April 30, 1999
Volume 1, Issue 18
Midwifery Today E-News
“International Day of the Midwife”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Checking In
5) Finnish Nurse in Norway
6) Working in Chile
7) Question of the Week
8) Switchboard
9) Coming E-News Themes

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1) Quote of the Week:

"The most important health statistic in the world is the worldw ide mortality rate--100 percent. Since everyone dies, what is important is how people live."

- Marsden Wagner, MD, in Pursuing the Birth Machine

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2) The Art of Midwifery

Russian midwives estimate fetal weight by using this trick : multiply the girth of the pregnant mom's belly by her fundal height, using centimeters.
The estimated fetal weight will be in kilograms. Girth x fundal height = fetal weight.

- Jill Cohen in Wisdom of the Midwives: Tricks of the Trade Volume Two, a Midwifery Today book

Drinking seaweed tea after birth is a Korean tradition. My mother, an RN, noted that friends of a newly delivered Korean mom brought her this iron-rich tea, which she drank along with orange juice. My mother remarked on the wisdom of increasing her iron absorption with vitamin C. The new mom had not realized the scientific justification for her great tradition.

- Lisa Noguchi, in Wisdom of the Midwives

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At Midwifery Today, we have lots of tricks up our sleeves! Purchase our two volumes of Tricks of the Trade and you'll see what we mean: Save $5 when you purchase both Tricks of The Trade Volume I and Volume II. Only $40 plus shipping! Call today to order:

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3) News Flashes

International Comparisons of Infant Mortality Rates, 1994

The United States infant mortality rate ranked 25th among selected countries* in 1994. The 1994 US infant mortality rate of 8.0 per 1,000 live births was nearly twice as high as the number 1 ranked country, Japan, with a rate of 4.3. The 1997 preliminary U.S. infant mortality rate was 7.1 per 1,000 live births. Following are the mortality rates of the top 37 countries: Japan, 4.3; Singapore, 4.3; Hong Kong, 4.4; Sweden, 4.5; Finland, 4.7; Switzerland, 5.1; Norway, 5.2; Denmark, 5.5; Germany, 5.6; Netherlands, 5.6; Ireland, 5.9; Australia, 6.1; Northern Ireland, 6.1; England and Wales, 6.2; Scotland, 6.2; Austria, 6.3; Canada, 6.3; France, 6.5; Italy, 6.6; Spain, 6.7; New Zealand, 7.2; Israel, 7.8; Greece, 7.9; Czech Republic, 8.0; United States, 8.0; Portugal, 8.1; Belgium, 8.2; Cuba, 9.4; Slovakia, 11.2; Puerto Rico, 11.5; Hungary, 11.6; Chile, 12.0; Kuwait, 12.7; Costa Rica, 13.7; Poland, 15.1; Bulgaria, 16.3; Russian Federation, 18.6.

* Includes countries that reported infant mortality rates to the World Health Organization Rates are per 1,000 live births Note: Rankings are based on more than one decimal place Source: National Center for Health Statistics Prepared by March of Dimes Perinatal Data Center, 1998

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4) Checking In

Midwives, your special day of recognition happens every year on May 5, the International Day of the Midwife. Although you will be recognized and celebrated by millions of mothers, families and other members of your communities, this might be a good opportunity for you to stop and take stock of your work. Celebrate yourselves! Think about all you do for others, think about the impact you have on health statistics, on the emotional health of those you serve, women's empowerment and self-esteem, and the safety and well being of mothers and babies everywhere. Think of the changes you have compelled the medical world to make: increasing rate of midwife-attended birth, an emphasis on VBAC, less routine use of episiotomies, better support of breastfeeding, decreased circumcision rates, family centered birth being made increasingly available in hospitals, more choice, respect for alternatives to mainstay interventions, and much, much more. Think of the impact your work has had on the future of the human race. Think of the example you set with the qualities you value:

wisdom, compassion, knowledge, patience, respect and flexibility, for instance. This year's International Day of the Midwife emphasizes the midwife's role in primary care. You are the first source of help, advice and protection. Evidence shows that preventive care provided by midwives results in fewer maternal and neonatal deaths. You are the first line of defense, the safety net, the pair of loving hands that safely eases a woman and baby through the life-altering passage of pregnancy and birth. Go ahead and give yourself all the commendation you deserve. Put your feet up on May 5 and say to yourself, "I have made a difference in the world and I'm proud of myself." And for those of you who will be catching babies that day--well, your actions speak even louder than words. Happy midwifing. Happy International Day of the Midwife.

