Episiotomies.

Episiotomies. I hate to even think about them. *Shudder*

I started this post planning on only writing about episiotomies, but it’s so hard to just stick to this one topic when it is affected by so many others.

Did you know that when you lie down to give birth your pelvic opening is much smaller than when you are standing? Also, the lithotomy position (on your back) causes more pressure on your pelvis and vaginal opening. So, sometimes a episiotomy may seem necessary to your doctor, when in reality if you could get up and let gravity do its thing, you could, in all probability, give birth without even tearing! If you think about the shape of your birth canal, you’ll realize that it’s in the shape of a J. When you are lying down, you actually have to push the baby UPWARD to get it out. Take this fact along with the fact that your pelvic plane is smaller lying down and you’ll quickly come to the “stuck baby” conclusion.

Another thing that can affect your chance of getting an episiotomy is “purple pushing” or coached pushing. By pushing when your body tells you too, or even better, letting your body do most of the pushing for you, you can reduce the pressure on your perineum, which in turn reduces the risk of tearing or of “needing” an episiotomy. Also, not purple pushing lets your tissues stretch gently to accommodate your baby’s head. If you are pushing forcefully when your body isn’t ready, you risk pushing the baby out too fast so that your body doesn’t have time to stretch and then risk tearing.

Sometimes episiotomies can lead to even worse tearing. The best analogy I have ever heard was that your perineum is like a bed sheet. If you make a cut on the edge of the sheet and then put pressure on it, it rips easily. If there is a small tear in the middle of the sheet and pressure is exerted on the sheet, it is much less likely to tear anymore. The vaginal tissue is the same. If you cut an episiotomy into the perineum, the baby’s head coming through the birth canal is much more likely to rip your vagina even more than if you tore a little bit in the middle of the tissues. Did you know that a tear heals faster than an episiotomy? Also, a small tear does less damage to your pelvic floor (important for avoiding urinary incontinence and sexual pain/discomfort). AND your body won’t tear unless it needs too.

**Combine upright positions, undirected pushing and a GREAT care provider to avoid unnecessary genital mutilation.**

Letting your body do what it is MADE TO DO (birth babies) is the best option – for your safety and your baby’s safety.

Some links:
Pushed Birth: But My Vagina

NHBS: EPISIOTOMIES (or “things that make my vagina want to suck up into my body”)

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“Pit to Distress”: A Disturbing Reality (via Nursing Birth)

I wanted to share this blog that I came across today. It’s written by a L&D nurse and this particular post deals with the practice of using “pit to distress” in maternity wards.

What really mortifies me the most about this is that the babies’ well-being is on the line, as well as the mothers’. Using Pitocin to induce fetal distress (whether or not the intent is to induce a c-section or whether the doctor is just in a hurry) completely goes against every ethical standard a doctor should stand for. It’s quite disturbing.

Dear NursingBirth,   I just saw a couple of posts about “pit to distress” on Unnecessarean and Keyboard Revolutionary’s blogs. Can you comment on that as an L&D nurse?! Is the intent really to distress the baby in order to “induce” a c-section?  I’m distressed that such things may actually happen, and am holding out a little hope that it’s a misunderstanding in terms….   Thanks!!! Alev  

Dear Alev,

I wish I could put your heart and mind at ease and tell you, from experience, that this type of outrageous activity (i.e. “pit to distress”) does not happen in our country’s maternity wards but unfortunately it does. I know that it does because:

1) I have read and heard stories from other labor and delivery nurses who have worked with birth attendants who practice “pit to distress,”

2) I have read and heard stories from women (and their doulas!) who have personally experienced the consequences of “pit to distress,”

and, most importantly…

3) I personally have worked with attending obstetricians who subscribe to this philosophy.

Before I start my discussion on this topic I would like to quote a blog post I wrote back in April entitled “Don’t Let This Happen To You #25 PART 2 of 2: Sarah & John’s Unnecessary Induction”. This post is actually the first post I ever wrote for my Injustice in Maternity Care Series. It is a TRUE story (although all identifying information has been changed to adhere to HIPPA regulations) about a first time mom who was scheduled for a completely unnecessary labor induction and the following excerpt is a good example of how “pit to distress” is ordered by physicians, EVEN IF they don’t actually write it out as an order (although some actually do!)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

“…At 1:30pm, right on schedule, Dr. F came into the room. After some quick small talk he asked Sarah to get into the bed so that he could perform a vaginal exam and break her water.

Sarah: “Umm, I was hoping we could wait a little bit longer to do that, until I am in more active labor.”

Dr. F: “Well, if I break your water it is really going to rev things up and put you into active labor.”

Sarah: “I’d really rather wait.”

Dr. F: (visibly frustrated) “Well I at least have to check you!”

Read More

via Nursing Birth

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Future Posts

I was talking to my dad the other day and he mentioned that I had a passion for homebirth, which got me to thinking. Yes, I had a homebirth and yes, it was a wonderful experience – I hope that every woman can experience in their own way what I did. But it’s not homebirth in and of itself that I’m so passionate about. I’m passionate about the way women and babies are treated, no matter where they are – home, hospital, birthing center. I want birth to be a good experience, the experience it should be, for every mother and baby. Nature works. Our bodies and the birthing process are set up a certain way for a reason and I don’t think we can fully comprehend how important each step of the process really is. Although, we do understand why some things are important and why others harm more than help when they aren’t really necessary.

I feel like it’s all been written about before, but there are some specific interventions and procedures that I would like to talk about in more detail in future posts.

Pitocin use
Inductions
Internal exams
Manual extraction of the placenta
Misuse of suprapubic pressure
Lying on back vs. changing positions
Purple pushing
Episiotomies
IV & no food/drink
Electric Fetal Monitoring (EFM)
Cutting cord immediately
Taking baby away from mother vs. skin-to-skin contact

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Yes, I’m The Brave One

One thing that really annoys me is when someone tells me that I was so brave to have my baby at home. Why, yes, I’m brave…I avoided needles, scalpels, drugs and strange places. Actually, I would have been terrified and so scared in a hospital that my body would probably have sucked that baby up in my throat trying to keep it in my body. So, yes, if that was me being brave, then I’m braver than Superman. I usually respond with a remark about how I think anyone who births their baby in a hospital is brave, not me.

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Infant Formula Marketing Survey

Want to tell someone how you feel about formula? Or about the information (or lack of information) you were given about using formula? Take this survey!

Here is a survey (I found the link on Enjoy Birth) that The Center for Science in the Public Interest is conducting to learn more about your experience with infant formula marketing. Please take this survey if you have had a baby or adopted an infant in the last four years. Formula Survey

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A Few Thoughts About Birth in the US

It amazes me how little people (especially women) really know about childbirth. I say people, because my husband has learned just as much as I have…we were both really clueless. I mean, I guess I shouldn’t be amazed or surprised. Just a few short months ago, I was among those people. At the beginning of my pregnancy, I toyed with the idea of just having a C-section so I didn’t have to go through all the awful “tortures” of giving birth (I considered birth to be torturous in my own mind because of all the things a woman typically has to go through – needles, monitors, drugs, espisotomies, lack of respect). I just didn’t realize there was another way.
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The Day My Daughter Was Born – Part 2

Part 2 of my birth story:

Finally, around midnight, I got out of the tub and draped myself over the birth ball. Twenty minutes later Layla suggests she check my cervix, and did her first internal exam. And sure enough, she said I was only dilated to 3-5 centimeters (later she told my doula that I had been at a 6, but had gone backwards). Even though it really upset me, I had known that would be the outcome of the exam before she even suggested it. Read the rest of this entry »

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