Midwives vs OB's

Reading on another blog recently, I came across an interesting comment by a physician.  He wrote that he    disagrees with a statement he frequently hears, that "midwifery care is superior care”.  Well, I’m here as a    midwife to tell you that midwifery care is not  superior care.

• Midwives are not as highly educated as physicians.  Regardless of what type of midwife you might see, she will not have an education equivalent to that of an OB, who has gone to four years of college, four years of medical school, and at least an additional four years of residency.
• Midwives cannot perform certain procedures that an OB can perform.  Some examples would be cesarean section, gynecological surgery, and forceps deliveries.
• OBs, by virtue of their more comprehensive education, have greater in-depth knowledge of complications of pregnancy and birth.

After hearing this, you might be thinking, “An OB is definitely the best choice then, for prenatal care.”  But let me share with you  what I see as the best features of midwifery care:

• Midwives listen more.  While there are many OBs who are good listeners, they generally have a much tighter schedule than midwives, on average allowing only 5-10 minutes per prenatal visit.  Contrast this with the 30-60 minutes a midwife allows.  The greater time at a midwife visit permits both parties to develop a real relationship.   Listening also allows midwives to pinpoint when things aren’t going right, as in this experience related by a midwife friend of mine:

“I was approached by a woman in my community who was receiving prenatal care from a local OB.  She asked for a consultation, and told me she was greatly concerned about symptoms of intense itching that she kept experiencing.  The itching was so severe that she was scratching in her sleep until her skin bled.  She’d gone to her OB several times, and each time he told her not to worry, that she had something called PUPPs, and it would go away when the baby was born.  He finally told her to stop calling him about the itching, because nothing could be done for it.  I didn’t have any knowledge about her problem that the OB didn’t have, and in fact, I had no idea what could be wrong.  But I listened carefully to her concerns, and she was worried that something more serious was wrong.  She told me she’d had hepatitis A as  a child, and wondered if this could be related?  I had no idea!  But I told her I would do some research.  I studied in my Williams Obstetrics, and read about a condition called obstetric hepatosis, which could cause intense itching, elevated liver enzymes, and in extreme cases, stillbirth.  I  ordered some blood tests for her, and sure enough, her liver enzymes were elevated.  I copied the pages from the textbook and the lab reports and gave them to the woman, who by now had decided she wanted a home birth with me.  When she took the information to her doctor, he looked at it, diagnosed her with obstetric hepatosis and told her that her condition was too high risk to be managed by only a midwife.  I did not have any special knowledge that I used, but I did use my ability to listen to this woman and trust her intuition that something was wrong, and then I searched until I found the answer.”

