The "what not to do at a birth" department

All right, loyal readers, who can name the (at least) 10 things that are being done wrong in this Monty Python-esque birth scenario? The biggest one is Linda, the midwife, wrenching on the baby’s head before the woman gets her next contraction to turn the shoulders, but there are plenty more. It’s great to use Youtube to practise your skills so that you have a better plan for when you walk into a home with a gutsy, powerful woman like this birthing spontaneously and refusing to allow her husband to call an ambulance.

Don’t be the one to zap her of her power by saying the goofy things that these meddlesome midwives are saying.

23 thoughts on “The "what not to do at a birth" department

  1. Sorry, I’m not a birth professional, just a birth junkie 😉 But I guess I didn’t catch much! What I did notice:

    Dad talking loudly on the phone during a contraction and I believe he said something about calling the ambulance which she didn’t want, which is not supportive!

    Wiping the heck out of the baby…vernix is a good thing!

    The obvious early cord clamping

    Not encouraging mom to nurse right away, not even skin to skin contact!

  2. Very good, Erin, and you get extra points for going first! I don’t blame the father for talking loudly to the person on the other end of the phone, they seemed a bit thick—what part of “my wife is having a baby NOW” weren’t they getting? Of course, she was lucky not to have them there any sooner, heaven knows what they would have done if they’d had more time. Any more submissions?

  3. dear god. the midwife was basically putting traction downward on the head which pushed the head UPWARDS towards the pubic bone. Ugh.

    that is called impatience, not shoulder dystocia. that chin was visible, the head was moving.

  4. besides Erin´s contributions.
    1-It´s annoying when touch baby´s head, and more yet when they are so rough!! and as you said what if the baby turns the face to the other side? and she´s turning the opposite side?

    2-is it necesary to tear the membrane from the baby´s face? I´m not sure, even more with this scary stick.

    3-the towel, instead of give the skin to skin contact.

    4- what about everybody shouting so close from the baby, “it´s a girl!” and every body talking so loud, instead of keep silence and low the light and let baby and mother recognize eachother for the first time.

    5-then the midwife is blowing the baby´s face? what for?

    6-what is the rush to check the baby, she can do it without disturbing the baby and mom. that´s why the baby´s crying. and the weight and size can be done later on

    Thank you Gloria to keep a doula learning

  5. Surely the continual pressing on the mother’s anal sphincter would cause her to tighten, rather than relax, her pelvic floor!

    Also I found myself wishing the mother would just pick up her baby, instead of stroking her cheek and shushing her while she wailed.

  6. Oh pretty baby! Beautiful birth despite unnecessary ridiculousness. Lemme see…why rupture the sack before the babe is born? I don’t get that, don’t see any reason to worry about it until the babe is out but that’s me. Cord cut too early, no reason to worry about that, either. GOOD GOD DON’T PULL ON THE BABY’S HEAD!! I would say ESPECIALLY for sticky shoulders. I don’t have much experience so I couldn’t tell form the video if that was a true distocia or a case of sticky shoulders, but in either case, I would not initially put Mom in McRoberts, I’dve had her stand up. That said, I don’t think that maneuver is WRONG, it’s just not what I would have done in the moment (assuming I have any clue what I’d really do in that situation :P). Can we fire the television announcer? The commentary was really getting on my nerves. Don’t tell mom to push! PLEASE trust that Mom, being in labor and all, will know when to do that! I have to wonder if perhaps being so quick to panic about distocia and start to demand pushing may have actually caused the “problem”? i mean, if mom was left ot her own devices and babe allowed to turn naturally, perhaps there woudlnt have been any sticking to begin with? Hard to say, though and I understand that sometimes you have to do what you think is best in moment.

  7. I hate the pulling on the babys’ head. When Elizabeth was pushing William out it was what the Doc. did. Yanking and pulling on poor little guys head. Arrgh. AND If it’s true shoulder dystocia putting mom on her back is the worst position to put her. The rest of the birth is noise and lots of it. When will people learn to be nice and quiet/respectful when a mom is giving birth?

