to think that it's the responsibility of every childbirth practitioner (i.e. OBs, mws, etc) to learn thoroughly about all the non-invasive practices for assisting with childbirth?

[SpeedyGonzalez]

If I as a non-medic can be bothered to research this stuff properly, why does it seem that so many medics simply don't know it?

I was discussing my first labour with DH this evening, and why I think the medics should have done things differently - in my case it is HIGHLY likely that my body would have remained intact and it would have cost me far less in emotional trauma, and cost the NHS far less money.

DH then explained why he thought what they did was right. I then presented him with about 5 different things they could have done to ensure a better outcome - all woman-centred strategies - and he agreed that nobody in my birthing room suggested any of these things at the time. I was in transition, so not really in a position to suggest alternative methodology!

I know about these strategies because I have researched them, but why does it seem that so many medics simply don't know this stuff? I have to say that in my case I give my fabulous mws the benefit of the doubt - they were brilliant, very sensitive to the way I was labouring, but then I had an apparent emergency (which turned out to be fine) but they had to call the OB just in case. After that it was a classic 'well, I'm here, so I may as well do something. I'm sure that having him in the room meant the mws then felt inhibited from proceeding as they would have had he not been around.

Still. IMO obstetricians (and mws) should know stuff like:

• episiotomies weaken muscle and increase the likelihood of tearing. They should not be the first port of call to avoid a tear, as there are several non-invasive ways to do this
• if a woman is lying on her back, it will place her baby in distress
• if a woman is lying on her back, it will increase the likelihood of tearing
• if you push on both of a woman's hips, it will open up her pelvis and enlarge the space for the baby to pass through
• apparently the cervix is perfectly capable of dilating beyond 10cm to enable safe passage of the baby

And heaps of other stuff. Shouldn't it be a requirement of their jobs to remain up-to-date on this stuff? If people like Ina May Gaskin (the source for my last two facts above) can report such astonishing outcomes such as 1% CS rate, less than 3% severe perineal trauma (I think that figure might actually be 0.3%, can't recall), etc - why isn't the medical establishment getting off its arse to find out how to achieve the same outcomes?

I for one would like to feel that I can have faith in my doctors and mws, but the way things are at the moment it makes that a real challenge - more so for the doctors.

It's scary but true! And it's not just childbirth- my mum had a brain aneurysm, and had to have brain surgery. She had lots of other problems, and the neurosurgeon was giving us the lowdown on the potential complications of such an invasive op, when my dad (computer programmer/ manager, who had done a fair bit of research,) asked why they didn't do a different op/ technique, and the brain surgeon said - "Ah! Yeah, I suppose we could do that, and it would be far less invasive and dangerous!", and that is what they did!!

I always question now, personally!!

That's unbelievable. My goodness, jooly. I'm speechless.

YANBU. Have you seen the Business of Being Born? There's a moment where all these new OBs admit they've never seen an unmedicated birth. Horrific.

IMO obstetricians (and mws) should know stuff like:

• if a woman is lying on her back, it will place her baby in distress
• if a woman is lying on her back, it will increase the likelihood of tearing

• sometimes the woman may be more comfortable on her back and will do everything in her power to stop you from turning her, even if you are doing it to avoid an episiotomy

Just a guess, but maybe one reason she has such good outcomes is because, as a midwife, she takes on much lower-risk women, referring higher-risk women on to the obstetricians?

I am ignorant about her though so maybe you can correct me.

I chose to give birth on my back and didn't tear or have an episiotomy. The instant I reached 10cm, I had to get on my back. I tried leaning against the back of the bed upright and it nearly killed me! This happened all 3 times I gave birth. No idea why, but for me it was just what worked.

I do however agree that often the professionals don't know as much as they sometimes assume they do - but more importantly they don't always follow what you wnat and I think that often you know best about your body. I would say that more than half of my friends were not 'believed' during labour about one thing or another.

Carmen, no, haven't seen it - don't suppose it was a C4 doco? If so it should still be on their website.

Timothy - yes, that's true, however that's quite different from the point I was making. The OB in my case appeared not to know/ care that there were many other ways to avoid my tearing before resorting to scissors.

Parakeet, I think that depends on what you mean by 'high risk'. For example, Ina May's book details how to assist a woman giving birth to a breech baby (different types of breech presentation) vaginally - something that no hospital would ever allow.

PotPourris - ! Perhaps you didn't tear because you weren't cut. It's impossible to know if my birth would have the same outcome as yours, had the OB not been so scissors-happy. It is shameful that, as you say, they are so often completely unconnected from the fact that labour and birth is so different from a medical condition and therefore labouring women should be given a hell of a lot more credence than they are.

I do find this overall approach to the body quite shocking, though. When I was in a private hospital for an operation some years ago (I veer towards the hippy end of healthcare, in case you hadn't guessed by now! ) I remember that the nurses were absolutely gorgeous, so attentive and lovely. And, strangely, almost all South African. Anyway! Anytime they asked me how I was, I'd say 'Oh, I'm okay except that I have this or that mildly irritating thing.' And they'd immediately say: 'Would you like a pill for that?', which I found utterly bizarre. Sometiimes you don't need a pill and all its concomitant side effects, you just need to rest and let your body fix itself. So this whole action-stations approach to dealing with the body is very peculiar, IMO.