• Midwives talk more. How could talking more be a good thing?  Let me share an experience that is representative of a situation I encounter at least once a month.  A woman came for her first prenatal visit, accompanied by a friend.  At the first visit, I normally go over all the tests she will be offered during the pregnancy, give her information on the risks and benefits, and let her know that she has the right to either accept the test or decline it, and her choice will not affect our care of her.  The woman’s friend kept asking me questions about the glucose test, the quad screen, and the group B strep test.  As they were leaving, she told me, “I had all those tests done during my pregnancy, but I never knew why.  My doctor only told me they were required and nothing more.  I learned more here in one hour than I learned my entire pregnancy with my OB!”  While I don’t have more knowledge than an OB, all the knowledge in the world does little good if it is not shared with the woman who will be the recipient of it.  It is a simple thing to explain risks and benefits of procedures, and ask the woman what her thoughts and questions are.  Another woman came to my office asking me to accept her as a transfer patient, three days before her due date!  I don’t mind taking transfer patients at any time, but I sensed she was not really seeking midwifery care, but just frustrated with her doctor.  I asked some questions, and she revealed that she was tired of being pregnant and wanted her doctor to induce her.  She was upset that he would not discuss it with her, but just said “NO”.  I spent half and hour with her, explaining the risks of induction, the benefit of letting labor start on its own, and reassuring her that she had the strength to wait out these last few days of pregnancy.  She was so appreciative as she left, hugging me, and thanking me for taking the time to explain to her the things her doctor never did.
• Midwives more often do nothing. This doesn’t sound like an attribute until you realize that many wise midwives and physicians have said the hardest thing to learn is the art of sitting on your hands.  The temptation to intervene and “help” the laboring woman with her work is sometimes overwhelming.  Midwives often do nothing more than simply be present.  That presence can be life-saving, as I have had multiple experiences where I was working in a hospital setting, and something I noticed because of being with the woman continually during labor tipped me off to the fact that there was a problem.  I’ve delivered many babies by myself in the hospital because the nurses were out of the room and the baby came before they could respond to the call light.  Although many physicians bristle at the notion that midwives are experts in normal birth, just ask one if they have ever sat through an entire labor with a woman, from start to finish.  So far, I have yet to meet an OB who has ever done this.  An ‘aha’ moment occurred for me when I watched Ricki Lake’s DVD, The Business of Being Born. Three resident OB physicians from Columbia University were being interviewed, and were asked how often they saw a normal birth occur.  The three looked at each other blankly, and finally one resident admitted, “Never”.   An experienced midwife has observed normal labor in its entirety so frequently, that if labor becomes complicated, she will pick up quickly on subtle indications that all is not well.  As I often tell my students, it’s impossible to learn every possible complication and condition.  It’s much more important to know what is normal–backwards and forwards–so that when you see something that’s NOT normal, you will know right away and can get appropriate consultation in a timely manner.

It all boils down to the fact that midwives do NOT give superior care.  They give different care. As long as we persist in drawing a line in the sand, and each camp thinking they are better than the other, we can’t give optimal care to the people who really matter the most–the women we serve.   A recent editorial in the  Journal of Family Practice stressed the need to work together, rather than compete.  I can’t compete with what an OB does best, but I don’t think most OBs can compete with what I do best.  We each excel in our own area.

Over two hundred years ago, Dr. Benjamin Rush, a physician (Rush Medical School is named after him) and signer of the Declaration of Independence, had this to say about competition among health care providers:

“The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic. … Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers.”¹

It is high time we recognize the unique abilities we each bring to the table, and work together to build respect among all of us, so we can offer the best of care to women and their babies.

1.  The Wellness Directory of Minnesota.  The history of medicine.  Retrieved 12/13/10 from:  http://www.mnwelldir.org/docs/history/history03.htm

http://www.themidwifenextdoor.com/?p=1320

Women Speak Out About What's Gone Wrong with the United States Birthing System

"Women die in childbirth as a result of systemic failures including: barriers to accessing care, inadequate, neglectful or discriminatory care, and overuse of risky interventions like inducing labor and delivering via cesarean section." -- Amnesty International 

For many of us who haven't yet been through childbirth, there's an image we have of what it's like: A woman is rushed to the hospital in a taxi; she gets put in a wheelchair and is rolled down the hallway in dire emergency; then we see her screaming, and yelling in pain and then... there's the baby.

Sadly, this is the image that a lot of television shows have put into our minds, and have led many of us to believe: Birth is scary. Birth is dangerous. And it might be better if we just numb out through the whole experience.

Because so many women don't have an image of what a natural, empowered birth looks like, there is a lot of fear surrounding the act giving birth. Accordingly, the majority of women give their inner authority over to doctors in their birth process. They trust the doctors more than themselves. The problem with this is that many women aren't aware that the majority of her doctor's medical decisions are being made today for monetary and legal reasons, and not necessarily for the good of her and her baby.

Here is the reality: Hospitals are businesses. They want those beds filled and emptied. They aren't really interested in having women with long labors hanging around. And there is something else you should know: Having a baby in a hospital might not be as safe as you thought.

