Another birth: Sometimes a bit of guidance is OK
Caroline was having her 5th baby. She is a quiet and controlled woman. When discussing past labors at a prenatal appointment, she had said that one of the things that she disliked about her last birth, and that seemed to make it more intense for her, was giving birth on her hands and knees. She didn't like that. I have found that this is a favorite birthing position so I was surprised to hear this. This time, as labor intensified, she lay down on her side rolled towards the bed, half belly lying. I wondered why this worked for Caroline. (I remembered that she had adopted this position which I had never seen before, during a prior birth, giving birth gently and back up out of the bed) Perhaps it was because she could maximize her inward focus and her control. Soon Caroline was pushing involuntarily, but gently. She pushed like this for a while, and fairly soon we saw the telltale peeping of a little dark head blinking at us as she pushed. Slowly, very slowly the size of the blinking head increased at the peaks of her contractions, but breathing in her controlled way, Caroline closed up again and relaxed as each contraction loosened. I kept seeing that blinking head and I kept thinking her baby was going to slide out, but he didn't. We waited. Caroline had done this plenty of times. She didn't need guidance.
But as her baby slid gently back in yet again, I thought "Goodness, maybe a little guidance wouldn't be such a terrible thing". "You could give birth to the head in the next contraction if you allowed yourself to push" I told her. "But I don't want to tear" she responded. "But you are stretching beautifully" I reassured her. So Caroline held her push just a little more and gave birth beautifully over an intact perineum.