Breech birth

Erin - posted on 08/31/2011

On the Aussie OBs thing... they have the same sort of qualifications and training as those elsewhere. They are not perinatologists (that is a different specialty here, same as elsewhere). It's just that our public health system functions as midwife-led care, so only high risk mummas are sent on to OBs. If there are serious complications (fetal abnormalities, maternal comordities like like clotting disorders etc) they will then be sent to the Maternal-Fetal Medicine specialists.



So it's just basically one more step in the chain. The lowest of risk see the midwives. Someone like me (suspected macro), or those with placenta previa, previous c/s or GD,or of advanced maternal age will get punted to the OBs. Anything beyond that goes to the perinatologists.



If you go private, like Jodi, you can choose to see an OB throughout even the lowest risk pregnancy. That system is much the same as in the US.

Tanya - posted on 08/31/2011

Jodi, I never claimed my opinion WAS a professional one! I'm not here as a nurse, I'm here as a mother, a woman, and someone who has taken a huge interest in birth and birth practices in the world.

I'm a NICU, not a L&D nurse, so my professional experience with birth practices is extremely limited. I have zero interest in becoming a L&D nurse, because I don't agree with a lot of things that are done in the obstetrical world. I do see myself becoming a midwife someday though!

Dana - posted on 08/30/2011

Thanks, Mary! That was one of those situations where I was hoping I was recalling everything correctly and wasn't talking out of my ass. Glad to know I wasn't passing on false info as that's one of my biggest pet peeves! :)

Mary - posted on 08/30/2011

Wow - that bugger of a hurricane caused me to miss a lot, didn't it? Not a lot of time to catch up on everything here, but a few thoughts:

First off - that person that most of you think is a "nurse" in the doctor's office probably isn't. Most offices just have med techs; nurses are entirely too expensive to employ in the office setting. Sometimes, a larger practice will employ one RN, who may do things like an initial history, phone triage, and NST's - but they are become more and more rare these days. And just because that woman doesn't correct you when you refer to her as a nurse does not necessarily mean that she is one. Office RN's are becoming rather rare these days; although the hours are great, the pay is substantially lower. If I had gone from my 3 12's a week to a M-F, 9-5 office job, I would have taken a pay cut of over $25, 000 a year, and worked more hours.

Where I worked, nurses did have a lot of autonomy, and our opinions were respected by the MD's. Care of any given patient was a collaborative effort, but at the end of the day, a nurse cannot work outside of physician's orders. As well, the longer you worked there, and the docs, midwives and nurses got to know and be comfortable with each other, the more collaborative the care was. Every nurse and doc is different - and yes, there were a few doc's who pretty much only showed up to "catch" at the end, with a few brief and sporadic visits in between. That didn't mean I could just do whatever the hell I pleased...it did mean that I would call, and suggest or tell them what I thought was needed, and they were usually amenable, since I was the one actually at the bedside with the patient. In general, nurses are not in any way restricted by a fear of liability (we almost never get sued individually, since we don't make enough money), so we are more likely to be candid, as well as an advocate for *your* wishes - at least, the good ones are!

As for the catheter post c-section....the general goal is to get that out ASAP, to minimize the risk of a UTI. Ideally, a young, healthy woman without complications should be able to get out of bed with minimal assistance within 12 hours of surgery. I'm not saying it won't hurt, but it is ideal to both decrease the risk of DVT's (blood clots) as well as to avoid severe gas pains. There typically is a standing order to remove the catheter by 12-24 hours post-op - but again, if there is an issue, it is the job of the nurse to assess this and report to the doctor why the cath might need to stay in longer, or why a specific patient is not yet able to move.

Cathy - posted on 08/30/2011

I wasn't staying in that hole of a hospital any longer than I had to. The minute I got feeling back in my legs I took myself off the the bathroom. The midwives came to check me about an hour later with a lecture on getting me up and helping me to the bathroom. Too late I went already. She was very taken a back since I'd been double dosed with the epidural. It was nice to get one up on them.

Dana - posted on 08/30/2011

Wow, yeah, Emma... he should have made sure you were capable of getting out of bed first.

I guess it depends on policy or whatever you would call it. Here, they want you up and peeing before 24 hours. Or at least where I was in the States. I wish Mary were here, she'd know if that's wide spread or not.



*Edited to add*



And here that would have been the nurse's job. The doctors would have expected her to make sure I'm up and about by that point. So the doctor would have assumed at that point that I was up and capable of peeing on my own.

