Re: [ozmidwifery] Re Episiotomy

[Marilyn Kleidon]

My understanding of the Hoop Trial was that there was no significant (statistical) difference in physical trauma between "hands on" and "hands off", but, that there was less pain (postpartum) experinced by women in the "hands on" group. While in the USA this was taken to support "hands on". However, since being here, I have been under the impression that the trial was interpreted the other way: to support "hands off".  Maybe not by all.   marilyn ----- Original Message ----- From: Nikki Macfarlane To: [EMAIL PROTECTED] Sent: Thursday, June 12, 2003 5:28 PM Subject: Re: [ozmidwifery] Re Episiotomy I am confused by this discussion so hoping for some clarification! My understanding of the results of the HOOP trial was that it favoured the use of Hands On - a finding that the midwives in the UK were surprised by. I had read summaries that clearer pointed out an improvement in perineal outcomes with a hands on approach. Was there re-analysis carried out that found the opposite to be true? It sounds from this discussion that the HOOP trial is now being said to have favoured hands off. Can someone help?   Nikki Macfarlane Childbirth International www.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas ----- Original Message ----- From: Marilyn Kleidon To: [EMAIL PROTECTED] Sent: Saturday, June 14, 2003 12:43 AM Subject: Re: [ozmidwifery] Re Episiotomy Actually Mary, if you want to get your hands on, the only position you can't is water birth (unless you are in the tub too (joke)) and possibly a deep squat.  We used the deBuy birth stool a lot there and trust me, you can definetly get your hands on. By hands on i am not meaning anything beyond perineal support (which as the article discusses is favoured by US midwives), and a gentle hand on the baby's head (not really doing much). Mum's (mom's) I attended in the USA truly expected this, perineal support especially is promoted in birth literature there. This means the midwife is also in many and varied positions.  I know it isn't usually done here, I don't know for how long it hasn't been done: before or after the Hoop trial?  It will be interesting to see what the outcomes of this study are, especially to see if it leads to practice change. By this  I mean if the study supports "hands off", then will US midwives change their practice? And if it supports "hands on" will Australian and Uk midwives change theirs?  Or will we have to do a repeat study here? Possibly the result will be ambiguous and claim there is no significant difference betweeen practices and so no change will happen anywhere. Interesting that's all.   marilyn ----- Original Message ----- From: Mary Murphy To: [EMAIL PROTECTED] Sent: Thursday, June 12, 2003 5:30 AM Subject: Re: [ozmidwifery] Re Episiotomy Marilyn Wrote.  I must admit after my training in the USA it has been hard to do and I am definetly more "hands on" than "hands off".   I find discussions about hands on and off interesting, given that if a woman is birthing in a pysiological position, (upright squat, hands and knees or kneeling leaning forward), there is nowhere for a midwife's hands to be except in the "catch" position, especially if a woman is birthing in water.  I wonder if all this discussion and trials  would be going on if birth was truly in the hands of women?  MM