And, when it comes to giving birth, it can cause unnecessary harm, which is simply unacceptable.

you can download the business of being born - you pay a small fee to have it on 'rental' for 48 hours. amazing film.

www.thebusinessofbeingborn.com/

I totally agree with the OP.

I was made to give birth in the lithotomy position despite begging the midwife to help me birth in any other position. I suffered permanent damage to my pelvis as a result. The physiotherapist who examined me said that the midwife had breeched hospital guidelines.

I too was really clued up on all sorts of great birthing ideas. I was utterly appalled at the ignorance of my midwife.

Ina mAy has helped women who would be deemed high risk, give birth with MW care.. breech babies, multiple births, VBAcs and so on, but she does lsit the women she would receommend hospital care for. so she and her practice don't take on everyone

i agree with the OP

however , as far as i can see and as far as i have experienced, MWs do not have the time to spend with each woman during her labour to ensure that she moves around, uses different positions, some units have one birth pool only so not everyone could labour in water, MWs don't have the one on one time with a woman in her labour, until really delviery is imminentm on the whole

also, there are lots of interventions , such as IOL, or CFM that require a woman to be fairly still for protracted periods,hte levels of pain women experience can often lead them to ask for strong pain relief and epidurals that further inhibit mobility, wheif they had one on one care, they could in some circs, avoid the intervention and pain relief and the cascade of intervention

also, i am confident the vast majority of MWs, certainly, know all of this and would dearly love to practice it, but NHS and hospital protocols often don't allow

for instance, you are expected do dilate at a certain rate, if you don't, you will be offered synto .. there you have a drip and taht will inhibit movement and can make you need more pain relief, again that will inhibit movement

i think it is more a quesion of practitioners knowing it, and not being able to put it into practice

YANBU. Different medical area, but it genuinely frightens me just how many doctors and paramedics have never heard of my anti-epileptic medication, or the type of epilepsy I have. Which is alarming as my neurologist told me that some common AEDs (anti-epileptic drugs) can actually CAUSE me to have seizures, so it's not unimportant...

I'm pregnant for the second time now. My DS was born about a week before my 21st birthday, and the pregnancy was completely unplanned, which meant that along with everything else I was carrying my DP through a bad bout of depression (as well as finding a house with him) and in shock enough that I really didn't know all that much about labour other than the pros and cons listed by the pain relief options in my leaflets. The NHS anti-natal classes were full of crap too. I had been told by one HCT that I had to go in the moment labour started (on account of my epilepsy), but when my waters broke I phoned up and they said not to go until I was having contractions every five minutes. My midwife was displeased when I told her that this time, so I'm sure it could have been the hospital's ignorance which led to the complications I had giving birth. (Labour completely stopped so the next morning I was given an epidural and induced; DS's heartbeat slowed with every contraction so I had an episiotomy and ventouse. The cord was around his neck.) Two (miserable - they put the canula in the back of my hand meaning I could hardly hold my son and refused to take it out until the following morning) days later, on discharge, they told me I was very anaemic from blood loss and handed me iron tablets. After all the struggling to walk unaided to the bathroom and dab my tender private parts with a wet flannel, I was rather annoyed at that poor display.

I'm going in a lot more clued up this time, but it does go to show just how many women really rely on the medical professionals to actually know their job. (At the time I was distinctly unimpressed at the lack of anyone who could actually help me get by great wobbly boobs into a position where my DS could breastfeed properly - I suspect they weren't that fussed as my AEDs meant I could only do it for 'a few days' anyway )

(eek, rank over, I promise!)

Lulu - ahh, yes - good old hospital protocols. Because every human body works to a clock, obviously. That protocol stuff is worthy of a PhD study in itself.

I've got an idea. If you have a birth partner with you let them know your preferences and then they can encourage you to mobilise etc. and also act as your advocate if midwives or obs suggest what you consider to be unnecessary interventions. That's what a birth partner should be there for really, not just as a spectator but as a support.

I consider myself very fortunate with my second birth. My first was induced, back to back, epidural, and midwives popping in intermittently during the 13 hour labour. After that experience, with my second pregnancy I took the time to read a bit further from that bloody Stoppard woman, read Ina May, educated myself a bit more basically. And dc2 was still back to back, but it was a 3.5 hour labour spent upright and with a truly brilliant midwife who was in the room throughout, but was very quiet in her role. The sad thing is that I consider myself lucky and fortunate for that experience. Every woman should have the opportunity to have such a brilliant birth but imo, the midwives are too stretched if the ward is busy, and an antenatal appointment lasts 10 minutes if you're lucky, no time to really talk about natural birth in any depth

Midwife to my friend who had her baby six weeks ago:

'You just need a little cut now, all my ladies have this and it won't hurt' !

Friend argued, didn't get the episiotomy, and ended up with a teeny little tear, nothing else.

Good gracious, what a bizarre approach to birthing care, LRD.

just - were you previously justabout? - anyway, so sorry you didn't get the level of mw attention you should have had during your first labour. I also agree with what you say about midwives. That's part of my reason for going for a HB this time.