Alison - posted on 08/29/2011

I'm not a confrontational person at all and I had to argue with the nurses to let my mom and sisters stay in the room with me. I had toxemia and was on medication to keep my blood pressure down. The nurses wanted to turn down the lights and have my family leave so I could relax and take a nap or something. HELLO! My husband is out of town, my water broke unexpectedly 6 wks early, I'm away from my regular doctor living with my parents during the whole out of college no job yet phase, supposed to be moving in 3 days, but yeah I'll totally just relax and dream about butterflies and candyland. I won--then they disappeared and came back to start me on petocin and then came back after my mom had to go convince the doctor (actually 4th year med student being supervised by a doctor) to come check me. I was dilated to a 9 1/2 after 1 1/2 hours of labor and he was like--well it probably still won't be for quite a few hours, but would you like an epidural? I said sure and then like 20 min. later I had a baby. While I was pushing, my sister had to rush up to the bed to tell me to breathe because the nurses gave like NO direction. I don't feel violated or anything, and I actually liked the med student, but my second birth--also with a preemie--was a much better experience. Part of that was because my body was taking things slower--but the doctor also involved me a lot more in decisions, didn't rush anything, slowly increased the petocin instead of full-blown right off the bat like the first hospital, and the nurses were great. Where you have your baby and who assists can make a light and day difference. However, I'm a generally trusting person and I think that most doctors are doing their best in the situation.

Stifler's - posted on 08/29/2011

I hadn't even stood up yet though and he wanted her to take it out. I tried to stand up later that day and the nurse couldn't even get me up she let me go until the next morning and then helped me stand up and took it out. I would have wet myself if they just took it out. The doctor didn't even remember my name lol or remember that I had had surgery at 1155 the night before (which he did) and here he was at like 2PM the next day telling me to get out of bed the nurse was like HAH NOT GONNA HAPPEN.

Dana - posted on 08/29/2011

Very true, Sara!

And I don't want to give the impression that I'd easily dismiss a nurse's opinion. I just wouldn't automatically let it override a Dr.'s orders.



And yes, Sherri, I think you're right. You can't compare our OBs to Australia's OBs. It's different.

It's seems like their OB is actually our perinatologists.

Jodi - posted on 08/29/2011

I went private in Australia when I had my daughter, so I did attend an OB, and he did see me each time. In his offices, however, they had a midwife service, which was great. Most women were able to visit the midwife whenever they chose. I visited a couple of times, but because I was high risk, and did have some concerns during my pregnancy, my doctor requested that I see him.

When it came to delivery, quite honestly, he only came to see me a few times. The midwives managed the entire thing. My OB was on call, and they called him when I was close to delivery. But he missed it, LOL - I delivered so quickly even the midwives didn't expect it to happen. One minute I was 6cm, the next the baby was just there!!

Sara - posted on 08/29/2011

I just want to say that in doctor's offices here in the states, the "nurses" in the offices are not usually RN's, but LPN's or even just medical assistants. The RN's are usually hospital nurses, and there is a big difference between a person with a BSN and a two year or one year degree, in my opinion. So, the "nurses" in the doctor's office I would not usually take their advice over a doctor's but the nurses in the hospital's, at the bedside, I would not as easily dismiss.

Charlie - posted on 08/29/2011

Im not saying there is a difference I am just saying in my experience with the way our system works this is what I have found.

Like I said cant make a comparison because we have totally different systems :)

Sherri - posted on 08/29/2011

@ Feen
They listened to what I wanted out of my birth , encouraged me to move around , talked me through contractions and followed my lead of course offering their opinion while giving me a choice.

they know what they are talking about because thats what they are trained for , that is what they do day in and day out .


This is exactly what my OB does. We don't have midwives here (or any that I personally have even heard of) so really there is no difference between what your midwife does and what our OB does.

Jodi - posted on 08/29/2011

"I think you need to read what I'm saying a bit more closely...now it almost seems like you are just trying to find ways to discredit me, for some reason."

No, not at all, just making it clear that your opinion is not a professional one.

Charlie - posted on 08/29/2011

I loved my midwives and would choose them over a doctor anyday .

They listened to what I wanted out of my birth , encouraged me to move around , talked me through contractions and followed my lead of course offering their opinion while giving me a choice.

In fact the only time you will see an OB is if you are highrisk or at the end of birth , Our midwives take on most of the work during pregnancy and birth , they know what they are talking about because thats what they are trained for , that is what they do day in and day out .

