|September 28, 2011|
Volume 13, Issue 20
|Midwifery Today E-News|
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In This Week’s Issue
Quote of the Week
We have a secret in our culture, and it’s not that birth is painful. It’s that women are strong.
— Laura Stavoe Harm
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The Art of Midwifery
I used to apply a warm herbal compress to the perineum during second stage and women said it felt great. However, I’ve cut back on this practice because I found it can bring too much blood into the area, resulting in unnecessary vulvar swelling and engorging the perineum to the point where it can no longer easily stretch. Now if I use a compress, I am careful to wait until just prior to crowning.
— Judy Edmunds, excerpted from Wisdom of the Midwives, Tricks of the Trade, Vol. II, a Midwifery Today book
ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to firstname.lastname@example.org.
Send submissions, inquiries, and responses to newsletter items to: email@example.com.
Update on the Global Midwifery Council
There have been many great e-mail conversations going back and forth between members of the Global Midwifery Council (GMC). Birth really is a human rights issue and the treatment of motherbaby during birth is of the foremost importance to the GMC. If you are not already familiar with the work we are doing, here is a link to my recent Midwifery Today editorial about the GMC: http://www.midwiferytoday.com/articles/ed_GMC.asp
I want to update you, E-News readers, on what the GMC has been working on, and invite you to be part of our work to support mothers and babies in every part of the world. The GMC’s founding members are currently at work on a Web site and writing interesting, informative and fresh content to fill it. They are busy advocating for midwives facing legal issues in several countries, and are facilitating dialogue with traditional midwives to help protect local traditions.
Sister MorningStar is teaching us all with her word medicine and I’d like to share some of it with you. Below, Sister shares her thoughts on traditional midwives and the role of the GMC.
A razor blade and a string? That sounds like cutting a cord. Humans are animals. Wild animals don’t have razor blades and strings. I think and I feel deep in my bones that if the GMC goes into global villages, we should first go to observe, listen, hear, watch and learn what is going on from the wise midwives, if any are left, still working in those villages. They are the ones who help to keep their people alive and attended to in birth. They do so much right and we need them to share their wisdom so that we can preserve it. What little we may have to share, if they wish to learn, needs to happen slowly and without assumptions on our part.
From the dawn of time humans and other animals have known how to get their offspring in, get them out and nurse them to grow. I am hopeful that the GMC takes the sane, simple and sacred, natural path of compassion, attendance, instinct and wisdom. We are a global council and I want us gain strength. I want people to believe in us and to believe in themselves.
A wild animal would never let a razor blade cut the cord between her and her baby, or let anyone near enough to do anything but comfort her. When I was working in Mexico, many villagers were the same. They would walk speechless into the little midwife-run maternity clinic, squat on the floor, pick up their baby and walk out. If you tried to come near them they would bite, snarl and glare. Sometimes they were sick, but you’d be surprised at how much healing comes from warmth, shelter, clean water, soup and trust. The world may need 300,000 more midwives yesterday, but there is no hurry to take another wrong path. Steady progress and a clear system of exchange will help us to bring home more global wisdom and knowledge to share.
I am visioning long; long cords left unsevered or charred by a candle or chewed by the mother, which I have seen often and is common for mammals. Let’s not introduce danger where wisdom is at work. Let’s keep the talk door as wide open as it will swing.
Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
Jan on Twitter: twitter.com/jantritten
News and Research
The health minister of South Africa recently announced that the government will no longer provide free infant formula to public hospitals and clinics. The new policy, which makes an exception for women deemed unable to breastfeed due to medical reasons, is a response to the country’s high child mortality rate. Health Minister Aaron Motsoaledi said he hoped the policy would encourage higher rates of exclusive breastfeeding in the first six months of life, calling the new policy a “child survival strategy.”
— “S. African to stop free infant formula hospitals: minister.” Posted August 22, 2011. http://www.google.com/hostednews/afp/article/ALeqM5hcuDeFcmrU-KEqYpbidGCS43JuJw?docId=CNG.28a184296dda6208bfa99078cd9b334d.341
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Country Contact Reports
Editor’s Note: For this international edition of E-News, we asked Midwifery Today’s country contacts what the biggest challenge facing normal birth in their country is and what is being done to address it. Read our contacts’ reports and updates below. (Learn more about Country Contacts.)
