Saturday, February 14, 2009

Mirrors, stools and other birth gadgetry

As I have read blogs of other midwives, I have found that some of the issues they are writing about remind me of what we used to do years ago, that I have dropped from my midwifery practice.

Today I want to reflect on mirrors, and birth stools. Another such topic, for another day, is psychoprophylaxis breathing routines, and other strategies that I was introduced to in the early 1970s; firstly as a midwifery student and then as a mother to be in the Lamaze childbirth classes.

I don't use mirrors at all. I don’t have one in my kit, and a mirror is not on the list I ask mothers to look at in preparation for birth. I think they are one of those active childbirth gadgets from the 70s and 80s that we should move on from.

My reason for this belief is very personal - I found the mirror a hinderance rather than a help, and I think I now know why. When I was giving birth to my first 3 children (in 73,75,&77), I lived in Michigan USA. As the birth became imminent I was put on a 'delivery table' in an operating room; my hands were strapped down with velcro so that I wouldn't contaminate a sterile field (as if there was one!), and someone held a *mirror* so that I could see how I was going once the head was on view. And, doing as instructed, I pushed with all my (considerable) might, got petichial haemorrhages in my eyes and on my chest, and tore my perineum - as you do.

It was not until years later, as I began to assimilate the knowledge of brain activity and intuitive processes, that I remembered the mirror. This was a shock to me at the time (I had recently graduated as a midwife, so of course I had held mirrors too). Using a mirror requires complex neocortical brain activity, as you become aware of the reverse image a mirror gives. The very part of the brain that needs to be kept quiet is stimulated. I have come to the conclusion that if people really want to use mirrors they should try using them for practice while the engage in other activities in the generative region, and see what happens.

I now encourage mothers, if they are unsure, to put their hand on their baby to gauge how much head is there, and just how much push they need to keep the baby moving. The touch sensation, by which we feel our own labia, and we feel that ‘other’ (ie not self) is a profound sensation. I don’t understand brain physiology very well, but I think the link formed in our minds by that sort of touch is very different from the link initiated by sight that is reversed.

Why did our Creator make our bodies to give birth out of sight? Perhaps we don’t need the help of vision for the job we need to do. I think if we were meant to see our births we would have been made with extendable eyes or much more flexible backs or something like that.

I came across discussion about birth stools at This midwife is setting up her practice, and she notes “I'm having a hard time deciding which birth stool to purchase. I want one that doesn't inhibit the sacrum, which is harder to find than you'd think.”
There are a number of comments to the blog; mostly giving their opinions about the best type of birth stool. One respondent, a midwife educator Sarah Stewart from New Zealand wrote “I have had women who had had nasty anterior tears using birth stools so I tend to encourage women into other positions like kneeling. Is that a general trend or just peculiar to me?”

I haven't used birth stools for years now. The idea of the birth stool seems to be linked to closely managed second stage, with the midwife pondering the perineum and directing the pushing. I have also seen tearing and bruising and nasty haemorrhoids after birth stool second stages. Like Sarah, I think kneeling is often preferable to sitting, and many women like waterbirth so no other support needed (and it's likely that noone sees the birth). I encourage the mother to guide her baby's birth by keeping her hand on the head as it emerges, so that her pushing is appropriate to the baby's movement. Occasionally a couple of good pushes sitting on the toilet gets the baby moving in the right direction.

I remember the days (and nights), in the late 80s and early 90s, when I was working in hospital birth suites – St Georges first, then Mitcham Private. Birth stools were in use, and as I read current literature and reflected on my midwifery experiences I developed a practice of encouraging the mother to move from one position to another in second stage. I felt that by changing from sitting to kneeling; by intentionally moving the pelvis as a belly dancer does; the mother is able to rock the baby’s head slightly, and release any muscle tension, which can achieve progress. When I was with a mother who was struggling with progress in second stage, I looked for several positions that she was willing to use, in sequence. The birth stool may have been one of those positions, used for only 2 or 3 contractions at a time.

The birth stool has been in various cultures for many years. But is it not just another way of containing or ‘confining’ the birthing woman? The freedom to find a position when the birth becomes imminent is a key to active birthing. Does the presence of a birth stool not subtly suggest to the labouring woman that she ought to use it?


Rachael said...

I just don't see the need for a gadget such as a birthing stool. With my third baby's birth (second homebirth), I laboured in a ridiculous position, sitting, leaning back, on the edge of my couch. There was no way I could have birthed in that position...intuitively I knew that once I turned on my knees the baby would come.

I was just delaying the inevitable really...and sure enough when I was brave enough to change position, she came in a few pushes!

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