I think for patients in a hospital outside of pregnancy I often got to the nurses for information only because its them who are dealing with the patient day in and day out , they know them more than the doctors seem to do because the doctors really only just pop in for a round once or twice a day ..unless a specialist is needed generally it's the nurses who have more knowledge Ive found .

Then our system may be completely different so its hard to make a comparison really .

Rosie - posted on 08/29/2011

like dana nurses take the blood pressure and pee and stuff before the doc comes in and does their thing. but while in labor, the nurses are the ones that are running the show. every now and then the doctor would poke in check on my progress and then leave. with my last one i didn't even see a doctor after he broke my water up until lucas' head was hanging out of me. the nurses did it all.

they took care of everything afterwards too-after i was sewed back up. i saw the doc once a day in the morning when they were making their rounds. of course everything the nurses did was along with the ideas of the doctor, but they did it all. i have much respect for nurses, they are completely underappreciated.

Sherri - posted on 08/29/2011

Sorry yes in the doctors office the nurse takes your bp and weight but then everything else is strictly with you and the doctor.

Dana - posted on 08/29/2011

Yes, it's very different here Emma. Going to the OB, you see a nurse first who takes your weight, BP asks if you have any concerns and then you see the doctor - that's from beginning to end of the pregnancy.

And yes, Tanya, nurses do know things and sometimes you'll get more info from the nurses. And of course it's good for the future doctors to get along with the nurses BUT, when it comes to actual health care, I prefer to listen to the doctor for the most part. Say in Emma's situation, here doctors and nurses wanted you up on your feet and the catheter out ASAP because it's better for you. So in her case I would have wanted to follow the actual doctor's orders, not the nurse.

Sherri - posted on 08/29/2011

Totally different here Emma. You don't deal with a nurse ever until you're in labor and in a hospital. Here you only deal with your doctor one on one until that point and even then, the nurses don't do anything without the doctors okay and say so. They simply do what the doctors have ordered to be done or not done.

Tanya - posted on 08/29/2011

Haha, totally opposite here, Dana! I've had many parents comment on how if you want to know something, you ask the nurses! :) I love it. The doctors totally respect us. When a new group of med students start, they are told how important it is to get "in" with the nurses, because we know how everything works. Even the seasoned neonatologists look to the nurses for our opinions and recommendations. It's an excellent partnership!

Stifler's - posted on 08/29/2011

Doctors here don't really deal with the pregnant ladies until 30 something weeks unless you choose to go to one. I just went to the midwives there's nothing a doctor can tell you that they can't in my experience. I was quite low risk though but the nurses know which way the baby is lying etc.

Dana - posted on 08/29/2011

Wow, that's wild Emma. There's no way I'd listen to a nurse over a doctor. Unless it was Mary N. ;)
Seriously though, I've met plenty of nurses who don't know up from down or left from right. It's kind of scary. Of course there are doctors who don't always know what's best, they're not without fault but, I'd still listen to my doctor over my nurse in most cases.

Stifler's - posted on 08/29/2011

Nurses here secretly have all the power.

Doctor Zvi: you can get out of bed tonight if you want and we'll take your catheter out etc.
Nurse: It hasn't even been 24 hours...
Him: She'll be right just take it out

He leaves.
Nurse: Yeah nah it hasn't even been 24 hours since your caesar you can keep it in another day.

He also wanted to induce me right on 40 weeks and she said I didn't have to be and to not let him pressure me if I didn't want to and she must have had a go at him because he changed his tune at my next appointment. Nurses are much better than doctors around here.

Tanya - posted on 08/29/2011

Oh yeah, that's VERY different than here! The doctors here write the orders, and make the major decisions, but the nurses really run things. It's the same where I work, in the NICU. The doctors come to us to get info and our opinions on things. Ultimately, they write the orders, and will make the biggest decisions, but when it comes to the day-to-day, we're the ones who know the babies best, so we make the decisions.

Sherri - posted on 08/29/2011

Here it has nothing to do with the nurses it is all the hospitals philosophies. A nurse can not tell you, you have to remain in a bed, Especially since your doctor is there in the hospital with you (or at least mine was) and is the one that okays everything. Nurses have zero authority.

Tanya - posted on 08/29/2011

Some nurses at my hospital are like that, too, Sherri, but it just depends who you get. But it's all on THEIR terms, not the mother's. And we don't have pools, which sucks. I had really wanted a waterbirth, because it's more gentle and calm for the baby. Here, the only way you can have a waterbirth is to be at home.

