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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    Gayatri Jagannath-Hall:
    My first baby was a vaginal delivery with no epidural but I was given cervidil and then pitocin to induce labor because I had gone past my due date and my amniotic fluid was low.

    Because I was induced they did not let me push in the position of my choice as I learned in the Lamaze class. I was on my back and my legs were in stirrups and thats how I pushed my baby out. Because of this I had an episiotomy even though I was strongly opposed to it.

    Im pregnant again and hopefully will not need an induction this time. If labor starts on its own and I push in the squatting position, will I still need an episiotomy?

    Was laying on my back the first time around the reason I was given the episiotomy as the baby's head was not coming out? Or do some women just end up with one because the baby's head is too big?

    Will pushing in a squatting position prevent an episiotomy?
    Archived User
    Henci Goer:
    There was no reason that induction should have prevented you from pushing in the position of your choice or that you should have been made to deliver in stirrups and on your back, which is possibly the worst position to push out a baby short of hanging upside down. When you are on your back, the weight of the baby and your uterus compresses the major maternal blood vessel that serves the placenta. Furthermore, anatomically, you are pushing your baby up hill. Nor should birth position affect your need for episiotomy. You were given an episiotomy because that's what your care provider wanted to do. If you do not want an episiotomy, choose a care provider who rarely performs one. In fact, find one who has practices and policies generally more in line with what we know is most likely to result in safe, healthy births. You can find out more about what these are on the Lamaze website at http://www.lamaze.org/default.aspx?tabid=53. If you do go looking for someone better, you can find interview questions by downloading "Having a Baby? Ten Questions to Ask" at http://motherfriendly.org/resources/documents/having_a_baby-english-8_5x11.pdf. As for finding likely candidates, try the Birth Survey at http://thebirthsurvey.org/, a kind of Yelp for doctors and midwives, or see if there is a birth network in your community at http://www.lamaze.org/GetInvolved/BirthNetworks/FindaBirthNetwork/tabid/114/Default.aspx and ask its members. The local doulas can often recommend someone as well.
    Archived User
    Gayatri Jagannath-Hall:
    Thank You !!!

    I did try to fight the episiotomy and being restricted to lying on my back but after being in labor for 9 hrs wasn't in too much of a position to fight. Also I had just taken a painkiller to knock me out a little and was quite delirious.

    When the doc said it was needed to gt the baby out I dint put up a fight.,.but I hv switched docs now and will definitely present him with these questions..

    Also I plan on hiring a doula this time..
    Archived User
    Henci Goer:
    I hope you did not take my post as a criticism of your efforts. It's hard to imagine any woman would be able to act assertively on her own behalf when in the throes of late labor, under the influence of medication, and with a doctor telling her she had to obey orders or her baby was at risk. That is why it is s-o-o-o important to chose a care provider who practices "optimal care" and a place of birth that supports it. "Optimal care" is a concept developed by the American College of Nurse Midwives and is roughly defined as care likely to produce the best outcomes with the least use of medical interventions given the woman's individual case. This model of care should be the norm, and it is shameful that women wanting it have to search hard to find it or fight to obtain it.
    Archived User
    Gayatri Jagannath-Hall:
    I did not take it as a criticism and I completely agree with you.. It was hard to fight and argue with the doctor as I was pushing so I went along with what she thought best and convenient to her. This time around though, I will be more prepared..

    All Times America/New_York

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