When Paradigms Come Crashing Down

Before I came to the Philippines, I had an idea of what a beautiful birth looked like and what was best for a mother and baby during the birth.

However, some of those ideas are starting to become muddled.

For instance, I was always taught that pushing on your back was really bad for the mother and baby and it closed off the pelvis and made progress difficult. Squatting is always a better alternative. However, after coming out here, a lot of women don't make any progress while squatting. They only progress when they push on their backs. Once the baby is crowning (or almost crowning), the mom is then moved back to a squatting position and progress usually slows again until the baby's out. It's highly perplexing since I was always taught the opposite.

Another thing I've seen that would make an Obstetrician's paradigm come crashing down is a vacuum extraction. In a hospital, whenever there is a vacuum extraction, the doctor will cut an epesiotomy in order to fit the suction cup inside the vagina and against the baby's head. However, I've seen two vacuum extractions out here and both times, the midwives left the perineum and vagina intact. They didn't need to cut anything at all and the vacuum extraction worked perfectly. It's enough to make me want to ask the OB why he thinks epesiotomies are necessary for VEs.

But boy, did that baby's head look funny after he was born because of the vacuum. I'll take a picture and post it on the blog because it looks like he's got some sort of growth on the back of his head. It's ridiculous looking. :-D

One thing totally unrelated to this post: when the moms push out here, they push with their faces and make a lot of noise. I'm used to faces remaining fairly relaxed and the moms holding their breath while they push. I wonder if that's part of why the pushing stage takes so long and the moms make so little progress. Pushing with your face (scrunching it up really tight) will tighten your whole entire bottom area making it really hard for the baby to come. Also, making a lot of noise (crying, yelling, etc) while pushing lets all the force out. Think about it, if you're making a ton of effort up top, not much is going to happen down low, right? Anyway, I think it would be better if they at least relaxed their faces and focused all their energy in their bottom when they pushed. But then again, easier said than done.

One more thing totally unrelated to this post: I absolutely love the midwives during a long pushing stage. When the mom is tired and frustrated at making pretty much no progress, they are energetic and encouraging. At the birth this morning, the baby was acynclidic (I'm probably butchering the spelling of almost all of these words...) which means his head wasn't correctly applied to the cervix making for a difficult birth and he was a compound presentation meaning that his hand was trying to be born next to his head. Basically, the odds were stacked against his poor mom.

Anyway, his mom was getting discouraged and tired because there was little to no progress after each push. However, the midwives were very encouraging and talking cheerfully to her. Then, when the baby would start moving  - even if it was only a millimeter - they'd start chattering and cheering as if it was the best thing they've ever seen. And they're like that each time. It's amazing. They never get tired. They never get discouraged. They remain upbeat and encouraging.