Sherri - posted on 08/28/2011

Which is exactly a lot of the reasons I would never go with a a midwife Tanya. I don't agree with there philosophies. Also here not saying everywhere they actually encourage you to walk and move around they rarely until you are in transition feel the need to check or monitor you and even then you can be in a tub or have relatively any birth you feel comfortable having. Whether it be on your back, on all fours, in a tub etc. and yes this is in a hospital.

Tanya - posted on 08/28/2011

Erin, you're absolutely right, what we think of as normal in birth these days is actually pretty ABnormal. Reading "Birth" by Tina Cassidy, and "Pushed" by Jennifer Block is pretty eye opening about the whole obstetrical system. As much as I would love to help deliver babies, I couldn't do it as a L&D nurse....I see midwifery in my future!

Tanya - posted on 08/28/2011

Jodi, I don't see what's so confusing. Most of what I am saying is based on my conversations with women online. I mentioned the tv shows because people were saying that they have never seen the stuff I was talking about, which I found hard to believe if they have ever watched a birth show.

I'm not talking about the births of the moms in the NICU. Like I said, I don't usually hear their birth stories, and if I do, it's the Coles Notes version.

I think you need to read what I'm saying a bit more closely...now it almost seems like you are just trying to find ways to discredit me, for some reason.

Minnie - posted on 08/28/2011

Well, clearly, Erin, a woman isn't in a position to be fully informed while in labor. :/

Erin - posted on 08/28/2011

Yeah see, that is an absolute breach of the informed consent process, and should NOT be happening. Women don't lose their right to bodily autonomy just because they are pregnant. Unless the woman is unconscious, or it is a true life or death emergency, it is a violation of that woman's rights.

Stifler's - posted on 08/28/2011

That happened to me too Cathy. They put the gel in and I went back 4 hours later for an exam and the doctor was like... AMNIOHOOK and bursted my waters without warning.

Cathy - posted on 08/28/2011

I was having an internal exam and started having a contraction ... in the middle of the contraction the hospital midwife announced she was going to break my waters to help things along... desperately gasping on gas and air, I was in no position at that moment to object.

Unless life threatening, choices shouldn't be made for a birthing mother without her consent.

Minnie - posted on 08/27/2011

Try being induced with cytotec without being told what drug was being used, it's risks OR the fact that the FDA has contraindicated its use for labor induction.

Erin - posted on 08/27/2011

Yeah Jodi, I can agree that those who have had similar experiences tend to group together. So sometimes, in the online birthy community, it can feel like the negativity is more pervasive than it actually is.



I know in my case, I was just unlucky. My doctor was a delight. He was supportive and honest and I can't imagine him handling my birth the way the on-call doctor did. But then there are also hospital policies and protocols, that even the most well-intentioned and open-minded doctor can't escape.

Jodi - posted on 08/27/2011

Erin, I don't think anyone is denying it happens, but rather questioning that it is at all common, that these ARE extreme examples. This is a case of using reality TV shows, experience only with NICU mothers and online birthing communities, where the extreme cases are going to be obviously more prevalent, as examples of what happens all the time when this simply isn't the case.

Erin - posted on 08/27/2011

Those things Tanya is talking about most certainly do happen. The fact is, it has become so mainstream and routine, that many women don't even question it. They just see it as part of the process. It's not until someone has a really bad experience that they start to look around and realise there is a better way (for them, maybe not for everyone else).

I have heard of women being given episiotomies without, or explicitly against their consent. There was a member on here who was given an IM narcotic for pain relief without her consent. Are these extreme examples? Yes. But they happen.

I had a doctor tell me he was just going to check the baby's position between pushes (found her to be asynclitic). But he kept his hand in there until another ctx came, and had me push against it (I couldn't not push at that point). I did not know he was going to do that, and the pain was excruciating. It was the only time I screamed. I told him to get out, and he didn't. Do I call it birth rape? No, I personally don't. But it was most certainly traumatizing, and I can see how someone else might (especially if they were sexual abuse survivors).

If it hasn't happened to you, I can understand you being skeptical. Nobody wants to think about it, so it is brushed aside as a hysterical post-partum woman with an inaccurate memory of events. And I think that's unfair. Perception is reality, and if a women feels like she was violated, or pressured or bullied, who are we to say she wasn't? Birth is really the last realm of life where women aren't encouraged to stand up for themselves and speak up.

