did the weigh, cleaning, etc etc. This is literally how I got her back.
Also funny you should mention temperature. One thing I always hated about the delivery suites there was that I was freezing cold!