These are easy to read and understand and are beautifully presented.
I feel strongly about some of these glove issues:
Yes, I always wear gloves at a birth, for lots of reasons:
To protect myself: I practice universal precautions and would never
take more risk just because I felt a client was less likely to be carrying
HIV. People can carry all sorts of things that I wouldn't want to
catch and that I feel professionally obligated to protect other clients
To protect the client from my germs: If a client's skin tears under
my hands, I don't want to introduce infection with my germs. Ideally, gloves
that started out sterile will have only the mom's germs on them, and she'll
have a much better chance of fighting off infection. This is especially
important if there's some kind of emergency that requires you to perform
invasive maneuvers, e.g. a shoulder dystocia, where there's a large chance
of incurring some tearing.
To protect the client from other clients' germs: Routinely catching bare-handed
turns a midwife into a great vector for spreading disease. I find
myself wondering whether midwives who catch bare-handed get informed consent
for this. Do they tell clients that this practice theoretically exposes
them to all the germs of every other client this midwife has ever attended
as well as the clients of any other midwives who might previously have
attended any of these clients? The disease-potential principles are
no different from those of unprotected sex.
To protect my profession. Midwifery is an underdog in the U.S. I
think we need to do everything we can easily do to present ourselves as
professional and responsible. Someone else wrote about her feelings about
seeing a photo of a newborn, where the midwife's gloves seemed glaringly
out of place. I don't get this. When I see a birth photo of a bare-handed
midwife, I just pray that the date on that photo is pre-1985. I am grieved
and aggrieved when contemporaneous birth stories posted on the web show
a bare-handed midwife. I think they do a dis-service to the profession
by providing fodder for the cultural prejudices that midwives are dirty
Yes, I think it's very important to wear gloves when catching a baby.
I often hang out during pushing with non-sterile gloves on my hands and
then change to sterile gloves when crowning is imminent. I try to
change my gloves often in the immediate postpartum, typically still using
sterile gloves until the placenta is safely out. I put on fresh sterile
gloves for the newborn exam, and I do not touch the baby without gloves
until I return for the "24-hour" visit. I figure by then the baby's
skin will be nicely colonized with family germs.
I think it's my obligation to minimize handling of the newborn during
the immediate postpartum, anyway, while the baby is imprinting on family
faces and voices, but when I do touch the baby, I've got gloves on my hands.
I do not offer a bare pinky for a newborn baby to suck on to calm them.
A moment of fussiness while we wait for a family member to offer a knuckle
is well worth avoiding thrush. Is there any midwife out there who truly
believes she doesn't carry yeast under her fingernails?
Others have commented on the intimacy of touching a woman's genitals
without gloves and the potential for this being a form of sexual abuse
if done without consent. I agree.
Like consensual sex, if a client and a midwife understand the issues
involved and both agree that they don't want the midwife to wear gloves,
then all they need to do is get the baby's consent and they're all set.
It's easy to wear gloves, although I, too, sometimes have a really bad
glove sensitivity. I don't wear latex anymore. Some days, even the
unpowdered vinyl gloves make my hands unhappy. But I still wear them
rather than compromise the care I provide my clients.
But maybe I'm missing something here. Are there substantial benefits
that accrue to the mother and baby in having a midwife not wear gloves?
Do these benefits outweigh the risks?