Interventions that make no sense at all!

I’ve recently had a client have a successful Vaginal Birth After Caesarean (VBAC) in the public hospital setting. Her labour and birth was a demonstration of strength, determination and courage. We sterted out at home in early labour, then transferred to hospital when she wanted to.

At hospital, while I viagra in canada pharmacy wasnt in the room, the Dr examined her, to find she was 5cm dilated, the cervix was thin and baby’s head was low in her pelvis, which were all good signs. Without properly consenting my client, he performed an artificial rupture of her membranes (ARM) without discussing the risks and benefits of the procedure. I was FURIOUS!

My client then proceeded to have contractions which she stated were ’20 times stronger’ than the ones she had been having. She couldn’t cope anywhere

near as well as she had been coping, and she was requesting analgesia.

So what was the indication to perform an ARM? On discussion with the midwife in charge, there was no indication, and she couldn’t understand why he had performed an ARM either. In buy cialis online canada pharmacy fact, most hospitals won’t augment women wanting VBAC as in some literature the risks associated with severe complications such as uterine rupture appear more common in women who’s labours are augmented ( After seeing my client going from a woman in labour, coping well to a woman very distressed, I feared what might come next – an epidural!

Thankfully my client was prepared to work with her team and work very hard and avoided an epidural, but what was to come next (1.5 hrs after the ARM) also made no sense to me. The hospital would only ‘allow’ my client 1 hour to actively push in the second stage of labour! What they recommended was for my client to ‘do her own thing’ for an hour, then she needed to commence ‘directed pushing’. Directed pushing in a women vipps online pharmacy canada wanting VBAC? This recommendation defies all logic. So a woman pushing in a way that does not work with the way her body is telling her to push is less risky? I don’t think so! This simply makes no sense at all! AND in fact, it sound very risky!

So after the hour of my client being ‘allowed’ to do her own thing, baby descending nicely, but not born yet, the pressure came, and in the end I suggested my client just say ‘no’ as there was no indication to push any differently. Her baby’s heart rate was fine, and now my client was coping better than ever since the cervix had fully dilated. There was also slow and steady descent of her baby’s head and her baby’s head was on view. Crowning took a while, but all that time, all was well with Mother and baby. Medical staff were hovering, and I could hear the conversation in the backbround of the need for an episiotomy only because of time, not for fetal distress and not for any other indication other than the clock…!

My client had a natural birth this time, of a baby over 4kg. She had a small tear that has healed very well and she feels very well in her early post natal recovery. She defied the odds really, avoiding an epidural, directed pushing and episiotomy to achieve a safe and healthy VBAC of her son.

So where did the time constraints of 1 hour physiological pushing for a VBAC come from, especially buy levitra online if her pushing, or active stage is physiological and especially if all is well with Mother and baby? I’ve just looked up Queensland Health guidelines, and their guidelines recommend second stage should not exceed 2 hours, one hour for passive descent, and one hour of active pushing. Thier guidelines are based on the Women’s Health guidelines which are based on ‘expert canadian pharmacy exam prep opinion guidelines’ not clinical evidence.

Surely it would make sense that ‘directed pushing’ might cause more damage than good. I think we should be leaving pushing to the experts – the women themselves…

References can be provided on request



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