Posted by My OB said WHAT?!?.
Jul
22
Posted by My OB said WHAT?!?.
“You Need To Get Flat On Your Back Or Else You Will Get A 4th Degree Tear.”
“You need to get flat on your back or else you will get a 4th degree tear.” – CNM to mother who felt that pushing on hands and knees was working best.
There are 31 comments to this post.
Stephanie P had this to say,
Jul 22, 2011 @ 4:42 am (Quote)
I think there are some women who enjoy pushing from their back just depending on where baby is. For 2 of my 3 births lithotomy worked a charm (no tears and quick push) but I know that’s uncommon. I think we need to follow our bodies and push where baby leads us!
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road2vba2c Reply:
July 22nd, 2011 at 4:57 am (Quote)
I was one of those. Squatting was excruciating. I couldn’t sit on the toilet if my life depended on it. I did hands and knees, but ended up on my back. It was what worked for me. The nurses even suggested I lie on my side, but that wasn’t working either.
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Jane Reply:
July 22nd, 2011 at 6:14 am (Quote)
During my homebirth, I did deliver in a C-position, sitting on my tailbone. The baby was born in one gigantic push with no tearing, so the position didn’t impede progress. 
But when I delivered in the hospital the first time, I *was* comfortably pushing on ahnds and knees and they forced me on my back, and THAT’s wrong. Like you said, we should follow our bodies. But the doctor didn’t know how to deliver a baby if the whole thing wasn’t arrayed for him exactly the way he liked it, and it’s harder to inflict an unnecessary episiotomy on a woman on H&K, so they forced me over and onto my back.
My third birth was the weirdest: I pushed three times in three different positions over one contraction, and then the baby’s head was out. My husband called it “birth fu.” But I needed all those positions because the baby had a mild shoulder dystocia, and every time I moved, I guess I was changing the interior geography enough that her body was shifting and moving and it helped her clear the pelvis.
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My friend had a homebirth with her 2nd baby, she was fine on all fours but the midwife decided (with no real reason) that she *HAD* to move to a more reclined position and she ended up with a 4th degree tear because of it!
Now she is trying for a 3rd baby and knows she is going to have to fight for a homebirth 
if this stupid midwife had let her listen to her body she’d have been fine we are sure of it. *grr*
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“And you know this because why…?”
I hate when they jack-in-the-box you with these bizarre and stupid scenarios **in the middle of birth.** Because you could go research it or look it up if it was after an office visit, but how’s a mother supposed to tell her care provider “No, that’s not true” when she’s away from any source of information? and they KNOW it, so that’s why they say these things.
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Stephanie P had this to say,
Jul 22, 2011 @ 5:23 am (Quote)
Road2vba2c: I’m on my iPhone so I can’t reply directly! I was the same way with squatting. I requested a birthing ball and after a minute couldn’t stand the sight of it let alone sitting on it. Only the tub and being half-reclined on the bed worked.
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Lysana Reply:
July 25th, 2011 at 10:28 am (Quote)
Me too. I INSISTED on trying squatting, with the birth bar. My midwife let me, and as soon as I tried, my whole lower body cramped up – hips, thighs, calves, and feet. So it was reclining position for me. I was just too physically exhausted and undernourished/hydrated to do anything else.
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I am a “bad patient”. With my first, when they told me move into a different postion, I just ignored them. They were left with “catch the baby as he comes” or “drop the baby”. Afterwards, when they asked why I didn’t obey, I told them I didn’t hear them. I’m stubborn.
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Jane Reply:
July 22nd, 2011 at 6:46 am (Quote)
It’s hard to ignore them when they’ve got their hands on your shoulders and are wrenching you around and pull away the birth ball you’ve been leaning on for support.
Other women on this board have reported being forcibly held down on the bed, and I believe in one case, strapped down. I don’t think even the police would be allowed to use that degree of force on someone who wasn’t violent, but apparently obstetric nurses can. :-b
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Details Reply:
July 22nd, 2011 at 9:01 am (Quote)
Corbin, do us all a favor and write that staff a letter telling them you heard every word they said and knew they were full of themsleves so you ignored them and listend to your body. Lying to them only results in them screaming in the next woman’s face, and we don’t want that. Neither do we want to be tied down or physically restrained. tell them they need retraining and they need to learn to follow the mother’s lead rather than give orders and expect them to be obeyed. OBEY Really now. Shove IT!
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The Deranged Housewife had this to say,
Jul 22, 2011 @ 7:03 am (Quote)
I’m wondering if directed pushing more impacts this than just positioning -considering most people think the nursing staff has to tell you when to push, even when you have no urge, that’s probably compounding the problem more than just positioning alone. I pushed for awhile on my side and had no leverage. I was semi-reclining and it was difficult, but probably moreso because I had no urge and was basically working against my body. Never again!
