Rasheeda and everyone,

It seems Rasheeda's questions have stirred a vibrant conversation going right to
the heart of issues in Turkey. I agree with Şebnem and Hakan when saying
that asking kindly for what you want will most likely get good results. It is
true that most doctors in Turkey perform episiotomy routinely, and have been
taught that this is the best way to help prevent tearing. While there is a
mountain of current evidence compiled over the past 20 years to disprove this
(and Joy has kindly provided links to many of it), it is important to keep in
mind that the doctors are acting to the best of their knowledge and with the
best of intentions.

Therefore, as many have already said, it is important to know what you want
going in, ask for it clearly and kindly, and to also be prepared if things do
not go as you had hoped.

I think this is especially important for those living outside of Turkey to keep
in mind when advising women birthing in Turkey. Yes, it is true that commonly
used interventions such as pitocin, IV, fetal heart monitor, rupturing the
membranes, stirrups, fundal pressure, episiotomy, manual removal of the
placenta, routine deep suctioning of infants, and many many more have been
proven in recent years to interfere with the normal progression of labor, impede
maternal and infant bonding and in some cases can cause injury or death to
mother or child. Obviously, it is a good idea to avoid these procedures unless
they are medically necessary.

However, it is important to keep in mind the circumstances under which the birth
is taking place. Here in Turkey, traditional midwifery care is not the norm by
a long shot. Most women do not have access to an adequate childbirth
preparation course and have not seen other women birthing. Birth is highly
medicalized, and in some hospitals, women are lucky to be allowed to have their
husbands with them. One other midwife and myself are the only "doulas" I know
of in all of Turkey, so telling a woman to hire a doula in such a situation is
not very helpful. Most women are birthing here on their own, or if they are
lucky, with their husbands or a female relative. The woman's supporters are not
usually trained, and are "only" there for her emotional support. I think that
it is a lot to ask of these individuals in the heightened emotions of birth to
be expected to keep an eye on and challenge the doctor. The reason women are
birthing in the hospital with a doctor is because they need to feel safe. It is
vital to keep this perspective in mind when advising women about how to proceed.

In countries where these interventions are no longer routine (which are few, I
must add), it was a slow process, with parents leading the way. For this
reason, it is important for parents who have the power to ask for what they
want, work with their doctors in partnership and respect, and perhaps even
provide access to recent medical literature.

But because the process of birth is not merely a medical one, parents must keep
in mind that they are going through extreme emotional and spiritual changes as
well, and the later stages of birth and delivery are so overrun by the ecstatic
birth hormones and excitement over the baby, that it must be acceptable for both
mother and father (and other non-professional supporters) to succumb to this
excitement. Attempting to birth in a hyper-vigilant war zone is not any more
conducive to a healthy birth than an unnecessary episiotomy (vs), and parents
should not feel guilty for not stopping the doctor for doing something which was
essentially out of their control to stop.

In short, parents should ask for and work towards their desires regarding the
birth experience, be as pro-active during their birth as they feel comfortable,
but should also keep in mind that there is a reason they have chosen to birth in
the hospital, and that at some point one has to trust one's doctor, as we have
not all gone to medical school. Be prepared for the unexpected, as this can and
does happen in any birthing environment. And keep in mind that is not the event
itself which is traumatic, but the ways in which our minds perceive it (and
usually the ways in which we blame ourselves for this or that event).

On a final note, one of the most powerful birth experiences I have had was a
couple of months ago at a typical hospital birth. There was pitocin, there was
AROM, there was an epidural. The birth was not at all how the mother or father
had imagined it. But they both maintained their connection to themselves and
one another. They were aware and present for each decision made, even when they
were not entirely happy about making it. They quietly expressed and negotiated
their needs with their doctor, who in turn did her best to honor their requests.
And in the end, the light and energy that filled the room as the parents
welcomed their baby was so tangible, it made me cry, which doesn't happen often.

Your birth experience is what you make of it.

I wish Rasheedah a safe and sacred birth experience, however she births her
child, and thank all of those members who have contributed their thoughts and
advice.