- Cher Mikkola, E-News editor

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5) Meet Finnish nurse Minna Jestila from Hammerfest, Norway

I am a student in the Master of Nursing and Health Administration program at the University of Oulu in Finland. My major is nursing science and my minor is clinical nursing sciences. I'll finish my degree between 1999-2000 when my research work is completed.

I grew up in Kemi, Finland, a town of 26,000 inhabitants. Eleven years ago when I was nineteen, I moved from Kemi to Oulu, which is a good-sized city of 110,000 residents and which has the largest university in Finland. For the last ten years I have been working, studying and taking care of my family.

My husband, three children and I moved to beautiful Hammerfest, Norway last year. Hammerfest is the northernmost town in the world. I'm working there as a head nurse in a small maternity house. We have about six hundred patients a year. My ward is a complex ward. We have three rooms for patients who are giving birth. In addition we have four beds for patients who are having problems during pregnancy and need observation. The remaining twelve beds are for mothers who have already had their babies.

We want to support mothers and their families during their pregnancy and birth (we are a Baby-Friendly Hospital). Our midwives work quite independently. We call the doctors only if a mother has a special obstetrical reason that requires assistance.

My ward is a very international one. We have two Swedish midwives, two who are Finnish, and one from Nigeria (a man!). One midwife from Germany will join us soon. The rest of the midwives and other personnel are from Norway (eight midwives and seven staff nurses).

I like to encourage my staff to get to know the women we serve and treat them as individuals. I would like to help them see how important birth is to each family. Feelings and empathy are very important in this job.

I don't know how long we will live in Hammerfest. As I gain more leadership experience I would like to aim for eventual participation in an international research team.

For the full version of Minna's story, see the fall issue (September) of Midwifery Today.

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6) Fighting the Odds: Working in Chile by Ann Davenport

A very strong middle class has been well established in Chile for many generations. In recent years it suffered what was a very repressive military regime. Many of those who are now in positions of authority and decision making were teenagers or university students when their aspirations, goals and idealistic dreams of youth were literally taken from them. Many people we know personally were taken from their homes and thrown in jails, tortured, given passports with the words "terrorist" stamped on it, and sent out on a plane to other countries in the middle of the night. These same people now hold such positions as the regional director of health programs, or director of the state level of educational curriculum development, or director of the local health clinic, or bank officer in charge of small business loans, or they direct Ministry of Health projects for adolescent health or women's health programs. Added to this is the very established phenomenon about being quiet and polite under any circumstances--don't raise your voice, don't wave your hands around, don't stand out in a crowd, and under no circumstances, don't question authority.

Another critical aspect of "behaving yourself" is the importance of appearances. This is a middle class who are losing their grip because of economic crises, but don't want anyone to notice. So they carry wooden models of cellular phones, they live in condominiums in a beautiful neighborhood with no furniture inside the house, they have bank defaults on their credit cards at alarming rates, and they do not want to appear to be suffering. So, when we asked college educated women about attending a homebirth center for their prenatal care and birth, again and again they would say "Natural childbirth? Are you crazy!? Why would I want to lower myself to biology? Why would I want to settle for a midwife when my insurance would pay for a doctor?" Or, "My doctor told me that if I have my baby vaginally, the muscles there will never be the same, and I would be floppy, and probably my husband would want to find someone else then who had a tighter vagina!"

And of course, the name of the private clinic, the name of "your" ob/gyn and the size of your bikini scar for a cesarean operation are all status symbols. Not only among the women who live in metropolitan areas such as Santiago, but even more so in the small cities around the country. This is a generation of women who want to distance themselves from their mothers or grandmothers who "had to have their baby" at home or with a midwife. It's "second class."

