My story is similar to Carolyn's. At first I had my hands down there all
the time - to feel the emerging head, not the perineum. This was more
because of the way in which I taught how to 'deliver' a baby in the
early 70's than for any other reason and because of that old notion that
one had to feel for the nuchal cord and pull it over the
head.(incidentally, I do not even do this for land births now).
My practice around waterbirth has changed enormously, both as a result
of simply being with women and watching how they birth in water and from
the work I did for my master's thesis. I rarely get my hands wet now;
most of the women I care for let the baby out by themselves, by
instinctively putting their hand over the emerging head to let it out
gently, then bring the baby to the surface (I am always amazed at the
ease with which babies unravel themselves from their cords when they
need to in the water). At a recent home birth (3rd baby, 3rd waterbirth)
the woman did her own VE to check for full dilataion ["I don't know
where I am at" - "why don't you have feel?" "Oh! The baby's right
there"], she proceeded to catch the baby and bring it to the surface,
then 20 minutes later birthed her placenta and placed it in a dish she
had ready.
With regard to the perineum; most of the women I have had who birthed in
water have had no perineal damage or smallish tears. Never a 3rd degree.
I think this is because the water warms and supports the perienum and
allows the head to move down without the women necessarily getting the
strong expulsive pushing urge that can lead to tears of the genital
tract. Many women have been surprised at how close they are to birthing
the baby when they put their hand down to feel. So I think the water is
protective. We do not need to be interfering at all. But it takes
courage initially to change the practices that were drummed into us and
to learn to trust women and the birth process.
Robyn Maude
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of
Carolyn McIntosh
Sent: Sunday, 20 January 2008 10:01 p.m.
To: [log in to unmask]
Subject: Re: water birth
A couple of colleagues of mine did postgraduate papers on water birth. I
do not have the research they used but I do know that there were several
stimulants for the baby to breathe after birth. One is being born into
air, another is cooling of the skin and another is tactile stimulation
particularly around the face. Yes, babies' faces are obviously
stimulated as they pass through the birth passages but the chest is
compressed at that time and unless they have some foetal distress they
are not otherwise being stimulated to breathe.
When I first started supporting women to have waterbirth I would have my
hands down there to catch the baby. In later times I have been an
observant watcher, ready to act but not 'in there'. One of the beauties
of waterbirth to me is that the baby's body is supported as it is born.
It floats into the world ready to be brought to the surface by the
mother. This is not the case with an air birth and the baby needs to be
caught is some way. I have never had a 3rd degree tear in water and very
few in air.
I believe if hands are on for the birth then you have to be very sure
you know exactly how the baby is presenting at that particular time. If
you are supporting the baby as it is born you need to be sure you are
not actually making the presenting part larger than it needs to be. I
have witnessed some serious manoeuvres involving stretching of the
perineum etc by midwives in the past this has never been part of my
practice.
Regards
Carolyn McIntosh
Midwife and midwifery lecturer
Otago Polytechnic
New Zealand.
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Rachel
Reed
Sent: Sunday, 20 January 2008 6:25 p.m.
To: [log in to unmask]
Subject: Re: water birth
I have just completed a literature review as part of my PhD. I thought
I'd summarise the findings re.
hands on and hands off. If anyone would like the refs or more detail let
me know.
There is no evidence that hands on reduces perineal tearing. There is
some evidence to associate hands on techniques with 3rd degree tears.
Most risk factors for perineal tearing are fixed and cannot be
controlled by the mw ie. size of baby, ethnicity, etc.
One of the benefits of a waterbirth is that the mw can't get in and
fiddle with the emerging baby.
There is evidence that when women are left to follow their own urges
they birth in the best way for themselves and their babies (and protect
their own perineum).
We need to stop blaming ourselves and colleagues for 3rd degree tears
and start trusting in the physiological process of birth.
Rachel
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