Julia

--- In naturalbirthturkey@yahoogroups.com, Joy Jones <pregnancydiet@...> wrote:
>
> Dear Rasheedah,
>
> I would encourage you to do whatever you can to avoid an episiotomy.
> Not only does the use of episiotomy often result in an additional 200cc
> of blood loss, but it also can cause unnecessary pain which makes
> sexual activity more difficult for many months after the birth.
>
> Also, contrary to what you may be told by those there in the Turkish
> medical system who support the use of episiotomy, a natural 1st to 2nd
> degree tear heals much faster and hurts much less than an episiotomy
> does.
>
> Also contrary to beliefs by those who believe in using episiotomies,
> 3rd and 4th degree tears are NOT prevented by the use of episiotomies.
> In fact, those kinds of tears are much MORE likely when an episiotomy
> has been used.
>
> The issue of episiotomy is not a minor one, in my opinion. I suggest
> that you have one person there, hopefully an experienced doula, whose
> job it is to watch for the doctor's hands and scissors at all times,
> but especially at that point in labor, so that no episiotomy is done.
> Otherwise, it can be done SO quickly that it will be done before anyone
> has a chance to object. If they see that one is about to be done, they
> can gently hold the doctor's hand by the wrist (behind the sterile
> glove, so as to not break his sterile field), and say to you, "The
> doctor is about to do an episiotomy. Do you want an episiotomy?" When
> you say "No", and the father can re-iterate "No, we definitely do not
> want an episiotomy", and the doula can turn to the doctor and say "The
> mother and her husband do not want an episiotomy." Then the mother and
> father can even suggest that they sign whatever the doctor might like
> for them to sign as a legal waiver so that he is not liable in any way
> if he does not do an episiotomy.
>
> Here are some resources which might be useful for you as you try to
> negotiate for your preferences with your care-givers.
>
> http://www.mothering.com/saying-no-episiotomy-getting-through-labor-
> and-delivery-one-piece-0
>
> http://www.sheilakitzinger.com/Research.htm#Episiotomy%20Research
>
> http://www.naturalchildbirth.org/natural/resources/labor/labor07.htm
>
> http://www.naturalchildbirth.org/natural/resources/labor/labor05.htm
>
> http://www.naturalchildbirth.org/natural/resources/labor/labor03.htm
>
> http://www.midwiferytoday.com/enews/enews1005.asp#main
>
> http://www.midwiferytoday.com/enews/enews0125.asp
>
> http://www.midwiferytoday.com/search/
> default.asp?query=episiotomy&x=21&y=8
>
> May you have much success in having a natural childbirth and a healthy
> labor and baby in this context.
>
> Best wishes,
> Joy
> (a nurse/midwife's assistant/former doula/former childbirth educator)
> http://home.mindspring.com/~djsnjones/
>
> On Wednesday, June 24, 2009, at 03:25 PM, Tamahine Alemdar wrote:
>
> >
> >
> > Dear Rasheedah,
> > i,m sure we are all wishing you good luck for your birth! Please let
> > us know how things go.
> >
> > Much encouragement
> > Tamahine
> >
> >
> <image.tiff>
> >
> > To: naturalbirthturkey@yahoogroups.com
> > From: hakancoker@...
> > Date: Tue, 23 Jun 2009 17:19:34 +0300
> > Subject: Re: [naturalbirthturkey] Re: living in Mugla - wanting
> > natural birth, no circ, etc...Help! :-)
> >
> >
> >
> > I think you might leave the rest of the talk to that day. ASs Serbnem
> > wrote to you, If you are polite and determined about your preferences,
> > I am sure they will try to help you.
> >
> > The most important think will be emotional and pysical support during
> > the labor. Who will be there to support you for these? Will she be
> > enough experienced to do the negotiation between the health care
> > providers?
> >
> > These are all important issues waiting for you.
> >
> > Best wishes in your labor. A healty nice babay will arrive, dont
> > worry...
> >
> > Hakan
> >
> >
> >
> > ----- Original Message -----
> > From: Rasheedah
> > To: naturalbirthturkey@yahoogroups.com
> > Sent: Tuesday, June 23, 2009 1:43 PM
> > Subject: [naturalbirthturkey] Re: living in Mugla - wanting natural
> > birth, no circ, etc...Help! :-)
> >
> > Dr. Hakan Bey,
> >
> > Thank you so much for your words of advice. You actually cleared up
> > some confusion we were having about our doctor who has both a private
> > and public practice. We were seeing him at the public hospital and
> > wondering why he wouldn't be attending our birth.
> >
> > I have to say that my husband and I were disappointed to learn that it
> > will be so difficult to avoid the episiotomy but from hearing the way