Stifler's - posted on 08/27/2011

I stood up and Logan whooshed out so I cant relate to all these stories I hear of pushing for hours and they make you mobilise here so I can't relate to being on the bed except if there is foetal distress and they want you on the monitor.

Jodi - posted on 08/27/2011

I'm really confused. First you say it's what you see on TV shows, then you say you got your information from and *online birth community*, now you are getting stories from the mothers in NICU (which probably ALSO have a biased view because, let's face it, their baby is in NICU, so the birth was more than likely not the norm anyway). Whatever.......

Tanya - posted on 08/27/2011

Why is that interesting? I don't see births as a NICU nurse, at least not yet. I'm junior, so I'm not a part of the resus team. Even if I was, we either see nothing (we just wait for the baby in the resus room) or we get into the room just as the baby is coming out. We don't see how the whole thing plays out.

And I don't generally probe my moms for details while their babies are in the nursery. Sometimes they will tell me their birth story, and that's fine.

Kate CP - posted on 08/27/2011

Only stories you've HEARD, not the births you've seen as a NICU nurse? Hrm. Interesting.

Tanya - posted on 08/27/2011

Yes, that's true, but my opinions are based mostly on the real stories I have heard from women themselves.

I am skeptical, however, that these births are really going much more smoothly and they are editing MOST of them to look like grand failures of the maternity care system...

Jodi - posted on 08/27/2011

Tanya, aren"t these reality TV shows? Do I really need to say more? It's all in the edit, people, it's all in the edit........

Tanya - posted on 08/27/2011

I have probably heard more than the average person because I talk about birth more than the average person, and because a lot of women who are seeking a better birth are doing so because they had an experience like that...so the concentration of women who have experienced it is higher.

Tanya - posted on 08/27/2011

You don't see the women lying in bed with monitors and IVs attached to them so they can't move, pleading for help that they aren't getting, oxygen shoved on their face because the baby is going into distress, and sometimes being eventually wheeled off for a c-section for "failure to progress"? Because that is what I see MOST on those shows!

I had never heard of birth trauma either, before I started really getting involved with the "birth community" online. It's not something that generally gets talked about in everyday conversation...

Kate CP - posted on 08/27/2011

I've heard of horror stories surrounding birth but they are generally few and far between.

Sherri - posted on 08/27/2011

I a with Jodi have NEVER heard of these things and have seen a baby story it is an awesome show there is nothing on there even relative to what you are describing.

Tanya - posted on 08/27/2011

Well, that stuff didn't happen to me, so I am lucky. But have you ever watched A Baby Story, or Maternity Ward, or One Born Every Minute? It's all over the place!

I have heard absolute horror stories from some women about their births. Some have even started using the term "birth rape". When I first heard that term, I was offended by it, being a rape survivor myself. But, once I actually heard their stories, I realized that "rape" really was an accurate term for it. It's appalling.

The hospital where I live isn't bad, really. But, I would never again have a baby here without a midwife.

Jodi - posted on 08/27/2011

OK, Tanya, I now understand what you are trying to say. Thank you for clarifying.

Personally, I have NEVER even heard of half the stuff you suggest as being forced on someone during childbirth. I have NEVER heard of anyone tied to a bed. NEVER heard of someone required to have a catheter (unless they were having an epidural or c-section), NEVER known anyone having things done against their wishes unless it is life or death.

I sincerely question the health system in which you operate should this be common place. And I am sorry for you.

Tanya - posted on 08/27/2011

I never said that ANY birth that didn't go as planned wasn't "natural". I said that there was nothing "natural" about screaming in pain while you are virtually tied to a bed, unable to move, having things done to you against your wishes. It may be CALLED a "natural birth", but it's not natural for women to birth that way.

It IS natural to experience pain. It's even natural to go a bit crazy during transition, vomit, etc. But to me, "natural" means the woman is able to work WITH her body, and be an active participant in the process.


"Not ideal" doesn't even come close to describing what some women experience during labour. "Traumatic" or "devastating" would be more appropriate for some women.


That's why terms like "unmedicated", "pain med-free", "low intervention/no intervention" are more preferred in a lot of the "birth world". "Natural" is more of an emotional term. There are many women, like me, who had a birth that would be considered "natural" in the mainstream world, but don't call it that, because for US, it wasn't!


Laura, a lot of women who have a lotus birth do indeed consume the placenta! Many women who DON'T do a lotus birth consume the placenta, too! Smoothies or capsules seem to be the most popular options these days. I personally had wanted to encapsulate mine, and am hoping to maybe start doing it for other women as a part-time business!