Keeping perineum intact

[BellyBelly]

Sorry - typo! http://www.dianegardner.com.au/ - she may do one on one with you or a crash course if you ask nicely Say you are from BB

[DoulaRelle]

Kelly I don't want to hijack this thread either, but I just have a quick question regarding the perineum, There was a lip of my cervix caught on Cooper's head, and therefor the Obs had to have his hand "up there" pushing it back as I pushed down with each contraction for the first couple of pushes. I ended up having an episiotomy, which I assume was in order for his hand to fit whilist pushing my cervix back.

Firstly - have you seen this, and does it always require you to be cut?

Secondly, I am really interested in getting a copy of my notes from both births, do I go straight to the hospital or do I have to go via the Obs and do the hospital have to get his permission to release the information to me?

[BellyBelly]

Relle, the lip occurs with your cervix (not the perineum which is the skin on the outside below your vagina) and is a tiny amount of cervix that hasn't opened. I've not heard of anyone having to be cut for this, but perhaps you can ask why he did it. There are some things you can do apart from an internal to get the lip to go, by using positional changes, lunge type of positions where there is a bit of movement in different directions to get the last bit to dilate. Most doctors will just know to push it back.

To get your notes, you can go direct to the hospital I believe. You can have access to your own notes.

[DoulaRelle]

Thanks Kelly, will look into getting a copy of them!

[chelleg]

Hi Relle, I also have never seen anyone perform an episiotomy to push an anterior lip over the babies head. Most often, if a lip will not slip over easily the practitioner will suggest position change (as Kelly said) and wait for a period of time for the lip to go away.
Obviously the issues within this thread are touchy and i can see everyone's point of view. I think there are lots of ways in which labour and birth can be a 'mind over matter' kind of thing but i also know that sometimes that just isn't enough. No woman wants to tear and no woman wants to have an episiotomy but sometimes it's necessary. It doesn't matter how experienced a midwife is, he or she is stil able to help women through second stage to avoid perineal trauma, i haven't been doing this for years and years but i have caught my fair share of babies and i have only ever had 1partial third degree tear and this was related to being positioned on the birth stool and having a shoulder dystocia with a 4.9kg baby, i have only had maybe 5 second degree tears at the most. I have had intact perineums with previous third degree tears and that is due to a good working relationship between myself and the woman so i do argue the fact that "experienced midwives" can help to prevent perineal trauma. (I mean they can, but experience doesn't necesarily have anything to do with it IMO)
I have also been in a birth with a very 'natural' midwife who was caring for her friend in the birth center. Unfortunately this womans perineum just didn't stretch up. This woman was extremely active throughout her labour and repeated positive mantras to herself throughout 2nd stage. As bubs head was begginning to crown a pinhole appeared, the midwife asked for the scissors but before she was able to perform an episi the perineum shattered and the woman ended up with a 4th degree tear. So positive thinking and visualisation doesn't always work and hence the reasons for episiotomies being around in the first place. I am an absolute believer that episotomies should only be used when truely needed and i don't think there would be many midwives who would think differently from me. Doctors, of course, are a different story.
It is absolutely 100% true that womens bodies were designed to give birth. But as with everything in this world even the best laid out plans go to the dogs. I am 100% a midwife. Yes i do work in a hospital BUT i also believe in womans choice and womans ability and i will not have that belief challenged by anyone, however with that belief and faith in woman also comes the knowledge that things DO go wrong and without medical intervention we would have a significantly higher mortality rate. I guess where i'm going with this is to say that just because a woman has an a birth that involves medical intervention, this doesn't mean that she has had a "less than ideal birth experience". Maybe she hasn't had your ideal birth experience or my ideal birth experience but who are we to judge what her ideal birth experience is? We are all individuals. I personally would never in a million years go through an obstetrician for pregnancy and birth care as i know there is no way my ideal birth experience would be fulfilled, however many women love their obstetricians and wouldn't have their birth any other way. I have looked after all sorts of women - some women want birth as natural as possible where other women want an epidural as soon as they feel their first contraction! Other women have elective cesarean's for any number of reasons and it is my job as a midwife to support women in whatever birth they desire to the best of my ability.
I see the flaws within our system, i know they're there, i know the intervention rates are too high and i know that we ned more one-on-one midwifery care but i do think it's wrong to judge any womans birth experience as less than perfect because she had intervention and i think statements such as this have the ability to promote guilt amongst women who have had intervention during labour and birth. Some things just are out of everyones control.

