Wednesday, April 15, 2009

Midwife's role at my birth

I figured I probably should update on the conversation I had with my midwife, back when I was having some concerns about her role at my birth. So here are some excerpts from my journal, back in January, when we spoke at length about my worries:
Well, I met with the midwife today and had a very fruitful discussion and felt much better afterward. I felt like I could be completely honest and open with her, without any passive-aggressiveness or hiding of information. She asked a lot of questions that indicated she really understood my concerns. She talked about how she had seen a lot of "bossy" midwives (direct-entry ones) in action. She asked whether my fear was about having a midwife present in general, or just whether or not she'd really do what she said she'd do, in the heat of things. (And I replied: a little of both). She said she'd be thrilled to sit back and just silently observe the birth and not have to "do" anything, since usually her women want her to do more things.

We talked about some specifics like 3rd stage routines, hats/suctioning/towels (she doesn't do hats or suctioning anyway), whether or not I wanted guidance when the baby was crowning if she saw me blasting the baby out or something like a nuchal hand (I still would prefer not for the most part). I indicated my wish to have her remain silent and out of sight until I initiated contact, except of course if there was something worrisome that warranted action or extra observation (SD, hemorrhage, baby struggling with the transition to breathing). She said that she gets the feeling that I know what I'm doing and also that I am being completely upfront with her. She still would like to be in the room for the actual birth, but provided all is well would be happy to step out fairly soon after the birth and just periodically peek in the room to be sure we both look well. She said (even without my asking) that it would be no problem to only have her there and keep the assistant(s) somewhere else in the house the whole time, only calling them in in the case of an emergency. Which is exactly what I would have wanted anyway.

When we were talking about heart tones, she said that the normal protocol is, once pushing begins, to listen every other contraction but if the baby has been quite happy, she will listen less frequently, knowing the baby has the reserves to make it through labor. Good to know she doesn't have to rigidly adhere to certain protocols. There was lots more we talked about--I was there for 1 1/2 hours after all!--but I think I summarized all the basic points of our conversation....

I do admit that there is part of me having a hard time admitting that I am hiring a midwife--the vain part that does find a certain sense of pride in having an unassisted birth, the part that wants to do everything myself and sees assistance as a sign of weakness. Just being honest here; I do recognize that I have those fleeting thoughts. I know that I need to let that need for an image, a certain label on my birth, go. It doesn't matter at all, except that I am doing what is best for this particular pregnancy and birth. It is not a sign of weakness to have someone there if that is what is right.
I've been thinking a lot about how my unassisted birth has changed what I want in a midwife. This is something that I mentioned in my dissertation: women who have had UCs, and then choose a midwife for a subsequent birth, usually look for midwives who are very hands-off and who take a backseat role, rather than directing or managing the birth. I know some women really like midwives who are very hands-on and in-your-face, who coach you through contractions, give lots of direction and suggestions, provide perineal massage or support, etc. But I prefer otherwise.


  1. my HB midwife was very hands off , cant remember more than 2 tone tests in 6 hours but i can tell you that when she placed hot wet towels on my lower back (i cant remember if she asked) her knowledge of what/when was just divine! i wouldnt have asked for that! too busy concentrating and in the moment. But was i ever soo pleased to be recieving. You may surprise yourself to find just how comforting and good (with woman)having some expereinced assistance can be. For me, the midwife saved my babies life. i couldnt have done that alone. UC is not the pinnacle of womanhood.

  2. Question about hats... I'm not understanding being "against" (not even sure that's the word) it.

    Can you explain your thoughts on that one?

    I mean from my point of view, they're just so darned cute!

  3. So hats...basically I see it as an unnecessary postpartum routine, just one more ritual we've cooked up that can possibly interfere with those magic moments when the mother meets the baby. It's not like the baby is going to get hypothermia simply because it's not wearing a hat! And some people, Karen Strange I think, have wondered if our putting hats on babies as soon as they're born might interfere with the complex hormonal and chemical interactions between mother and baby.

    Anyway, I think they are darn cute--they just don't need to be put on immediately after the baby is born! Just leave mom and baby undisturbed for a while before doing all sorts of "stuff" to them!

  4. I'm not certain, buy I think that hats probably became routine when medicalized birth separated mothers from their babies right away, because of sedation or nursery protocols. If a baby cannot be skin to skin with mom and is wet, he will get chilled quickly. Unfortunately, this still happens too much in hospitals and we need to use the hats.

  5. you know never having had a hospital birth and living in a warm climate i just assumed that 'hats' was a colloquial term for a piece of hospital medical equipment!

  6. Hats primarily cover the wound from the internal monitor. These often swell up and look nasty by the time the baby is born and the hat keeps the mom from being concerned about it right then.

  7. @Valerie
    Yeah, that made me chuckle. I had to turn one of those down multiple times, but my poor boy had scrapes and cuts on the top of his head anyway . . . *sigh*

    I'm with Rixa on the importance of the first moments of birth being undisturbed. Every natural thing about us is beautiful and was meant to help. Why wipe off the vernix or afterbirth when it's beneficial to the newborn? When the scent is part of the complex bonding moment between mom and baby? Why wrap the baby in a blanket and top them off with a hat when the best "incubator" is the one who just gave birth? When skin to skin contact is the natural order of things?