There are so many factors that have been challenging midwifery in Ethiopia. Here, no more than 6% of the total births are attended by trained health professionals, for a number of reasons. Among them, pastoralists’ mobility, lack of awareness about the risks of births unattended by health professionals, a lack of respect for midwives, the low ratio of midwives to the population and poor infrastructure. The Ethiopian Government is collaborating with many NGOs to solve these problems by constructing infrastructures, increasing the number of midwives and encouraging the pastoralist to live permanently in a one place. The number of midwifery schools is also increasing.
— Gebresilasea Gendisha
The words “parto humanizado” (humanized birth) are becoming wider spread in Mexico. Sadly, this doesn’t mean that episiotomy has been eradicated as a standard practice, or that the percentage of cesareans has miraculously been reduced, or that more babies are spending their first hours in their mother’s arms.
It does mean (if my mail is any indication) that more women are asking for the names of respectful caregivers in their hometowns, questioning the need to automatically have a repeat cesarean and/or asking who can help them achieve a waterbirth. It means that each new entry on my Facebook wall that focuses on gentle birth practices is assured a dozen “likes”! It also means that, this year alone, I have attended the home and/or waterbirths of newly graduated medical students who know that what they are taught is not what they want their own families to experience. It means that so far this year, there have been 5570 visitors to my Web site. What it means is that some families are questioning, investigating and often actively looking for alternatives!
The conference I spoke at this past June in Morelia, Michoacán, was entitled 1º Encuentro sobre el parto y nacimiento humanizado (“First Conference about Humanized Birth”), and Barbara Harper’s visit to the city of San Luis Potosi was entitled Como lograr un parto humanizado (“How to Achieve a Humanized Birth”). Amayla, an educational center in Monterrey, has hosted three congresses with the title “Humanized Birth,” and Luna Maya, in Chiapas, offers an apprenticeship program for fluent Spanish speakers who understand that “the humanization or mammalization of birth is a fundamental right.” Nueve Lunas, in Oaxaca, is teaching a second generation of midwives who focus on humanized care during pregnancy and labor.
Here in Guadalajara, Nacer en Plenitud continues to offer an alternative to the prevailing slice and bake birthing culture. This year families have traveled to us from Sayulita, Puerta Vallarta, Tepic, Aguascalientes, Puerta de Angel and Mazatlán in their search for a safe and respectful birth experience.
For the moment, the philosophy of humanized birth is still only a theoretical construct in far too much of the country. Childbirth educators, doulas, midwives and some obstetricians and pediatricians use it as a general term to refer to birthing conditions that are respectful of the gestating/laboring/newly birthed mother and her family. As the term becomes more pervasive, one hopes that so too will its practical implications—women giving birth instinctively and intuitively while whole heartedly and actively supported by their caregivers. As we say in Spanish, Ojala! (God grant it!)
Even though almost all births are attended by midwives and we do have a great deal of autonomy in our work, we face challenges: increasing cesarean and induction rates, as well as an extended use of augmentation, even in what’s supposed to be a physiological birth.
Due to a centralization process, many small birth units have been closed, or are in danger of closing, and the birthing women transferred to larger hospitals. In rural areas it is not uncommon to have several hours of transport to the nearest hospital. All communities are obliged to provide midwifery services to pregnant women, which includes transport in labour.
— Tine Greve
We are a country of 10 provinces and 3 territories, spread out over 4000 miles from coast to coast. In 1993, after 10 years of political lobbying by parents and midwives, midwifery was finally proclaimed a regulated profession in the province of Ontario, which is our most populous province. British Columbia had legislated midwives working by 1998 and, in the following decade, most of the other provinces/territories followed suit. The East Coast provinces have been slower to pass legislation, lacking population, midwife practitioners and financial resources. However, Nova Scotia, the tiny province where I have practiced for over 20 years, finally passed its legislation in 2007.
From a couple of hundred midwives scattered across Canada in 1994, there are now almost 1000 midwives in practice, either working as employees of government health districts or as independent health contractors. There are also at least three different provinces offering a four-year Baccalaureate of Health Sciences in Midwifery, with several dozen new midwives graduating every year.
Midwives are mandated to offer women primary maternity care, choice of birthplace, informed choice options and as much continuity of care as individual practice constraints will allow. Midwife waiting lists are always full!
There is a downside to this rosy picture, unfortunately. Canada, like many industrialized countries, is now facing a severe shortage of maternity caregivers, with no easy way to replace older caregivers who are retiring or getting out of the demanding field of obstetrical care. Midwives are feeling the brunt of this shortage, with local governments asking that they curtail their time with women, take on heavier caseloads or even share call with family doctors or obstetricians.
