Well, if she’s being told to do Valsalva pushing, she’s bound to get a nosebleed.

I could?! Oh My God!! Will a C-section prevent that?

I tore in 3 places (DS also had a gigantic head!) and I’d still rather go through that than be cut. I don’t dread the tearing, the pita it is to go to the bathroom etc.. but I absolutely dread someone taking any kind of sharp object to my skin. I probably would not have torn had the OB not said “If she doesn’t deliver this baby soon I’ll have to cut” so I purple pushed.

I can completely understand why repairing a nice, neat incision would be much easier than repairing a natural tear. However, you only have to spend a few minutes repairing and it involves no pain on your part either way. We have to spend days or weeks healing, and if there’s scarring we have to deal with it forever. A natural tear is likely to be smaller than a cut, heal better and faster, and leave less scarring.

PLUS, as has been mentioned plenty of times, a episiotomy is a 100% chance, whereas a tear is not. With my third child, I had a 45 minute labor (not much time for stretching!), she got stuck and wasn’t getting any oxygen, and a paramedic had to literally reach inside me and carefully pull her out. BOTH HANDS around the baby’s head and shoulders inside my vagina. And I DID NOT TEAR. Not even one tiny skid mark — nothing. In fact, I never tore, at all, with any of my three vaginal births, and I never had an episiotomy.

Give a woman’s body a chance. Not every woman will tear, especially if she’s properly supported and encouraged to follow her body’s cues, and not every woman who does tear will need stitches. Some will, but there’s no evidence that cutting them will prevent it, or do anything other than ensure that they will have a surgical incision, stitches, and a scar.

Nurse, you’ve seen one tear in six places.

How many years have you been an obstetric nurse? How many deliveries have you seen?

So what’s the overall percentage: one woman whose vagina looked like it had exploded, versus how many women with normal tears?

I would bet you’ve seen more deliveries over an intact perinium than deliveries with jagged tearing in six places, and yet that’s not what gets remembered.

Tact is not my strong point, so if I get offensive, my apologies. I’ll try to be diplomatic, I really will.

“We’re brave?!?”

Any woman who goes into the hospital to have her baby and subjects herself to enforced starvation, constant interruption by well-meaning professionals who want to check her cervix or get blood samples every hour, pressure to dilate on a timetable or else, constant undermining in the form of “You don’t have to be a martyr to the ghastly pain, you can just have these nice drugs, of COURSE they always work and there are no risks of side effects,” being forced to lie nice and still for the belt monitor because even if it’s telemetry rather than a belt hooked up to a machine by a short cord moving around might mess up the results, being forced to push on her back with legs raised (thus narrowing the pelvic outlet and vaginal opening, also putting pressure on the vena cava and risking the baby’s oxygen supply), being forced to PUSH! PUSH! PUSH! TO THE COUNT OF TEN!, and from all this, facing a one in three chance of abdominal surgery (at least; some doctors have higher rates) -

Any woman who willingly walks into THAT is brave.

Or, if she is not in ill health or experiencing a true emergency of birth that needs medical attention from specialists, very foolish.

There isn’t all that much difference between bravery and foolishness, really.

There is a LOT of difference between ignorance and being informed, however (notice I said “ignorance” and not “stupidity;” smart women can be ignorant, too, and often, it’s not their fault, it’s just that they don’t know any better).

You are a nurse. Are you familiar with the Cochrane database?

How about the research of Henci Goer? I recommend _Obstetric Myths Versus Research Realities_, which has a wealth of information in it, compiled from various medical journals. If you want a quicker read, go for her book _The Thinking Woman’s Guide To A Better Birth_.

How about _Baby Catcher_ by Peggy Vincent? Have you read that? The author was a nurse for many years before she decided to become a midwife.

BRAVE?

If women were not micromanaged, belittled, treated like invalids and patients, and basically set up to fail the instant we check ourselves into the maternity ward, we wouldn’t need to worry about things like “exploding vaginas.”

A vagina that isn’t splayed open in the lithotomy position, possessed by a mother told to push until she is purple, isn’t going to explode, anyway. Giving birth on all fours or in a supported squat, with the woman’s perineum supported and soothed with warm compresses, and without coached pushing (if she’s not numb from the waist down due to an extremely “friendly” epidural or stoned on narcotics, she won’t need coaching on how to push in the first place, because she’ll be able to work with her body and listen to its cues) is MUCH easier on the perineum.

*SIGH*

I am NOT brave. A risk of tearing over a guarantee of tearing. I’d take the tear, thank you.
I’d much rather tear naturally than have a “nice staight line” There is no other part of my body where there is a nice straight line, why should I have one on my perinium?
Yes, I tore during my first birth. But I also had nurses yelling at me to do that awful Valsalva pushing. Maybe I wouldn’t have torn at all if I’d been free to push how I darn well felt like it.
My second birth (in the comfort and safety of my living room)I did push how I wanted to. Lo and behold, no tear.

In my current neck of the woods (Indiana) the episiotomy rate in vaginal hospital births is much higher than 33%. Depending on the doctor, it’s more like 66% to 100%.

