Hands off the hoo!

[klone]

I've got to say, working with residents, one of my biggest pet peeves is when they "conduct the orchestra." If you're an L&D nurse, you probably know what I mean - taking their first two fingers and running/pressing it repeatedly around the lower rim of the perineum as the baby is descending/crowning.

It drives me crazy that they do that. Especially when they do it repeatedly, for hours of pushing. The worst cases of perineal edema have been as a result of that.

The midwives don't ever do that, and yet, the babies still seem to come out okay.

[bagladyrn, RN]

I've worked with a couple of docs who did that habitually. One in particular had more 4th degree tears than any other provider I've known. I made a habit of waiting as long as possible to call him to try to minimize the "stretching".

The one I really can't comprehend is a female doc who does this - you'd think she'd be aware of what this does!

[RNLaborNurse4U]

I see some docs being overly aggressive with the perineal stretching. And the resulting hugely edematous labias. When hands in the hoo is acceptable is when she has a dense epidural, and you are pushing down on the muscles inside, to help her focus where to push. And if she can't feel you, she can't feel enough to push. So - hands out, and let her labor down, or turn her epidural rate down (or off).