​Recently during a birth, my client commented on how hands off I was. I took that as a huge compliment.  

I've attended many hospital births. At every birth I attended except one, all the doctors were very hands on, stretching vaginal tissues as baby's head came down, reaching hands in to grasp baby by the shoulders to bring baby out, or worse yet, placing both hands on either side of the baby's head and applying traction to pull baby out. These were births where there were no indications the baby needed any help to get out.  

Being hands on, intervening in the physiological process of birth, can have negative impacts. Pulling on a baby's head can cause nerve damage to the shoulders, and/or face. Placing hands in to stretch tissues may actually stress and weaken the tissues compared to letting them stretch gradually around baby's head.  Placing hands in to pull baby out by the shoulders can lead to tearing when there normally wouldn't have been tearing or it may make a tear worse.  

There are times I need to use my hands to help baby navigate its way out. A shoulder could get hung up on the pubic bone, or baby's torso could be larger than the head leading to the need to help baby out. Often in those situations, simple position changes to open the pelvis in different ways are all that is needed to help baby out. It is rare that I actually have to use my hands to help baby. In fact, I have only needed to use my hands to help baby out twice in the births I've attended in my own practice so far.

I firmly believe birth works best when it is not interfered with. I am mindful of this at every birth I attend. I don't want to disrupt physiological birth unless baby lets me know they need help, and then using an intervention that involves my hands is a last resort when other options have not worked. Balancing my knowledge, and intuition with trust in birth helps me keep my hands off unless there truly is a need to use them to help baby.

Can we talk? I think there's a myth that anything that comes up during pregnancy is because of being pregnant or should be handled by your maternity care provider. Pregnancy can bring some typical complaints and discomfort, but not everything that happens during pregnancy is because of being pregnant. Sometimes pregnant women can get sick and it has nothing to do with being pregnant.

My focus and expertise is on pregnancy, labor, birth and postpartum, so everything pregnancy and birth related. As a CPM in Kansas, I have to rely on holistic remedies to bring relief or resolve something. I cannot prescribe medications even if they are necessary to treat an illness that pops up during pregnancy.

If I have a client who has a urinary tract infection that is not resolving with herbal remedies, I will ask them to see their regular doctor. If a am working with a client who has extreme morning sickness that natural treatments aren't able to make manageable, I will encourage her to see a doctor. I have asked a client with heat exhaustion to see the doctor.  She needed IV fluids right away. I have had a client seek care with medical professionals who learned her symptoms were caused by food poisoning. Both these clients needed more help than I could provide. I do not take it lightly that I am asking someone to see a doctor.  If I am asking it is because I'm concerned that something is going on that needs more help than I can offer.

I am thankful that we have doctors, and can avail ourselves of their expertise when needed. I also appreciate when clients understand that we need more help and are willing to see their doctor. Not everything that happens during pregnancy is related to the pregnancy, and sometimes medical help is necessary.
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