Jackie, you asked: < Do the homebirth midwives on the list agree, or do you experience fistula?s often in your clients?>
NO! Fistulas (recto-vaginal, in which faeces and gas escape into the vagina, or vesico-vaginal, in which urine escapes into the vagina) are usually the result of severe tears which involve the anus, or obstructed labour, or poor surgical repair techniques, or complications with healing. In the case of obstruction or severe tears, a woman planning homebirth with a known midwife would probably have been advised to transfer to hospital, and the midwife would attempt to work with the obstetric specialist team to provide appropriate care. I don't want to sound absolute here - these bodies of ours sometimes do unexpected things that have surprised everyone. In my experience the women in labour have understood their situation, and have accepted the need for specialist intervention in much the same way as you accept surgery when your appendix is severely inflamed. I let my clients know that I have limits to my professional ability. If a perineal tear goes close to the anus, I would much rather ask an obstetrician to do the repair, with the assistance of good light, Lithotomy position, and an operating theatre if needed, than let her possibly develop a fistula or incontinence. If the anal muscle is involved I understand that a permanent suture is used to prevent a u-shaped muscle developing. This sort of incident is a time when the woman and midwife will probably experience criticism from other professionals and from some family members. It's a time when the partnership and trust between the woman and her midwife are put to the test. We can't promise any particular outcome, but we can usually give clients evidence so that they can make decisions that they are happy with. We have good statistical data telling us that the number of perineal tears and the severity of the tears is consistently less in women who give birth at home (or in the car or for that matter) than for women in hospital. Why is that? Is it possible that a woman who is 'unobserved' (read bright lights and strangers looking intently at the business end - M Odent talks a lot about this) is more able to let go of her baby, and her muscles and skin go into a softer, more pliable state to let the baby make its way out of the birth passage? That's my theory. Joy Johnston -----Original Message----- From: Jackie Mawson [SMTP:[EMAIL PROTECTED]] Sent: Monday, December 17, 2001 11:37 AM To: Ozmidwifery List Subject: Re: sanctimonious pretentiousness << File: ATT00015.htm >> > If they didn't there would be no need for Catherine Hamlins Fistula Hospital > in Addis Abbaba, > correct me if I am wrong.. female genital mutilation a factor here?? ... And delays in treatment/receiving help. I have heard reports that the women with fistula?s have often laboured for days and days with a baby in the wrong position, etc, with no medical help available. These ?women? are often young girls. This is no valid comparison with what women in Australia should expect to experience during childbirth. Yes, fistula?s happen in Australia too, (a good friend of mine experienced one and had to have it repaired later) but women in Australia expect a better level of care during pregnancy and labour, whether they choose a hospital or a home birth. Hospitals are there if needed for a transfer, thank goodness, but homebirth will not cause more fistula?s to occur. Do the homebirth midwives on the list agree, or do you experience fistula?s often in your clients? Birthing Beautifully, Jackie Mawson. Convenor of Birthrites: Healing After Caesarean Inc. Visit our Website at: http://www.birthrites.org Email: [EMAIL PROTECTED] Phone: 61 08 9418 8949 Please note I am not a Professional Healthcare Provider, and all opinions given in this email are not to be taken as medical, or legal, advice. Please seek such advice from the relevant professional service. Email me your postal details for a FREE copy of our quarterly magazine, if you live within Australia - Overseas postage costs are above budget, sorry! Too many Gods; so many creeds, Too many paths that wind and wind, When just the art of being kind Is all the sad world needs... ---------------------------------- -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
