Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives. Looked after a woman today, 1st baby, came in fully dilated, went on all fours, did as her urge inclined her to in the way of pushing.Head coming out steadily, then big push and head sort of a third of the way out. Asked for the labour suite manager to review the tear as it looked like just the skin of the anus involved.There is an issue and has been for a while between doctors and midwives re.

Of course she will be nil by mouth as she is going to theatre in addition to probably having had nothing to eat all day while in labour!

I was with a woman last week who had a third degree tear.

Later, expected to find small vaginal wall tear – instead found deep tear in wall. (Another midwife suggested that maybe the baby’s shoulder or elbow caught in a smallish tear and enlarged it…) Three points: First: I’ve discussed these experiences with both my supervisor and manager. I seem to recall that a MIDIRS search a year or so ago drew a blank, but I’m wondering if I’ve missed anything. Third: What has been the experience of other members of this list regarding birth in all-fours and trauma?

Most of our women give birth kneeling or on all-fours.

She had to wait 3 hours to go to the obstetric theatre for a spinal and suturing.

She was uncomfortable, bleeding from the wound and dreading the thought of waiting 12 hours or perhaps even more if it is not given high priority (is it? You don’t often get to know long term outcomes but the women (who have such experiences) do seem to be OK postnatally on the ward.

The practice at our hospital is a pudendal block with the repair done in the birthing room.

I had another client who was diagnosed with an molar pregnancy at 20 weeks. Her procedure was done under epidural and I was allowed to be with her for support.

I said just a small push now, wham bam baby, head and body caught in one push and ? But got a co-ordinator who seemed to think I was asking whether it needed suturing at all!!

When I pointed out I was querying 3rd degree, to my horror an SHO (relatively junior doctor) was sent in.

When I asked her, she said she would not consider a c-section for a subsequent birth.