Keeping perineum intact

[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