Sorry to ramble guys - and i hope i haven't offended anyone

[BellyBelly]

I've reworded my post because I didn't put it right - I often post in between disruptions... I am not saying that one birth is better than the other but what I mean is that we all don't want to have anything that in unnecessary - I am pretty sure that is universal and I don't mean caesareans just anything. And what ideal birth is to one woman varies between the next, absolutely. We all have to support women for the birth they want, so it's important to make sure you trust your care provider and do your research into what's important to you. Also the psychological aspect was just something I added and I am not saying it's the only cause, but it got drawn out as it was questioned as a valid option. But I believe that too does happen from time to time - again not the only reason why but can be a contributing factor.

To address the main question, yes the rates are high and that is of concern to me as a woman.

[chelleg]

I totally hear you about the high rates but look at how far we have come already!! You know those births where the mothers or mother-in-laws are support people and you can almost always be guaranteed to hear the famous words: "i remember when i had (insert name) and i had to lay on the bed with my feet in stirrups"(and lets not get me started on the whole separation from babies in the postnatal period) In some cases this was only 20 years ago. So we have come a long way. And with higher numbers of midwives and midwifery led services, not to mention websites like this that help inform and empower women, things can only get better. I'm not sure about other states but here in NSW we curently have two stand alone midwifery services and many other midwifery group practices, and NSW Health is in the process of introducing a 'homebirth policy' which i think is a great move forward.
It's kinda nice to see these sort of debates don't you think? Shows how passionate we all are about women and childbirth and that can only be a good thing

[Trish]

Chelleg, well said sweety

ETA What a shame I missed out on their HB policy. But a fantastic thing that they are implementing it

[DoulaRelle]

Chelleg, well said sweety

I totally agree Trish, it was well said and covered everyone's point of view!

My 2nd birth did have medical intervention, but it was my choice and ultimately I had the delivery I was after (Bar the cut!)

[babydustplease]

Hi Kelly,
I am in the ACT. I will try and get a hold of a copy of the book you mentioned.
I am not sure about hypnobirthing, but I will do some research and find out a bit more about it.

[tiggy]

Babydustplease,
you are in a great place for hypnobirthing!
Peter Jackson is in Bowral and does the best! When I did his course, there were lots of midwives who came from ACT.

He has a website called calmbirth and runs courses on weekends as well as through the week. GL

[julesr]

Hi all

I haven't had computer access for the last 4 days and I was certainly surprised to see the debate I triggered in my absence...

There are a lot of useful comments in here though - and it sounds like that I'm really just going to have to take my chances! I don't have my heart set on a completely natural birth, even though that is my ideal, because I've read in other posts how devastated some women are if that didn't happen - which I think is a great shame, because in the end, as long as Bubs comes out okay with a minimum of damage to mum - that's really all that matters. I would have every intervention procedure under the sun, if I had to, in order to ensure my baby boy is okay.

It's a first baby, so I do find the idea of perineal trauma a bit frightening, but the hospital I am going to is actually very supportive of active birth, and the beds fold in such a way that gravity can still be used if the woman has an epidural. I have New Active Birth and some other natural birth type books, so I shall go in there fairly educated anyway. I'm planning on having a chat with my obstetrician beforehand and the midwives on duty and I've worded up DH - so I feel that really, I'm doing all I can do and the rest I shall leave to the angels!

I have heard the "watermelon through lemon sized hole" comment many times before so I wasn't fazed by it. I do however like the "walnut through the toilet seat" analogy and will keep it in mind!

My mother has been very interested in the changes in childbirth policy in hospital (eg no stirrups, using gravity/not lying on back, getting to hold the baby straight away) and thought it was absolutely wonderful. I agree that while childbirth may still be over-managed medically - the pendulum certainly seems to be swinging the other way, thanks to passionate childbirth advocates and midwives, and rather than wish things were "perfect", I am simply very glad to be giving birth in a first world country at a time when natural birth is far more accepted than it has been in a very long time, but the best medical assistance will be available to me and my baby, should I need it. I think I'm a very lucky girl!

As for perineal massage....can't say that I was too keen on giving it a go to be perfectly honest, I'll try it out, but if I don't like it - I won't stress!

Thanks ladies.