Did you know that the United States has the second worst newborn death rate in the developed world... and one of the highest maternal mortality rates among all industrialized countries?

You can go to any other developed country in the world, and you will find that they are losing fewer women and fewer babies around the time of birth. The important thing to know here is that in these countries, midwives are attending 70 to 80 percent of the births (doctors are there for the small percentage that have complications). In the United States, midwives attend less than 8 percent of births.

Why is this number so low?

"I've interviewed a lot of nurse midwives and I've noticed that as soon as their practice reaches over 30 percent of the women in a certain hospital, the doctor will start firing them because that's too much competition," said medical anthropologist Robbie Davis-Floyd, PhD, in an interview for the documentary The Business of Being Born.

Hmmmm... interesting.

The common way to have birth now is be Cesarean section. Today in the United States, the Cesarean section rate is at an all-time high. Since 1996 the C-section rate has risen 50 percent, according to the National Center for Health Statistics.

Today one out of every three babies comes into this world by C-section.

This seems like a crazy statistic. What is really going on here?

Marsden Wagner, M.D., former director of Women's and Children's Health at the World Health Organization, gave his opinion in an interview for The Business of Being Born: "A Cesarean is extremely doctor-friendly, because instead of having a woman in labor for an average of 12 hours, 7 days a week. It's 20 minutes, and I'll be home for dinner."

Many women come to the hospital with a plan for a natural birth, but all too often their birth plan changes very quickly based on a doctor's decision (that is not necessarily based on any real complication). For example, one friend of mine had written a birth plan with her doctor. She would be having a natural, vaginal birth at St. John's Health Center in in Santa Monica, California. On the day of my friend's birth, her doctor did not show up. So my friend was then under the charge of another doctor. This doctor decided that instead of the natural birth my friend had wanted, she should have a C-section. His reason: she was taking too long in labor.

But the doctor forbade my friend from squatting and getting on all fours (apparently against hospital policy), even though it felt so good for her and it opened up her pelvis. (FYI: When he left the room, she went ahead and squatted anyway.) My friend knew she could give birth naturally. She felt deep inside that she had the strength and power to do this. She trusted herself. But the doctor kept insisting on a C-section.

After fighting off some medical interventions that the doctor was insisting on (one of these was the "fetal probe"), and a lot of eye rolling and shaming from the hospital staff in the process, her baby was born. While my friend was happy as can be about her new baby girl, she explained to me: "The birth was something that should have been beautiful, but degenerated into something that wasn't."

As Nadine Goodman, Public Health Specialist, has put it: "What the medical profession has done over the past 40, 50 years is convince the vast majority of women that they don't know how to birth."

I have heard too many stories from friends and family members where the hospital told them that they were open to the natural birth they wanted, but then the reality was so different. First came the Pitocin to speed up the labor, then the epidural to dull the pain from the strong contractions caused by the Pitocin, and then the C-section "for the safety of the baby."

"We need to make sure that we reduce the overuse of interventions that are not always necessary, like C-sections, and increase access to the care that we know is good for mothers and babies, like labor support." -- Maureen Corry, executive director of Childbirth Connection

As Dr. Eden Fromberg, OB/GYN, has admitted in an interview: "There was a doctor who used to train me who said, 'They can never fault you if you just section them. Just section them.'" In other words, the current thinking in the medical world is: avoid being sued at all costs.

"There's the prevailing sense among doctors that you don't get sued for the C-section you do, only the ones you don't," said Nan Strauss, a maternal health researcher for Amnesty International, quoted in The New York Times. Amnesty International published a report earlier this year declaring the country in the midst of a crisis in maternal health care.

The reality is that once the hospital starts with an intervention, it becomes a domino effect. They say: Thank God we were able to do all of these interventions to save your baby. But, as Eugene Declerqc, Ph.D., Professor of Maternal and Fetal Health at Boston University School of Public Health has said
.... the fact of the matter is if they didn't start the cascading of interventions, none of the rest would have been necessary.