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Stephanie P had this to say,
Jul 22, 2011 @ 7:06 am (Quote)
Jane: Bahaha! Birth Fu! I’ll have to remember that one. I’m 38wks tomorrow so I’ll hopefully be doing some of my own soon!
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Jane Reply:
July 22nd, 2011 at 7:56 am (Quote)
I started on H&K, one push. Then flipped onto my side and held my leg up like a flagpole. One push. Then rocked onto my back and pushed again. Baby’s head popped out and contraction ended. The rest of her was born on the next contraction.
A woman can’t do that if strapped down, epiduralized, or tied up with monitors and IV lines. That’s probably why most hospital care providers can’t imagine it happening.
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Jena Reply:
July 22nd, 2011 at 10:11 pm (Quote)
Please tell me you videoed this birth so your kids can see what an amazing birther you are!
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Jane Reply:
July 23rd, 2011 at 4:54 am (Quote)
I wish — I would ALSO have gotten video of the stupid nurse who made me sign a consent form when I was 9.5cm dilated giving them permission to assist me in birth, and had on tape for all eternity her telling me that she was not legally allowed to help me if I didn’t.
(Later on, I complained and asked the L&D manager whether they really were in a better legal position to let me deliver unassisted in their triage room. She said the nurse was “overexuberant.”)
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BAHAHAHAHAHA. I pushed out DD on hands and knees without tears or even skidmarks. Walked home 5 hours later. I was forced into lithotomy with DS (who weighed 1lb less btw) and suffered two 2nd degree tears… So yeah mhh I don’t think so CNM.
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I could have believed that an OB said this, but I’m stunned that a CNM said this. Am starting to wonder what training CNMs are getting. Are doctors training them? Would love a response from a CNM.
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Kat Reply:
July 22nd, 2011 at 9:29 am (Quote)
It depends on the CNM. Some CNMs come into the profession from being an L&D nurse. So they start out in L&D, strapping women down to monitor them, holding their legs back and screaming at them to hold their breath while pushing, and recommending they get an epidural now, how about now, now sounds good, the anesthesiologist is here so get it done now. They have already been to medical school to learn nursing, and their mindset is medical through and through.
Others develop an interest after giving birth naturally themselves, or acting as a doula for friends/family. Maybe they taught natural birth classes, and wanted a more active role in supporting moms during birth. These tend to have a more midwifery-based mindset, despite going through the medical aspect of the CNM training.
Most states require CNMs by law to practice under the oversight of a physician. Sometimes, this works well if the physician believes in the midwifery model of care, and sees the midwife as a skilled partner. Sometimes, the physician has a view of midwifery as hippie voodoo and seeks to limit the midwife instead of supporting her. Or only agrees to work with the type of CNM who is so steeped in the medical model of care that she will do whatever he says without question.
This is why it is SO important to interview a CNM practice, and get info from others who have birthed with that practice on how well they do at practical support for natural birth. The CNM designation alone does not always indicate a person who has a basic grasp on what the midwifery model of care is.
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During transition right before I delivered my son I was changing into different positions that felt right. This was an un-medicated natural hospital birth. Being on all fours felt the best for delivery. Even though stated in my birth plan that I didn’t want to deliver in the lithotomy position. The hopsital CNM said “You need to get flat on your back or else you will get a 4th degree tear”. I ended up with a 2nd degree tear and felt a lot of my power was taken away because I was forced to deliver in the lithotomy position. My son was born May 2nd 2009. Next birth will be a home birth.
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Heather Reply:
July 22nd, 2011 at 11:28 am (Quote)
I am so sorry My wishes were forcibly violated as well–I was yelling, “No! I do not want to be in the stirrups!” as the nurse pulled my legs into position against my will. I had a walking epidural, so I could have moved out of position, but I was afraid of falling off the bed and being stuck on the floor. It pissed me off so much and I pushed the button on the bed that put me into a full sitting position the best that I could. Since I actually wanted to curl around my belly, it was workable, but the fact that they took away my choice was NOT okay.