  8. I also thought it was a bit stupid how the one midwife was explaining about how the baby is going to be funny looking for a few days because her head was “stuck” so long. Im not sure how they edited the video, but it didnt really seem like that long. anyway, why is the midwife blabbering to the mother about how weird looking the baby is when the mom is trying to look at her child for the first time? the mother had to look up and pretend to care!

    and all that noise and chatting and laughing like they’re over for lunch or something! some people just dont know when to keep their mouths shut I guess.

    I didnt quite get why they were discussing an ambulance anyway. it seemed pretty clear that it was a planned homebirth.

  9. First off my last baby was the same size!!! lol I had the same experience with the head it isn’t shoulder dystocia its just hard work to push a almost 12 lb baby out of your body, it takes more then a freaking min. people!!!

    Secondly I am to annoyed to comment on what they did wrong it would be easier to say what they did right which was umm nothing? Poor mother, if only they didn’t show up at all, I am sure that silly man wouldn’t have called anyway, or if he did the ambulance wouldn’t of showed in time, heck they might of done a better job.

  10. “… the midwife has arrived, and as yet, she hasn’t even been able to introduce herself to Doris.” – I would not want a stranger to show up behind me and start shoving on my rear like this lady did. It sounds like they had never even met before.

    And what on earth is up with the white plastic apron?? It’s the same type that butchers over there wear, I kid you not. (I used to live in the UK for a while.)

  11. I feel I really must speak up for these midwives who probably walked in on a situation that wasn’t ideal (imminent birth, father irate, mother in the midst of intense contractions). No that midwife shouldn’t have been pulling on the baby’s head but these are hospital trained midwives who would do the same again in the hospital. When I had a home birth in Glasgow Scotland I was introduced to maybe 6 midwives prenatally, any one of whom might be at the birth if she were on call the night I went into labor. They were all hospital based and practiced midwifery as if homebirth was taking place in the hospital. My husband too was a little irate (nervous red haired Scot) but was quite happy to let the midwives (there were 2 of them) take over. They were a little put off by my wanting to be “left alone to get on with it” but everyone went away to another room for tea and biscuits and husbandly hospitality until baby was ready to be born. I don’t know if they used head traction but it was very commonly used in the maternity hospital where I worked as a NICU nurse in the 90’s. And early cord clamping was practiced across the board I’m afraid (and of course still is). Faced with a true shoulder dystocia I think I too would have Mum change to the McRoberts position if she had already been hands and knees. And finally I believe this video has been edited quite a bit and probably more time elapsed after baby’s head was out than we can see here. Just my $0.02.

  12. Thanks for your input. I would hope, if it’s a teaching film on McRoberts that it hasn’t been edited at all because the timing is very important in true shoulder dystocia. I think it’s an excellent film for showing that,yes, in the excitement of the moment human beings can be all atwitter and say some dumb things. If other midwives can learn from watching this to calm themselves, notice what is normal, remember that birth is as safe as life gets, and take a big breath—that is the value of critiquing the film. NOT to be in judgement of the mws personally because we weren’t there for the whole thing, after all.

  13. Actually, the mom was not in a true hands and knees position. She was more like elbows and knees. According to my midwife, the first course of action should have been to guide her into a true hands and knees, with her back flat and parallel to the ground. Had she been in a different position and experienced the shoulder dystocia, putting her into a true hands and knees position, also known as the Gaskin maneuver, is a quick, safe, and extremely effective way to manage shoulder dystocia. Another option is to attempt to manually dislodge the shoulders by reaching in and pulling the bottom arm free.

    I’ve had shoulder dystocia with two of my children, and both times I was on hands and knees. The midwife with my son was not paying attention and did not realize that he was stuck. She simply noted that it was “taking too long” and that, if I didn’t start making progress soon, she was “going to have to do something.” I freaked out, of course, and gave a mega push, which got him out, but resulted in an “at least third degree” tear from his elbow, which wasn’t caught until my 6 week check up. Needless to say, I did not use that midwife for my third baby.