[By the way, putting a woman flat on her back for giving birth literally makes her pelvis smaller and makes it much more difficult for her to use her stomach muscles to push. The result: It is much more likely that she will need an episiotomy and a vacuum or forceps will be used to deliver the baby.]

Negotiating their way through the hospital environment is a power struggle that many women aren't interested in, so they are choosing to have their babies at home.

"For most women who are having a normal, healthy pregnancy, it can be safer to have a home birth," saidCecily Miller, prenatal and perinatal specialist living in Los Angeles, in an interview with me.

When I asked Ms. Miller to tell me more about the benefits of a home birth for expectant moms, here is what she told me:

"Giving birth is a rite of passage. It is an initiation into motherhood. If we want an empowered initiation where women are honored in the female body, and we are ushering in new life to the society, then women need to feel safe in their birth process... Giving birth is the most intimate experience we can imagine. And how we make love is how we want to give birth."

Cecily explained to me that the qualities of making love and the qualities of the environment -- dim lights, private space, intimate space -- is the same conducive environment for birth. It should be a place where a woman feels she can be herself, which, as Cecily explained, is usually at home.

Sure makes sense to me.

When a woman is at home she can groan and make natural sounds (these sounds actually open up her pelvis); she can eat when we she needs to; rest when she needs to; have privacy when she needs to; kiss her partner, be held; walk around, look out at nature, and basically do what feels best for her. "The comforts of home afford a woman her ground, her roots... and then the body will naturally in most cases, open, and will give birth," explained Cecily.

A friend of mine who had both of her babies at home described just that: "The best thing about giving birth at home was that I never had to leave my home. I could be rooted there. My husband brought me smoothies. I could hop in the tub when I wanted to. I could get on all fours. Then after the birth, I was exhausted and all I wanted to do was curl up with my baby, and that is exactly what I did."

When I asked her about her confidence level for her home birth, she explained to me that through her birth classes and her yoga practice she felt prepared. "Deep breathing, steady focus, determination, and a desire to do it myself helped me bring my babies into the world." she said. My friend explained that when the time came, she allowed her body to take over and do the rest. "I really do believe we are all strong women. I think the whole hospital realm has brainwashed women to think: 'Oh you can't handle this, so we will give you drugs.' It's pretty sad." Agreed. She added: "While giving birth was the most challenging thing I've done in my life, having my children at home was comforting, inspiring and empowering."

While a home birth might not be for every woman, it's my hope that more women will consider it as an alternative to the institutionalized and currently over-medicalized environment of the hospital. As Cara Muhlhahn, a Certified Nurse Midwife in practice for more than 10 years, has said: A home birth gives the power back to the woman.

To join an online community of women sharing information, advice and experiences about home births and natural childbirth choices, please visitwww.mybestbirth.com.

To learn more about the current situation in hospitals, please see the documentary film, The Business of Being Born

Tabby Biddle

Writer/Reporter dedicated to amplifying the voices of women and girls

Rest!

The Undervalued Therapeutic Power of Rest

Posted on August 20, 2009 by gloria

I developed very sore nipples when my youngest daughter (now 28 years old) was about 8 months old. I was working as a midwife at the time and I was completely perplexed and dismayed to be having sore nipples for, what I thought was, no reason at all. I called the La Leche League to see if they had any ideas about cause or cure and the first response on the other end of the phone was “Have you been getting your rest?” Oh, how I hated those words. . . I wanted a much fancier diagnosis than “you’re tired, dear”. The truth was that I’d just come off a very long birth and had been up two nights in a row. I was rushing around trying to pull my own household together and do postpartum care for the new family, too. That LaLeche League Leader gave me such a gift by causing me to pause and see that I wasn’t taking care of myself and my nipples were a first alert that things were falling apart.

