I know that I have certainlly 'advised' women NOT to push at certain times
in their labours. Or even though I absolutely cringe at some of the
coaching pushing you see on ER and such programs, I have been guilty of it
(very rarely). Generally with very tired primeps who are battling
exhaustion and are so tired that they are barely capable of speaking. We
don't have access to epidurals, so it's quite literally vaginal birth with
some gas/peth or LUSCS and nothing in between.
Because I'm often the only midwife on at night, and the dr is on call, but
not in the building, I do everything possible, showers, birth stools,
massage, support and even 'intensive coaching' if that's whats needed. Last
shift had a beautiful birth, young mum with her mum, birthed herself (even
when she had screamed for an hour that she couldn't!) intact peri, and a
gorgeous little one. And Yes, I coached her when to push. But the result
was wonderful.
Cheryl
From: "Mary Murphy" <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: <ozmidwifery@acegraphics.com.au>
Subject: RE: [ozmidwifery] intact peri Date: Mon, 2 Oct 2006 14:16:14 +0800
Not so clear cut. On the whole it means not directed, as many of the women
I care for are on their knees in a water tub and I cant see their
perineum.
I talk about this during their pregnancy and try to remind them to go
gently. I find that women who are free to move their body as they choose
(water is great for this) are able to be in touch with what they need to
do.
Does this mean hundreds of intact perineums? No. It means that sometimes
there is a tear and sometimes not. A hard question to get the right
answer.
MM
_____
A little off-topic when you dont do directed pushing you do not tell a
woman when to push, but do you tell her when not to push? Or another way to
put it does directed pushing only include telling a woman when to push,
or
telling her when not to push as well?
Vedrana
_____
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Mary Murphy
Sent: Monday, October 02, 2006 4:59 AM
To: ozmidwifery@acegraphics.com.au
Subject: RE: [ozmidwifery] intact peri
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
wouldnt
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
_____
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Päivi
Sent: Monday, 2 October 2006 4:54 AM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] intact peri
Hi all,
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.
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?
Do you all practise hot compresses, perineal massage with oil (during
birth)
/ perineal support?
What is the % of intact peri in a waterbirth?
Many questions... Thank you for any ideas or comments.
Päivi
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