  8. Your midwife sounds like a gem--someone YOU hired to help if needed and stay away when needed. Perfection! Honesty, no head games, and no her being the star, etc.

    Very very great!

  9. Rixa I applaud your brutal honesty with yourself. THe truth will set you free but first it will piss you off.

    You don't know when a midwife may have a good idea. As referenced by Kel's comment. I know I do thing by force of habit. But it is because some folks look like they need it. Most of the time I just know what will work from watching so many times.

    As for hat!!!! Come on people pick your battles! We do not put hats on to cover up anything. The spiral electrode is actually a good tool to keep the baby on the monitor when the mother wants to stay mobile and we need to keep a good watch on the baby. I would rather put in a spiral electrode and let the mother do her thing than tie the poor woman down if she does not wish an epidural.

    So please do not start rumors that are untrue. Women who are delivering babies have enough real issues to worry about. The spot where the spiral electrode is placed looks like a little pin prick. At least it does up here in the North East coast of America. ANd my buddies in California concur with me. One of my friends put one in her hand to see what it felt like. She reports it was not too bad.

    Newborns can get chilled pretty quickly. The mother usually does not think to dry the baby off. If you put the baby on the Mother's abdomen, you can dry her off and wrap both Mom and baby together in warm blankets if it is your preference.

    And yes, for the record, I too think the hats are cute.

    Now Rixa. This was my first thought when I read your post. I like to do everything myself too. But in an emergency where the Mother is hemmorhaging and the baby is blue, I need another set of hands. I would prefer it to be one of my cronies cause they know what I want them to do instantly. But any port in a storm. As of late I have had to be very patient because 1) there are new labor nurses on my floor and 2) I am teaching nursing students.

    So having some extra insurance sounds like a good thing. A mature midwife listening along with you also sounds good. We are a slave to our cognitive biases as you well know. Another set of hands and another set of ears are a bonus in my book not a detriment.

  10. Oh and one more thing! I think Karen Strange is full of Sh1t. Nothing can stop you from loving your baby and/or child. Do you think adoptive mothers love their children less? Think again. We are more than the sum of our parts.

  11. If I had the option of hiring a mw, I would want one that was happy to sit on the couch until needed. One of the most attractive aspects of UC for me is the fact that nobody touches me. I especially hate VE's. I don't mean that I don't like to be touched physically, only that I truly do not want to be directed, told what to do, asked to move into a more convenient position for someone else or have someone's hands anywhere near my vulva while laboring. If I could find a mw who'd take me on charity and follow those rules, we'd be GOLD. I'd be happy in the best of both worlds.

  12. Hats do serve a purpose. If baby's temp is dropping, they can go downhill pretty quickly. A hat is a pretty simple step to take. But taking a temp is probably a better first step. With my first, we had to take his hat off, it was making him too warm. I would be more cautious with an early baby, and take temps soon after birth, and often.

  13. Hi Rixa, I have a question for you:

    If your midwife will check the heart tones every other contraction during pushing - errr....what does that mean in terms of your flexibility to intuitively choose a position?

    I recall during pushing phase I walked, then during the contraction, I either hung off my partner or half kneeled/squatted.

    I can't imagine someone interferring with my space at such a high energy time as the pushing phase of labor.

    I would find their presence annoying and disruptive because I would just want to take the position my body would tell me to take.

    Any ideas on how you will handle this?

    Also,some midwives prefer that women are lying down during pushing/crowning to make it easier on them. Hope you talked to your midwife about flexibilty of positions (though I am pretty certain you have!)

    Good luck! You must be excited to meet your baby soon!

  14. Err one more thing, I couldn't stand the idea of someone touching/pushing on my perinium.

    Actually, putting pressure on the perninium does not prevent tears, and can in fact cause more tearing:

    Another good article on how to prevent tearing:

    "The position a woman assumes when giving birth may be the single most important contributor to avoiding perineal damage. The top three positions for preventing tearing seem to be hands-and-knees, kneeling and squatting."

    Interestingly, the midwife I had for my last pregnancy (I UC'd but did not UP) told me a flat out lie (one of of MANY) - that the reason they ask a woman to lie down during pushing vs letting her take an instinctive position such as squatting is because she felt that squatting caused more tears!!

    OH that irked me like nothing else!

  15. Hey, you don't need to tell me about these things! LOL I was quite clear that I don't want coaching or perineal support/massage, or really anything unless I ask for it, while I am pushing. I anticipate I'll catch my own baby and probably support my own tissues as the head is emerging, much as I did last time.

    Although I don't use Dopplers during pregnancy--my fetoscope works just as well, without any possible risks from ultrasound exposure--they are great tools during labor. You can listen in any position, under water, without needing the mom to move for the care giver's benefit. It would be really hard to check heart tones during labor with a fetoscope, since you would have to be lying down, holding totally still, and silent. Ummmm, that's not happening during labor!


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