I notice that my clients have the same dismayed reaction when I bring up rest. Isn’t there another way? Isn’t it possible to have those 3 birthday parties I have scheduled for my 4 year old? Can’t I pick someone up at the airport, go to the library and cook dinner for six in my first week after giving birth? Whaaaaaaaaa.

We live in a culture that has no value or respect for rest. If you’re resting, you’re lazy and incorrigible. We have been raised on Tampax ads that say “Go play tennis, golf and volleyball when you’re having your moon time. An active woman is an attractive woman.” I love the Orthodox Jewish practice of giving women a bed of their own from when their period starts to 12 days later and arranging a complete day of rest from all household duties on Saturday. We would all be well advised to adopt these customs.

Some of the problems that are cured by rest in bed:
-breast problems of all kinds in nursing mothers
-heavy or prolonged vaginal bleeding in post partum or perimenopause
-general crabbiness or depression

For building up milk production, go to bed with the baby for 24 hours. Mother should wear only panties, baby only a diaper. A tray with fluids, magazines and flowers beside the bed for the mother and all diaper changing needs for the baby close at hand. Another adult woman in the house brings meals to the mother. After 24 hours of this bed rest, the milk will be abundant. (I’ve had one client who said it didn’t work. When I went through what she had done, it turned out that instead of following these instructions exactly, she went to her cousin’s place for the day and lay on her couch.) No, no, no. The naked skin and privacy are a big part of this “Babymoon” formula. Don’t modify. Probably, when you read this, you thought “This would be a luxury for a new mother.” It’s actually very basic and pays huge dividends for the family and larger community. Some cultures understand this and make sure the new mother is given a 40 day period of rest/care when she has a baby. (interesting: when I just looked on Google images for a photo to go with this post, the first 3 pages of pictures were new mothers and babies ALL sitting up.  The baby in this photo looks about 3 months old.)

I hear many dramatic stories from midwives and nurses about women who had to be operated on after giving birth because they were bleeding heavily and had “retained pieces of placenta” or “retained clots”. My personal experience is that ALL post birth bleeding is remedied by resting in bed. The lochia is red for the first two days, changes to pink and serumy around the third day, and then proceeds to being brownish and quite smelly for about two weeks. If it turns red again after going through the pink and brownish stages, it means the mother is doing too much. She needs to follow the “BabyMoon” lie-in instructions above. Remember, THIS IS NOT A LUXURY, IT’S BASIC. The family needs to be told that, if they don’t help the mother to rest in bed, they will end up visiting her in hospital.
We need to give up the notion of supermom. Do whatever it takes to get your rest time after the birth and then you will be back to your busy life sooner. When women have homebirths, they usually feel so well that they want to get up and “prove” to the world that they can do anything. Be mindful of the Zen maxim “If you have something to prove, you have nothing to discover.” The really smart women don’t even get dressed for weeks after the birth. If you’re all perky in a track suit, people will expect you to run . . . therefore, find the nastiest old nightie possible and wear that to convince family and friends that you need their assistance.

If you can’t figure out how to ask for help in the early weeks with a new baby, photocopy 20 copies of this list and hand out freely.

Rest, high protein meals, and lots of skin to skin time in bed with baby . . . these are the basics of getting motherhood off to a good start.

By: Gloria Lema

The Waiting Game

The Waiting Game: Why Baby Knows Best

October 22, 2010 By Cara Terreri 6 Comments

By Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE

Patience is truly a virtue after 9 long months, especially when you’re a few weeks or days from your due date. The swollen feet, extra pounds and late-night bathroom trips can take their toll. Wouldn’t it be easier to just schedule your baby’s birth and get the show on the road?

Elective induction offers the satisfaction of knowing your baby’s birth date in advance, but it might not go as planned. Sometimes women scheduled for induction are bumped from the hospital agenda because the staff is busy. Plus, induction doubles your risk of cesarean birth. The major risk of elective induction is that your baby may not be ready to be born. Experts agree that a normal pregnancy lasts between 38 and 42 weeks, and research indicates that the baby actually initiates the labor process. Once his lungs are fully mature, he releases a protein that tells his mother’s body that it’s time. A baby born even a few weeks early is at an increased risk for breathing problems, admission to special-care nurseries and breastfeeding difficulties.