There are other complex problems as well; for example, the necessity to acquire and maintain hospital privileges so midwives can attend their clients who are choosing to birth in hospital. Midwifery is still a young profession here, and most hospitals do not have a department of midwifery, so midwives’ practice falls under the jurisdiction of obstetrics. As a result, many midwives have their practice unofficially “supervised” by obstetricians. This arrangement narrows the freedom that midwives and clients have in their decision making.
While I have some serious concerns about the future direction of midwifery care in Canada, I cannot help but admire the tremendous hard work and dedication of so many parents and midwives who have literally recreated an ancient profession from the ground up, here in this beautiful country. For more information, please visit www.canadianmidwives.org.
— Louise McDonald
Saudi Arabia is a unique mix of technology and tradition. Unfortunately, like in the United States, technology and obstetric dominance is the norm for birth. It’s said that out-of-hospital births are illegal. Although I haven’t checked the law personally, I can attest that there are no out-of-hospital birth centers, let alone professional midwives attending homebirths in the metropolitan areas.
There are some gems in the hospital birthing world, but finding them can take some dedicated detective work. In the local culture, seeking a second opinion is considered shameful, which often leaves women stuck with the first care provider they visit. In government hospitals it is not even allowed. This makes women extremely vulnerable to the protocols of their doctors.
Women are often naïve to this and simply visit the clinic nearest their home or the one included on their insurance provider’s list. Families who do this are especially subject to the hit or miss chance of exercising personal choice in their care plan. Sadly, “miss” seems to surface more than “hit.”
There are a mix of hospital rules, some of which still forbid anyone, even the father of the baby, to attend women in labor, let alone delivery. A contributing factor is the strict segregation of the sexes, with the maternity unit restricted to “women only” in some hospitals. Fortunately, some hospitals do allow and even encourage personal labor support, though it is usually limited to just one person at a time. Doulas are not known in the culture and hospital midwives are oftentimes just obstetric nurses who do not catch babies nor preside over care.
However, there is a growing expat community of women who are entering the doula and childbirth education fields. A handful of them are also embarking on distance education programs of midwifery from the United States, myself included. The public voice for natural birth on the Saudi Life motherhood column (http://saudilife.net/motherhood) has begun to raise awareness and draw together women who advocate for natural birth and choices in labor and delivery.
This expat community of “birthy sisters” are pioneers for expectant families. The dream is to open women-focused freestanding birth centers. Although we are not sure how we will overcome the cultural barriers and address current governmental structures, we are optimistic and moving forward in our personal education efforts to ensure that we are prepared and ready when the time comes.
There have been reports in Arabic news about the ministry of health’s vision for a more European model of women-centered care. This will take extensive infrastructure and planning and we hope that we can do our part to propel this vision and contribute from the ground floor.
— Aisha Al Hajjar
Ukraine now has quite a few Baby-Friendly Hospitals. These are maternity houses where the birth rooms are private, partners are allowed and the baby is not separated from his mother. Kangaroo care has also been introduced to some maternity houses for premature babies. Several of the laws recently added are supportive of healthy birth practices.
One practice that is different here from other parts of the world is that both a doctor and a midwife are present at a birth. They each have specific roles. The doctor conducts the labor, checking the heart tones, breaking water, etc. The midwife comes when the mother is pushing. She is the one who touches the baby, not the doctor. (I have seen some disturbing aggression in getting the baby out—the midwives stroking their fingers around the baby’s head during the pushing phase to get it out, tugging and manipulating the head to get the body out, etc.) Both doctors and midwives do the active management of the third stage together. The doctor is the one who sutures. So when I say the word “midwife” here, in this culture it doesn’t refer to someone who is a stand-alone caregiver at a birth.
One of the positive things I like about birth in Ukraine as a doula and midwifery student is that the risks of epidural anesthesia are widely known in the culture and maternity houses don’t pressure women to have them.
— Anne Sokol
Read more country reports and full-length articles on international issues in the 100th issue of Midwifery Today magazine, coming in December.
Web Site Update
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Birth Wisdom from the Web
The root of yoni is the Sanskrit word yuj meaning “to unite.” The yoni is the crucible where things are combined (male and female, mother and fetus) where creation and re-creation takes place. Where the unseen (not perceptible to the senses) world takes material form.