    With my younger daughter, we had shoulder dystocia again, and again I was already on hands and knees. This midwife was aware of what was going on, however, and when a normal push after a slight position adjustment didn’t free her shoulders, the midwife simply reached in, pulled out her arm, and that was the end of that.

    I would like to note, also, that the tear with my son was never repaired. By the time the former midwife noticed it, it was far too late to stitch it. (I have been advised that it is possible to repair it via outpatient surgery, but that I must wait until I am done having children.) However, because of the care and attention of my current midwife, I did not tear at all with my youngest.

  14. Shoulders dystocia? Really? I have seen a true SD and this was nothing like that at all.Yeah, shoulders were sticky, but mine would be to if I would not get the chance to turn them into the right position.

  15. 1. when a man says his multip wife is having “constant” contractions, less than a minute apart at 1:22 p.m., why are they needing more info to send a mw out? MWs arrive at 1:41 p.m.

    2. first thing they do is get the doppler out—the membranes are intact, the woman is full term, and the baby is going to be born in the next 15 minutes, what is the point of checking the heart tones? Time would be better spent getting the area prepared for birth, getting postpartum tea started, calming the family.

    3. The talk about never delivering a baby in the caul before and asking for an amnihook did not contribute anything.

    4. She has her sterile glove on a piece of gauze with feces on it. You don’t flip the gauze over like that.

    5. Forced rotation of the baby’s head

    6. the mother should not be told to push when she doesn’t have a contraction. The uterus needs a few minutes to regather the fundus. The baby is not turtling up against her bum and there’s no purpling of the head. . they have lots of time to wait.

    7. Pulling directly on the head when they turn her over instead of trying to free the shoulder (if that’s what they think the problem is.)

    8. When baby is handed to mother there’s cloth between them. Baby should be skin to skin.

    9. They clamp the cord quickly and, then, assess the colour and well being of the baby. You’d think they would leave the baby’s oxygen supply alone until they are certain the baby is well. There’s no rush to cut a cord and I’m sure that father would have liked to at least touch and say hello to his baby before having to get engaged in cord cutting.

    10. Saying “after pains are killer” doesn’t really help anything.

    11. What is the rush to weigh her? The woman hasn’t had a chance to even get her breath and the weighing is going on.

    It can be unnerving to walk into a home and catch a baby 15 minutes later. This film is a good reminder to all of us to breathe, relax, tap into the inherent safety of birth, and calm ourselves down so we don’t inflict this fire drill mentality on a birthing woman and her family. One of my favourite midwifery expressions is “It’s not about us.” We can’t say that too much.

  16. i find it ironic that much of this blog calls for midwives to support each other, yet in this post you refer to her as meddlesome and saying goofy things. this film is a good reminder to not judge each other harshly in a public forum, but rather recognize we all struggle some of the time. midwives are usually just doing their best, and care a great deal about doing even better next time.

    while it seems obvious this midwife is not used to helping when the mum is in hands and knees position (her downward traction will NOT deliver an anterior shoulder!) i didn’t see any forced rotation or pulling on the baby’s head. i just saw downward traction. she did pause a few times to wait and see. she did try to communicate throughout the birthing. sure she seemed a little overwhelmed and uptight about documenting times and getting the baby to cry, but i don’t think it’s the end of the world. keep on learning, keep on doing your best.

    and i’m glad to see she didn’t get fussed over sterile gloves!

  17. This is a perfect example of hospital training transplanted into homebirths. A homebirth midwife needs to be trained in HOME births! It is obvious by the rigidity of everything that midwife did that she might as well have been in the hospital attending a women with a epidural. It irks me to no end how often people cry shoulder dystocia. It is not shoulder dystocia if it has only been 30 seconds for heaven’s sake! I was recently at a hospital birth as a doula when the father and I were urgently shoved out of the way literally 1 or 2 seconds after the head was born and “dystocia procedures” were initiated. The baby didn’t even have an opportunity to go through the normal physiological movements of birth. I left feeling like “Gee maybe you guys should go back to your first medical textbook and look up THE CARDINAL MOVEMENTS!”

    Jessica

  18. Pingback: Gloria Lemay » Blog Archive » How Not to catch a baby–#2

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