- The talk on Wednesday went very well - Ina May wasn't there (something happened and she didn't show until later) but Elizabeth Davis did a nice talk before me. I received so much warm feedback on my talk - and Jan from Midwifery Today asked me to write an article on the topic.
- I don't like writing much - I feel woefully inept communicating my feelings via writing. I've had some of the worst fights/disagreements/bad feelings from email communication with my friends/partner/past apprentice, etc. I'm not a writer, really. But I have great friends and a partner that are wonderful editors.
- Had a birth Thursday night. Perhaps she'll give me permission to write about her birth from my perspective. (it will be short!)
- At Your Cervix asked about why I don't check for nuchal cords. Here are a few reasons:
- I don't believe in perineal massage or support so my hands are not usually on women at the time of the baby's birth
- It hurts women - it's very uncomfortable/painful and most women gasp in pain when it's attempted
- Exposing the cord to air and handling it starts the vessels clamping down. If the birth of the body is delayed, I've messed with the natural progression of things
- I feel like it's not necessary. I don't really buy the theory that a tight nuchal cord keeps a baby from being born completely (the uterus shrinks in size to follow the baby down the birth canal and if it "allowed" the baby to get that far, it's not likely to inhibit the rest of the body). If the cord is very tight, simply holding baby close to the mother and somersaulting it through the cord can work, but this is a very rare occurrence - in seeing over 270 births I have yet to witness this.
- Cutting the cord on the perineum because you cannot loop the cord over the head is dangerous and risky - it robs the baby of its only life force. It usually results in a need for resuscitation - and said resuscitation robs the mother/baby of an important bonding / transition time.
- Here's a great article on the topic from well-known UK Midwife/Author, Sara Wickham
- I've been out to a client's house twice for at least four to five hours in the past day. It's been hard going home, knowing that she wasn't in active labor but also realizing she didn't want us to go. Wondering if tonight she'll kick in - with three children, the odds of it happening during the day is slim. Ah, the unpredictability of birth!
And because it really is applicable to all of midwifery, the quote from the above-mentioned article is something that needs to be posted again:
Whether or not we do things like this as a regular part of our personal practice, why do we feel we need research evidence to support the argument for not intervening? In a model of midwifery that assumes normality, I would assume that midwives would need to see evidence that something is useful before incorporating it into their practice, not the other way around. Have we become that uncomfortable with the physiology and normality of birth that we would rather intervene than not? Are we so fearful of litigation that we feel we need to “do” rather than “be with”? And are these practices really so ingrained in us that we feel compelled to continue them on a routine basis unless – or until - they can be proven unhelpful?
4 comments:
"I don't really buy the theory that a tight nuchal cord keeps a baby from being born (the uterus shrinks in size to follow the baby down the birth canal and if it "allowed" the baby to get that far, it's not likely to inhibit the rest of the body)"
I was present at a birth where the umbilical cord was so short that the uterus inverted when the baby was born.
I often see cords before I feel them anyways....so it wouldn't be too hard to take this out of my regular "routine"
I have seen at one delivery, where the baby was partially delivered unassisted (I was present, the patient was not actively pushing, however, the baby decided he was coming right now - an unmedicated/non epidural delivery I must also add).
However, the baby delivered only halfway (to the mid chest level) due to a nuchal cord that tightened during his rapid birth, and then held the rest of his body inside his mother. I ended up having to reduce that (now) tight nuchal cord, in order for her to deliver the rest of her baby.
So, although this was just one time I witnessed this, I'm positive that not reducing a nuchal cord can result in a baby being only partially born, and needing to reduce the cord to allow the rest of the body to deliver.
I have had to deliver 2 other babies with very tight nuchal cords that I clamped and cut before delivering the rest of the baby. This was what I was taught, and unless a study is done that can show me otherwise, I will continue to do that with cords that cannot be reduced. Unless the baby does deliver quickly with the nuchal cord still present, of course :-)
I appreciate your points about not reducing a nuchal cord though. Thank you!
You are a writer, and a very good one. The only difference between you and me is that you are not an editor *also*. There are some drawbacks to being both, as I take a million years to finish anything (as evidenced by my difficulty updating my blog.) It's a *good* thing to be able to just get stuff out there, and worry about editing it later (or letting someone else worry about editing it later.)
I've said this is a million times already, but your conference talk ROCKED and I thank you for encouraging me be brave and find a way to be there.
Re: nuchal cords that allow the baby to be born only halfway... isn't this where the somersaulting would come in?
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