Here in Miami, this has become a business…. It is so out of whack it’s scary. You don’t find this anywhere else in the US.
— Manuel Fermin, CEO of the Healthy Start Coalition of Miami-Dade, on the city’s c-section rate, which is over 50% and the highest in the US.
Her talents vary according to the region of residence. Her gift as a midwife and her intuition help create an intimate, unique relationship with each mother and infant under her care. The use of diets, plants, various infusions, immersion baths, sweat baths, incense, enemas and massages integrate her knowledge. She understands and uses minimal intervention and special maneuvers to work with the most difficult births. She practices hygiene, promotes breastfeeding, and protects the mother with her presence, advice and prayers. The traditional midwife considers birthing a natural event; for many it is a ceremony.
— From “The Traditional Midwife,” compiled by the Latin American and Caribbean Network for the Humanization of Childbirth.
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to firstname.lastname@example.org.
Conference Chatter: IMBCI International Day
We will be having an International MotherBaby Childbirth Organization (IMBCI) meeting on Tuesday, 18 October, the day before the Midwifery Today conference in Bad Wildbad, Germany. Robbie Davis-Floyd and Debra Pascali-Bonaro will be leading the meeting. This is an opportune time to understand the activities and far-reaching effects of IMBCI’s global work for mothers and babies. The meeting is an all-day event that will be held from 9 am to 5 pm. It will be a great opportunity to meet with colleagues from different countries and plan how you might assist one another in your goals for motherbaby. The IMBCI Web site (http://www.imbci.org/) will familiarize you with the organization’s history and the 10 Steps to Optimal Maternity Services worldwide. I’d be thrilled to see you and hope you can make it to this exciting meeting.
The conference itself is going to be a fantastic international event with midwives and doulas from nearly 30 different countries. Come join with us as we learn, with the theme of “Preserving Our Traditions, Improving Our Skills.”
— Jan Tritten
Think about It
Midwives often forget that our beliefs in [mom’s] abilities can alter her accomplishments. It is important to check our hearts and push through any lack of belief that may inhibit her strengths. This may sound silly or ethereal, but I guarantee it can make a difference for a laboring mom and family.
A licensed CPM, Katie McCall, was recently sentenced for a felony conviction. She was convicted in what many see as a selective prosecution of the practice of conducting prenatal visits without her supervisor being physically present for each visit. Were supporters of birth liberty around the country, the world even, to rally behind Ms. McCall, we could collectively send $100,000 to more than cover her fines, and give her some assistance while she is barred from working.
Birth Freedom is inevitable. The natural progression is for people to move from tyranny to liberty. The agents of the status quo, however, rarely yield power without a fight. Today the biggest front in that battle is California. What a beautiful statement we could make if supporters of birth freedom would mobilize for Katie today and someone else tomorrow; maybe you. Learn more at www.supportmidwifekatiemccall.com. Please make a donation, today.
— State Senator John Loudon (ret.)
The Royal College of Obstetricians and Gynaecologists recently came to the conclusion that too many babies are born in hospitals. In other words, according to the college, it would be beneficial to increase the number of out-of-hospital births (www.bbc.co.uk/news/health-14145862). This would lead to a radical rethink of the selection and education of midwives. Outside hospitals, where women must rely entirely on the release of their natural hormones, the main preoccupation should be to protect the involuntary process of birth against situations that can inhibit it. Modern physiology can identify such situations, particularly those associated with a release of adrenaline, and those that stimulate the neocortex (the part of the brain highly developed among humans only).
The time is therefore ripe to underline the historical significance of one of the 27 workshops offered during the Mid-Pacific Conference on Birth and Primal Health Research (Honolulu, October 26–28, 2012). It will be called “The Silent Knitting Session.” The participants will realise at which point a repetitive task such as knitting (or, in Hawaii, making a wreath of flowers to be draped around the neck, for example) is an effective way to reduce the levels of adrenaline.
Since the release of adrenaline is highly contagious, the main preoccupation of an authentic midwife, after the paradigm shift, will be to maintain her own level of adrenaline as low as possible when she is close to a labouring woman. Midwives of the future will also need to train themselves to remain silent, since language is the most powerful stimulant of the neocortex. The silent knitting session will be a necessary step towards an understanding of what authentic midwifery is. We present it as the symbol of a vital new phase in the history of childbirth and midwifery.
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