Inductions & Interventions

An induction usually requires more interventions than a naturally starting birth. You will need IV fluids and continuous electronic fetal monitoring, making you less mobile. Also, artificial contractions may peak sooner and be more intense than natural ones. You are therefore more likely to request an epidural, which increases your chances of needing forceps or vacuum assistance, developing a fever and/or requiring a cesarean section. Plus, the most common medication used for induction (Pitocin) interferes with the release of hormones that promote birth happening normally and breastfeeding.  

Because of these risks, some hospitals do not offer or limit elective inductions. “It seems that, if we are too cavalier about inducing labor for the convenience of either the mother or the provider, we are ignoring the baby’s essential contribution and asking him to participate even when he is not ready,” says Biddy Fein, CNM, who attends births at Brigham and Women’s Hospital in Boston. “We accept this as necessary when the risks of continuing pregnancy outweigh the benefits. But in all other circumstances, we should be respectful of nature’s plan for the initiation of labor and the exquisite interplay between mother and baby.”

Baby Makes the Date

If there are valid medical reasons for labor induction, your health-care provider will weigh the benefits of immediate delivery versus continuing the pregnancy for the health of your baby. But if you are like the majority of women who have a healthy pregnancy, the safest option for you and your baby is to wait for labor to begin on its own. Your baby may decide to come on his due date (although less than 10 percent of babies do), but you may want to plan for a later date in case your pregnancy does extend to 42 weeks.  

If your pregnancy lasts longer than expected, try not to worry. Continue normal activities and remember that you are giving your baby the best start by allowing him to decide when he is ready to make his grand entrance into the world.

This article was reprinted with permission from Lamaze International and is available on the Lamaze parent resource Web site along with many more helpful tips and advice for pregnancy, birth and parenting.

5 Unnecessary Hospital Procedures

Birth should be an awesome thing with as much focus on making it as easy and safe for you as possible, and of course, as safe as possible for the baby as well.

Today's labor and delivery wards are much more like an assembly line, and some typical L&D staff policies and procedures not only make birth harder and more painful, but can be the very reason for unnecessary medications and c-sections.

Here are the top five myths associated with hospital procedures that change your birth experience.

Myth 1: You need a monitor on your belly the whole time you're in labor.

Fact: You absolutely do not. Intermittent monitoring is shown to be just as effective, and actually allows the woman to focus on things other than her contractions. Consider that women are often made to lie down and stay relatively still with the monitors on as well, and you're put in a position where you have nothing to do but focus on and internalize any pain of contractions.

In fact, constant fetal monitoring often leads to unnecessary concern, and even intervention, including c-sections, so says the American Academy of Family Physicians, not some holistic home birth website, for those of you in doubt. In fact, only monitoring the baby's heartrate and your contractions every 30 minutes during early labor, and every 15 during transition and pushing is the current recommendation, but one that you almost never see actually practiced.

Myth 2: Lying on your back is a good position for pushing.

Fact: It sucks, big time. The only reason women end up on their backs is to make it easier for doctors to get in there. So, really, unless they NEED to be in there, it's a bad move. It's not only shown to reduce the size of the pelvis significantly, but it puts pressure on the vena cava, which reduces blood flow to the baby and your lower body -- why is it not okay during pregnancy, but they tell you to do it for hours on end during labor, and then are surprised at reduced blood flow to the baby?

The National Center for Biotechnology Information states that being upright, in addition to increasing blood flow also makes contractions and labor less painful, faster, easier, with a lot less trauma to the mother's birth canal, minimal to no tearing, and less trauma to the infant as well. It also makes for less postpartum complications, damage to the pelvic floor, incontinence, and in general, a much better, faster, less painful birth.