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Lil had this to say,
Jul 22, 2011 @ 2:14 pm (Quote)
My mum gave birth in 1980 to my youngest sister. She is quite short (about 4’11″) and the stirrups are uncomfortable for her. But the midwives insisted she give birth using them. I’m not sure if she tore or was cut, but she needed stitches afterwards, she wasn’t allowed out of the stirrups after the birth, but stayed in them for the delivery of the placenta and then to be stitched, the height was such that her lower back was actually raised slightly from the bed during all that time. The OB managed to drop her out of them, presumably as he didn’t realise she wasn’t fully flat on her back. She was in acute agony from the mid October of the birth until mid January. The doctors denied that it was the birth position, claiming it was siatica (sp?) And just coincidence that it started at the birth. Then on 13th jam 1981, when my sister was 3 months old, my mum walked us to school, dropped us off and then collapsed just outside the. School grounds. By the time the ambulance got there, she was paralysed from the hips down. She remained paralysed, despite numerous treatments, for 10 years. Apparently, the bed of nerves at the base of the spine had been damaged by the way she was held during her labour and stitching up, and aggravated by being dropped down out of the stirrups. Even now, my mum can’t stand for long and has difficulty with stairs, getting into and out of chairs etc. Her labour was 10 hours long, and yet the way she was forced to remain for those 10 hours has had lasting affects. My father was working aboard when my mum became paralysed, and although my baby sister stayed in hospital with my mum as she was being breastfed, the rest of us were sent into fostercare. My mum was in hospital for nearly 8 months, so we were sent back into foster care when my father had to return to work. When my mum did come out of hospital, she was unable to care for herself, let along a baby, a toddler and 2 school children, so I had to play mum. My relationship with my youngest 2 sisters isn’t the same, because I washed, dressed, fed and even potty trained them. I could bore you further with lots more details, but suffice to say it has coloured my life.
I wish I could say ‘thankfully, that sort of thing doesn’t happen anymore’…but it does. I was strapped down for my second birth in 1991, for my fourth birth in 1997 I was *ordered*, by midwives, to lay on my left side with my right foot flat against my left thigh -possibly okay for those of a normal size, but I am large and it would have been uncomfortable for me without the added pain of labour added in. For my seventh birth (this past jan), I was at home and allowed to move around in labour as I wished. I actually laboured mainly sitting at the edge of a chair and on the floor on my knees. At one point I did find one foot and one knee, leaning slightly forward was the best position, and started pushing in that position, and then at the last minute, I wanted to lie down more, and my husband and midwife piled loads of cushions up(covered by a shower curtain and blanket!) to make a sort of recliner position for me to give birth in. I’m not sure it was an improvement over time, as I know the hospital would have had me linked up to monitors and flat on my back with maybe 2 pillows, if I was lucky, behind my head, but the choice of location made all the difference…and I struck it lucky with 2 experienced and laid back midwives.
Sorry…rant over! Mums-your bodies know best, listen to them. Midwives do have experience, and it’s wonderful for them to share it, but they’ve never delivered the baby you’re delivering right then, so it should be advice they give not orders! And OBs should be used for antenatal checkups and those few times c-sections are actually needed!
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Knitted in the Womb Reply:
July 25th, 2011 at 6:50 am (Quote)
Wow! So sorry to hear about your mom!
I know someone who similarly was paralyzed due to nerve damage during a medical procedure, but in her case it was a dental procedure and it was the position her head was held in for 2 hours. She was paralyzed down the right side of her body for a couple of years.
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Add Your Comment.
Obviously this is complete BS, but has there ever been a study about the impact of the hands and knees position on tearing? It seems that it would greatly reduce the stress.
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Petra Reply:
July 22nd, 2011 at 5:36 am Petra(Quote)
Yes, there is literature on hands-and-knees deliveries.
http://www.ncbi.nlm.nih.gov/pubmed/16627774 Delivery in non-supine positions (including hands-and-knees) resulted in a significantly lower rate of perineal tearing.
http://www.ncbi.nlm.nih.gov/pubmed/9892890 Among primaparas, hands-and-knees delivery was associated with intact perineum.
http://www.ncbi.nlm.nih.gov/pubmed/11843786 Lateral position was associated with higher rate of intact perineum. (The abstract doesn’t mention whether hands-and-knees was included among lateral positions or a separate group).
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Heather Reply:
July 22nd, 2011 at 11:24 am Heather(Quote)
My midwife said that she’s found the lowest incidence of tearing occurs with mom in a position with one knee down and one foot on the floor (with her upper body supported, such as with the wall of the birth pool or birthing partner if on land) and her hand down, supporting her own perineum. Certainly not a position a hospital care provider would be comfortable with!
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Liss Reply:
July 22nd, 2011 at 3:49 pm Liss(Quote)
Hey! That’s the exact position my body decided to go into when I had my son 9 months ago. Indeed, I didn’t tear – just a couple of “skid marks”. A nice side-effect of this position: you end up catching your own baby. I highly, highly recommend lateral positioning if it feels right for the mama.
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Heather Reply:
July 22nd, 2011 at 4:31 pm Heather(Quote)
Yup, she knows I want to catch my own baby, so she was definitely recommending that position. She said she’s seen some moms who seemed to be having trouble in hands and knees just switch to that and have the baby just come right out.
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