October 04, 2004

More on Italian childbirth practises

I learned some more today about the Kristeller manoeuvre for speeding up second stage. This technique, invented by an Italian obstetrician by the name of Kristeller ( I think this is the correct spelling) involves heavy pressure on the top of the uterus to push the baby out. It is usually applied by the midwife and she uses her forearms to press down on the hapless woman’s belly during contractions, as the woman pushes long and hard. A fast birth is the aim.

It is hard to imagine how such a barbaric technique could be invented and then applied, without any reference to the women receiving it. But then I guess Dr Kristeller is a man who of course has no concept of what this might feel like. It is also amazing that midwives would go along with it - perhaps it says a lot about the status and professionalism of Italian midwives.

It was also revealed that in Italy, when a woman enters hospital to give birth, she has to sign a number of consent forms so that any procedures that are felt to be necessary can be performed on her without further discussion. These forms cover everything, except episiotomy - this is considered so standard that it doesn’t even require consent!!! It seems that the Italians have raised routine genital mutilation by professionals to such a ritualised status that its implications, for the women and their own legal position, can be safely ignored. We had a robust discussion about this issue, from a number of perspectives: feminist; medical, legal, psychological, emotional and professional. I can’t see maternity care changing much unless these topics are brought into the open and the very powerful obstetricians are challenged by women (both mothers and midwives) to be accountable for their actions.

It has been an interesting weekend. The group was a mixture of experienced, new and wx student midwives together with some childbirth educators. The only negative remarks on some evaluations stated that the group was not “homogenous”and I wondered what they meant by this. Perhaps they didn’t like the outspoken group members who did tend to dominate, but then perhaps they were unhappy about having their midwifery expertise challenged in front of people who were not midwives, but educators. No group is ever homogenous and mixed groups are usually very stimulating. Midwives need the opportunity to hear from educators and students so that they are exposed to other points of view - without some feedback from the wider population of women they may never hear of the results of their work.

There are certainly very few, if any, opportunities in Italy for midwives to talk to women postnatally - they last time they see them is in the labour ward, lying there with their episiotomy being stitched and their belies sore from being physically attacked during birth. It is a shame, if not scandalous that women’s emotional and psychological needs can be so thoroughly overlooked or ignored - otherwise something would surely have been done by now to stem these physical abuses of women’s bodies.

You always think that things are bad in your own patch until you visit someone else’s.

Posted by andrea at October 04, 2004 02:54 PM

Comments

Hi Andrea,

I once met a midwife and doctor who had worked extensively in remote third world places like Africa,parts of Nepal, PNG etc. They described that extreme fundal pressure being used by village birth attendands to 'get the baby out',
Not surprisingly there was a high maternal and infant mortality rate and from what they described, it sounded as though placental abruption was not uncommon.

Gruesome!!

Regards,

Jeannie Minnis

Posted by: JEANNIE MINNIS on October 6, 2004 07:29 PM