C-section rate is about 33%, though – except in some private hospitals where it’s closer to 50%. (Cadillac health insurance, and all that.) And of course there are a few doctors whose rate of baby extraction via abdominal incision is much higher than 33%. But as we all know, of COURSE they just see a lot of high-risk “patients.”

Hey, don’t forget other perks of nice, controlled, neat episiotomies:

Like cutting into the network of nerve endings that connects to the clitoris, resulting in considerably diminished sexual pleasure. Pain from intercourse, too, if the doctor has been so kind as to add a “husband stitch.”

Or damage to the muscles in the perineum causing incontinence – urinary or fecal. Spontaneous tearing can do that, too, if it’s third or fourth degree, but third and fourth degree tearing is extremely rare unless it’s an extension of an episiotomy. Most spontaneous tearing consists of first and second degree tears, and near-tears from bruising (“skid marks.”) It doesn’t go into the muscle, therefore, isn’t likely to permanently damage the pelvic floor.

Which, by the way, is why the idea promulgated by certain OBs about vaginal birth endangering the pelvic floor, and c-section saving the pelvic floor, is utter bullshit. The pelvic floor is more likely to be damaged by cutting of any sort than it is by pushing out babies. This is not the third world. We do not have labours that stall so badly that the baby dies, something makeshift has to be done, and the mother winds up with tissue necrosis leading to fistulae. When there is a true emergency, we do have surgery, and it is reasonably safe. We do not need unnecessary surgeries to save ourselves from our own bodies.

Thea – you’ll enjoy reading _Baby Catcher_. (Wait until you get to the part where a midwife’s teenaged son mistakes a placenta in the freezer for a pizza. It was only a short description, but tears were rolling down my face by the time I got done reading that passage, I was laughing so hard.)

If you have time you might also want to read

_Birth: The Incredible History of How People Are Born_ – Tina Cassidy

_Pushed_ – Jennifer Block

_Hard Labor_ – can’t remember the author, and the book might be out of print, but it’s the memoirs of an LDRP nurse who had aspirations of eventually becoming a midwife. I picked it up for a dollar at a Once Upon a Child store and it was a really good investment.

_Heart and Hands_ – Elizabeth Davis (a midwife)

_Spiritual Midwifery_ and a much later book, _Ina May’s Guide to Childbirth_ – Ina May Gaskin. There are many happy stories of natural childbirths, and many photos. It’s kind of mind blowing to see this hippie woman grinning, lolling back into the arms of her best female friends, with this head sticking out of her vagina. I like to show it to my friends when they say they like the idea of natural childbirth but don’t see how it could be possible.

_Open Season_ – Nancy Wainer Cohen. Warning, she’s got even more p*ss and vinegar than I do.

_Birth as an American Rite of Passage_ – Robbie Davis Floyd. The author is a cultural anthropologist who, like Margaret Mead, has a keen interest in childbirth customs. It won’t be as fast a read as some of the other books, but if you’re curious about the origins of some medical procedures and hospital routines, you won’t want to put it down.

Also, check out
_Misconceptions_ by Naomi Wolf.
_Born in the USA_ by Marsden Wagner.

I commend you for staying with the board and learning from the posts that everyone shares. We need more OB nurses like you that are open to learning new ideas

Ha! When I read the description of the birth in _Spiritual Midwifery_, my first reaction was, “Boy, those must have been some unusually large cojones there.” My intuition was correct!

And very trivial, all things considered, but it must have made the birthing interesting.

Anyway, I don’t think we should fire all OBs, because they do come in very handy in emergencies, which is what they train for anyway, and they are probably wiser to keep on for extremely high-risk pregnancies as well due to their general medical training (I don’t know any midwives that will take on clients who have congestive heart failure, for instance).

It would make sense to make most OBs hospitalists. The ones that remain can be on hand for public health clinics as consultants/backup, have private practices as specialists who only see the pregnancies that are so high risk that the mother has a chance of risking her life (but still desperately wants to keep the pregnancy) or is on medications for serious health conditions that need to be managed to avoid teratogenic effects, etc.

For the vast majority of clients, it makes far more sense to see a midwife, yes.

The reason OBs are in business as the practitioner of choice for healthy pregnant women in America is that American women are brainwashed into thinking that more expensive/specialized is better and doctors are safer than “mere” midwives and nurse practitioners (rubbish!)

Also because thanks to the ACOG arrangement of being listed as primary care providers for insurance purposes, while most CNMs and other licensed types of midwife are not even recognized by said insurance companies, mothers don’t have much choice. We pick what we can afford. I’m paying out of pocket for my direct-entry CPM, and the only reason I can even afford it is that my husband and I have a huge tax refund every year thanks to the earned income tax credit and to our not listing ANY deductions throughout the year. If it wasn’t for that tax refund, I’d probably be going unassisted, and having a trip to the nearby ER in case of a mishap.

Only a pediatrician? Wouldn’t a pediatric neurologist be safer? Or, better yet, a pediatric neurosurgeon?