Also, if you opt for an epidural and can't feel your legs, you can't walk or kneel. So consider that you might not need that if you actually get up off the bed, and that just because you can't feel the pain with an epidural, your baby can, and you will once the drugs wear off. I wish I'd known as much about epidurals as I do now 15 months ago when I had my daughter. I was ashamed of myself for getting it then, but now I really, really wish I hadn't.

So why are 75 percent of births still done with the woman flat on her back? Back to the beginning of this point -- to make it easier for the doctor.

Myth 3: You can't eat or you'll barf it up and aspirate the vomit.

Fact: You wouldn't tell a marathon runner to skip breakfast, would you? Telling a woman about to engage in major physical work not to eat is almost as bad -- except what is at risk here isn't just a race, but two lives. Yes, there has been some concern that with intubation before anesthesia would come vomit, and then aspiration of said vomit.

MedScape discusses a study on the matter that says:

"Aspiration pneumonitis/pneumonia is significantly associated with intubation and ventilation," the study authors conclude. "In modern obstetric practice it is the use of regional anaesthesia, thereby avoiding intubation, rather [than] fasting regimens that is likely to have reduced mortality from aspiration. Although the National Institute for Health and Clinical Excellence has recommended, on the basis of consensus opinion, that women in normal labour may eat/drink in labour, our trial shows that this will not improve their obstetric and neonatal outcomes."

In other words, forcing women not to eat hasn't reduced aspiration -- not shoving tubes down their throats has. In their study, women who ate light meals showed absolutely no difference in anything -- no more vomiting, no more risk than women who were only allowed ice chips or water.

Myth 4: You need to be told when to push.

Fact: Do you need to be told when to poop? You no more need permission and direction to push out your baby than you do to push out a bowel movement. Just as your body uses contractions to move the baby towards the cervix and through it, it moves the baby down the birth canal, too. Your body will tell you what to do. You will feel when you need to push, and you will just work with it. When you feel the need to relax, do it. Push as hard as YOU are comfortable and if someone is yelling to you to push harder or longer than you feel you should, yell at them to shut up.

Pushing to the point of shaking, not breathing (called 'purple pushing' for the color your face turns) and breaking blood vessels in your face is not going to help you. In fact, it can cause the cervix to swell if you're not ready, it can make you exhausted, it can create much more severe tears, and is just a bad idea in general, even according to the World Health Organization.

Drugs can inhibit the feeling of needing to push (or the ability to know if you need to stop), though, but that's a whole 'nother topic all on it's own.

Myth 5: A break in contractions/labor stalling is a bad sign.

Fact: Women can get fully dilated and have the baby ready to go ... and then have a period that has been appropriately nicknamed the "Rest and Be Thankful" stage. It is nature's way of giving you a break after all the work to get your body ready, before the final hurrah. You can also have a break like this earlier in labor as well. Sometimes you can even be in early labor for what ends up being days, often called prodromal labor. We are mammals, first and foremost, and our bodies aren't stupid -- if a woman gets really stressed or really exhausted, often her body will sense that she doesn't have the energy for birth, or deems that it's an unsafe situation and halt labor until mom is rested or calmed. Think of a mother rabbit in labor realizing a predator is nearby -- she NEEDS to get safe before she can birth the babies.

Doctors often start up pictocin here, when the recommended things are anything but that -- squatting, moving around, getting in a bath all are proven safe methods to help the mother relax and get her contractions going in a normal pattern again. In fact, my midwife told me that studies show nipple stimulation and relaxing in water had been shown to be as effective, if not moreso, than pictocin. Considering that pictocin is an artificial chemical designed to mock those from things like nipple contraction, it's not exactly a far leap in logic.

If your labor stalls, don't rush for the meds -- relax, move around, have a light meal for energy, try to take a nap. In and of it's own, it is NOT an emergency