I would only use a hot compress if the woman wasn't using water... I seem to be running about 95% waterbirths these days (or under the shower)
Perineal massage during labour is a NO,NO in my practice.
I sometimes find women put their own hands in front of the presenting part as if to keep the head flexed when giving birth .. it seems to be something that happens spontaneously for some women.
Episiotomies? I've never done one ... even managed to get through my training without having to perform one "for the records"
If there is going to be a tear ... so be it ... the perineum will give in the line of least resistance ... usually straight down the midline.
Jan
Jan Robinson Independent Midwife Practitioner
National Coordinator Australian Society of Independent Midwives
8 Robin Crescent South Hurstville NSW 2221 Phone/Fax: 02 9546 4350
e-mail address: <[EMAIL PROTECTED]> website: www.midwiferyeducation.com.au
<x-tad-bigger>Hi Paivi, I cannot give you statistics of homebirth as I do not have immediate access to them. I will see if we have any stats on our service that I can access. Just in general, the main way to protect the perineum is not to tell the woman to push, but to allow her to use her natural open glottis pushing, an keep hands off. At home we do not do directed pushing. I cannot speak for birth centres, but their philosophy is much the same. Each midwife does different things, but it is not usual to use compresses or perineal massage during birth. Is that what you have found Jan? I wouldn’t put too much weight on the Bastian research as not all of us completed her surveys. I personally have done 3 episiotomies in 24 yrs, but would do one if I thought necessary. Hospital midwives will have to answer the one about epidurals. MM</x-tad-bigger>
<x-tad-bigger> </x-tad-bigger>
<x-tad-bigger>From:</x-tad-bigger><x-tad-bigger> [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] </x-tad-bigger><x-tad-bigger>On Behalf Of </x-tad-bigger><x-tad-bigger>Päivi</x-tad-bigger>
<x-tad-bigger>Sent:</x-tad-bigger><x-tad-bigger> Monday, 2 October 2006 4:54 AM</x-tad-bigger>
<x-tad-bigger>To:</x-tad-bigger><x-tad-bigger> ozmidwifery@acegraphics.com.au</x-tad-bigger>
<x-tad-bigger>Subject:</x-tad-bigger><x-tad-bigger> [ozmidwifery] intact peri</x-tad-bigger>
<x-tad-bigger> </x-tad-bigger>
<x-tad-bigger>Hi all,</x-tad-bigger>
<x-tad-bigger>I am writing an article on episiotomy. I need to know what is the % of intact perineum among homemidwifes or birth centres? This is when the mother is having a natural birth.</x-tad-bigger>
<x-tad-bigger>Does this change if the mother has an epidural and is having the baby in a hospital? What I mean is that how much can the hospital midwife do to save the perineum if the mother has opted for epidural? Is it still mainly to do with the skills of the midwife? Or is it a harder job with a medicated mom?</x-tad-bigger>
<x-tad-bigger>Do you all practise hot compresses, perineal massage with oil (during birth) / perineal support?</x-tad-bigger>
<x-tad-bigger>What is the % of intact peri in a waterbirth?</x-tad-bigger>
<x-tad-bigger>Many questions... Thank you for any ideas or comments.</x-tad-bigger>
<x-tad-bigger>Päivi</x-tad-bigger>