> > my GYN and sister-in-law (who was trained as a nurse) spoke about it,
> > I was beginning to get that feeling. We met with the nurse midwives
> > once before and they seemed very sweet and helpful - which was
> > comforting to me. We are wondering if it might be worth it to meet
> > with them once more to ask more questions or if it is better to simply
> > talk with them when we arrive.
> >
> > Thank you again for your thoughts and advice. Should we begin this
> > process again, we would know where to look!
> >
> > Thanks so much,
> > Rasheedah
> >
> > --- In naturalbirthturkey@yahoogroups.com, Op.Dr.Hakan Çoker
> > <hakancoker@> wrote:
> > >
> > > Dear Rasheedah,
> > > In Mugla state Hospital your cesarean rate will be approximately
> > 50-60%. This was the rate in most of the state hospitals. (Getting
> > down recently)
> > > I can quarantee that you will not be offered to have any painkillers
> > or epidural anestezia because it is never used in that state hospital.
> > But I can not guarantee some interventions. Your labour might be
> > fastened with induction, you might be forced to not to eat anything
> > and have drops.
> > > You epiziotomy rate will also be nearly 100%.
> > >
> > > But if you dont have any private doctor agreement for the state
> > hospital, you will be cared by the midwifes. If you have a nice
> > correspondence than you will probably have a very nice labor. If you
> > trust and respect them, they will respect you more. And definately
> > they will try to help you a lot.
> > >
> > > So good luck to you in your labor.
> > >
> > > Dr.Hakan Coker
> > > www.dogaldogum.com
> > >
> > > ----- Original Message -----
> > > From: Rasheedah
> > > To: naturalbirthturkey@yahoogroups.com
> > > Sent: Monday, June 22, 2009 3:28 PM
> > > Subject: [naturalbirthturkey] living in Mu&#287;la - wanting natural
> > birth, no circ, etc...Help! :-)
> > >
> > >
> > >
> > >
> > >
> > > Hello All,
> > >
> > > I am new to this group and stumbled upon it because my mother was
> > reading an article in Today's Zaman that mentions this group and
> > midwifery today (which mentions Dr. Hakan). I am an American citizen
> > and my husband is Turkish. We are at 40 weeks right now and are
> > expecting the baby any day now. We are big on natural birth but this
> > is our first baby and we have both recently relocated to Turkey (so,
> > we have been used to the American medical system and resources there).
> > >
> > > So far, all is normal in our pregnancy and the due date is June
> > 25th. I am wondering if there are any tips and suggestions you might
> > be willing to share to help us prepare and advocate for a natural
> > birth at the state hospital here (Mu&#287;la Davlet Hastanesi). I
> > would like to deliver vaginally without the use of any painkillers and
> > hopefully without an induction or any other interventions if possible.
> > >
> > > I really wish I had seen these resources sooner because I swear I
> > had been seeking out advice wherever I could find it. We wanted to go
> > the slightly inexpensive route so, because we have state insurance, we
> > see a private hospital doctor occasionally because she is my Gyn but
> > have been mostly meeting with a recommended Ob/Gyn at the state
> > hospital and making occasional visits to the Sa&#287;l&#305;k
> > Oca&#287;&#305; as requested by them. We personally supplement this
> > with prenatal yoga, lots of online research, and an Our Bodies,
> > Ourselves and Dr. Sears pregnancy books. If I had known of midwife and
> > home birthing options and doulas here in Mu&#287;la, I would have
> > jumped at that opportunity.
> > >
> > > Again, any tips you can share about how to go about a natural birth
> > (we are about 10 minutes from the hospital) from how long we should
> > stay at home during labor to once we get to the hospital are very much
> > welcomed. Also, after delivery, what do we HAVE to do? I was told the
> > baby will be given to us and they will try to do tests (blood and
> > shots and so on). The sa&#287;l&#305;k oca&#287;&#305; says to insist
> > they wait on those and come visit them a couple of days later for that
> > kind of stuff. We are a bit confused on what to do.
> > >
> > > Also, we are big on not doing unnecessary surgeries. Neither of us
> > are practicing Muslims or Jews so we feel no cultural pull to have a
> > circumcision but we know that is practice here. Anyone else who
> > decided not to do this have any thoughts or suggestions/tips?
> > >
> > > Thank you so much,
> > >
> > > Rasheedah
> > >
> >
> >
> >
> >
> >
> <image.tiff>
> >
> > Hotmail® has ever-growing storage! Don't worry about storage limits.
> > Check it out.
> >
>