First, Do No Harm
by Jan Tritten

© 2013 Midwifery Today, Inc. All rights reserved.

[Editor’s Note: This editorial originally appeared in Midwifery Today, Issue 105, Spring 2013.]

The most important thing I can say about hemorrhage is, “Don’t cause one.” If the body is well fed and mom is low on stress and feels loved, motherbaby and their process of labor and birth work well. Our first and most important job is to facilitate what is already a beautiful process. God designed this process to work, but birth workers can come along and do interventions that may cause hemorrhage. The baby is born of its mother’s efforts. Don’t tell her when or how to push. Let the fetal ejection reflex take place without interference. Deeply respect the process and the great need of the mother and baby for each other without talk or other disturbances. As Carla Hartley says, “Birth is safe; interference is risky.”

We need to “First, do no harm.” Michel Odent tells us, “Do not disturb the mother.” When we do, we interfere with the natural and strong oxytocin infusion that happens for mother and baby at birth; the peak levels of oxytocin naturally occur if mother and baby are not disturbed by interventions, talking, drugs, etc. When the baby is born, he needs his mother. Do not put a hat on the baby—mom needs to be able to caress, kiss and smell the top her newborn’s head. Even little things we do (like putting on a baby hat) can be too disrupting. The baby belongs skin-to-skin with his mom. She is a perfect heater and can regulate baby’s temperature—she has been doing this for baby’s whole lifetime!

When we were at the Mid-Pacific conference that Michel Odent put on we learned so many more ways we unknowingly disturb the process, as well as the ramifications of these disturbances. The baby gets her first exposure to bacteria at birth—it is so important that her exposure is to mom’s bacteria, not the hospital’s. The possible dangers of not getting inoculated by mom are just beginning to be known.

The subject of noninterference is important, but being ready and knowing what to do is equally important. That is why women need midwives because midwives are trained to help in real, not imagine or caused, emergencies.

My Facebook page has proved an interesting place to learn about midwifery and birth. I asked a question about hemorrhage and Margie Dacko had the most interesting response:

I never used Pitocin in over 2400 homebirths. My hands are my favorite and best tool to stop bleeding (or getting placentas out). BTW, I don’t use eating placenta, herbs or homeopathic bleeding remedies either. They are unnecessary. The uterus wants to stop bleeding, just needs a “helping hand” on occasion.

In my first year of being an independent midwife (1984) I transported two moms with retained placentas and bleeding because that was what I was taught was appropriate—the thought of messing with the uterus with a placenta in it was horrifying. A year or two later a woman with a retained placenta refused to transport to the hospital. I called a friendly CNM who came to the home and removed the placenta. I was stunned at how rough he (yes, a male CNM) was inside her uterus. Here I thought I would poke my finger through a uterus if I touched it, yet he had his whole hand and arm up there! The mother was in pain, but afterward she was thrilled to be able to stay at home. Since then I have never transported a bleeding woman. The knowledge that the uterus wasn’t going to fall apart if I handled it some was very empowering. I have manually assisted in the removal of 3–4 placentas with hemorrhaging, which immediately stopped the moment the placenta exited the uterus. I would say I deal with heavy bleeding with or without a placenta about 1–2% of the time and all have resolved well.

So amazingly, with your well-trained hands, you are equipped with what you need to control hemorrhage almost all the time. Partial placenta accreta might be an example of where you might need to transport. I do think cord, membranes and placenta have an important part to play in hemorrhage control, especially in undernourished populations.

Each one, reach one,

Jan Tritten Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine and a midwife who was in active practice from 1977–1989. She became a midwife in 1977 after the powerful homebirth of one of her daughters. 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! [ PHOTO BY ANDREA NOLL ]   >  Editorials   Click here to read some of Jan’s Midwifery Today editorials.   >  Curriculum Vitae   1947 Born in Los Angeles, California. 1965 Graduated from Placer High School in Auburn, California. 1966 Trained for one year as a psychiatric technician. Courses included basic nursing, pharmacology, microbiology, anatomy and physiology, psychology. 1966–1971 Worked at DeWitt State Hospital in Auburn, California as a psychiatric technician. 1968 Graduated from Sierra College with an Associate of Arts degree. 1970 Graduated with honors from Sacramento State College with a Bachelor of Arts degree in Social Science. 1971 Earned Lifetime California teaching credential with fifth-year program from Sacramento State College. 1972 First daughter born in a hospital. It changed my life forever. It was an unsatisfactory birth experience, but I had a wonderful postpartum experience with 2-1/2 years of breastfeeding. 1976 Second daughter born. She was born at home with a doctor who talked me into a homebirth. The difference between the two births sent me on a path to do something to help women have positive birth experiences. 1976 Began training as a midwife. Because I was raising young children and running a business, and because there were no CNM schools in my area, becoming a CNM was not within my reach. 1977 Began attending births with the Birth Co-op in Eugene while organizing courses in our community taught by CNMs, physicians, nutritionists, etc. 1978 Began a midwifery practice, New Life Care, with a partner, Chris Howard, and apprentice Monika Dunsmore. 1979 Son born at home. 1980 Did a one-year program with Marion Toepke McLean, CNM. Four of us completed the program, which was modeled after CNM curriculum at that time. She took a year off from her practice to teach us and to go to our births with us. 1982 First group of midwives certified by the Oregon Midwives Council. Our board was composed of CNMs and physicians. 1986 Slowed down practice and started Midwifery Today magazine.

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