Thanks for the comments Andrea. Your comments are certainly borne up by our experiences here in Singapore as well. Whilst we only have a small sample to use as an example (about 90 births so far) they are for the most part natural, vaginal births with hands poised, in positions chosen by the women themselves with absolutely no direction from anyone else, a calm, dimmed environment, no controlled pushing techniques, and completely natural third stages. I have seen 2 PPH's - one with a managed third stage and one with a physiological, both with the same caregiver. Those women who have birthed vaginally almost always choose to birth their babies in an all fours position or standing, and usually their partner catches the baby with caregiver guidance if needed. I have seen one third degree tear in a woman who had serious pre-eclampsia and severe oedema to her tissues. Our episiotomy rate is only 3%. No fourth degree tears. Some second degree but predominately intact or first degree, and rarely any stitching for these. No retained placentas diagnosed at all. Although several have taken more than an hour to be born.
So our conclusions based on small sample size? Hands poised works best in an environment where the woman is well supported, provided with good information, has a suportive caregiver and a normal labour. It has no impact on perineal postnatal pain, no impact on infant outcomes, and no impact on placental problems. Oh yeah. The caregiver we work with? He is a Singaporean obstetrician. No midwifery care here - just doesn't happen. The midwives are limited in what they are able to do and effectively restricted to working as obstetric nurses. Nikki Macfarlane Childbirth International www.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