(Editor's note: Because of space limitations, we were unable to print Ann's entire story. She and another midwife had planned to open a homebirth center but were confronted by the problems she speaks of above. Now they are working in the province of Quillota on the serious problem of adolescent pregnancies. They were asked to do research about it and design a project for educating young people about how to prevent pregnancies and STDs, etc. Ann comments: "We discovered that everyone wants something to be done, but no one wants to be the one responsible for doing it. Or even for hiring us to design and implement a program. So we have a great project for training midwives, teachers, teenagers and parents about reproductive health matters, and nowhere to go with it. It's been a very frustrating year for us, but we are made hopeful by the enthusiasm of some wonderful midwifes we have met who are dynamic and committed to changing health for the better for mothers and babies in Chile.")

Read Ann's in-depth article on maternal healthcare in Chile in the fall issue (September)of Midwifery Today.

To subscribe to Midwifery Today magazine, a quarterly 72-page magazine for all practitioners and parents, email inquiries@midwiferytoday.com or call 800-743-0974 for information on how to order. Please mention code 940. Each issue includes an extensive International Midwife section.

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Learn more from these Midwifery Today issues:

No. 13, Cross-Cultural Birthing (Regular price $7.00)
No. 19, Trends vs. Traditions (Regular price: $7.00)
No. 25, International Midwifery (Regular price: $7.00)

Save $1.00 on each of these back issues! Call 800-743-0974 to order today!
Mention code 940 and save $1 per issue.
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7) Question of the Week: How and why do you induce labor? Send your response to:mtensubmit@midwiferytoday.com

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8) Switchboard

An important court hearing will take place on 11th May.

Mme Suzanne de Bearn, a midwife of fifty years' practice, will be appearing before the High Court in Bordeaux, France. The prosecution appealed against her acquittal in 1997 of the charge of running an illegal health establishment: illegal not because of any failure on her part, but because French law, while not criminalising homebirth, recognizes only the larger hospitals as appropriate places for childbirth.

Your support and that of people whom you inform, will help Mme de Bearn in her personal battle to keep her birth centre alive. From a wider perspective, the outcome of her case will determine the future of independent, family-oriented, non-interventionist birth centres throughout France.

Please visit her site at http://www.ctanet.fr/birth-freedom

Mme de Bearn was midwife to my three babies. I cannot adequately express my gratitude for her simple and unintrusive help. Her birth centre at Sarlat is the perfect expression of support and security and the joy of a newborn baby. While the political significance of these legal forays is immense, my predominant thought is that the Maison de Naissance at Sarlat is a shining example of all that is right with the world, and that its destruction must be prevented.

- Alison

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IXMUCANE, a midwifery-run women's health and birth center in Guatemala, was started 18 months ago with three main intentions:

1) Provide quality full scope midwifery care to underserved women
2) Work with local traditional midwives to cocreate a culturally
appropriate training program to improve skills and enable them to continue community based midwifery in a country that wants to phase out the traditional midwife.
3) Provide a nurturing, clinical site for North American midwives who want to improve and broaden their skills, integrate traditional midwifery with appropriate use of bio-medicine and work with a Latin and indigenous population.

We have received a small grant for this work and are eligible for more. The program is designed to be economically sustainable, however, and we expect it will reach that goal within the next six to eight months.

The work with the traditional midwives is very powerful and after 10 months we have established a close working relationship with them as well as the local Minister of Health. We are beginning to coordinate our efforts to improve maternity care in rural communities and demonstrate that the midwifery model is affordable, effective, essential.

There is a position open now for another midwife to join the project. We need a seasoned midwife, fluent in Spanish, who is above all dedicated to midwifery activism as well as quality care. Helpful but not essential are skills in project design, community building, and networking.

The job is located in Antigua Guatemala, 45 minutes from the capital, in a beautiful colonial tourist town with an international community and a great lifestyle. There is ample time every three to four months to travel. Salary is negotiable (not competitive by North American standards), the work is very rewarding and there is possibility for profit sharing/buy in for the committed solid midwife who wants to go deep with this work. I want a partner, not an employee.

Web site with more info on Ixmucane:

http://www.womanway.com.

For more information on maternity care and midwifery in Guatemala, read the article "One Step At A Time" also at the web site. Contact Jenna Houston CNM Ob/Gyn NP email address Womanway@aol.com
Houston@conexion.com.gt
Telephone 518-678-3154 in New York or 011 502-832-5539 in Guatemala.

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[In response to SF, Issue 17]: In regard to you not being able to obtain delivery privileges at a hospital in Kentucky, it took two and a half years for me to get on staff at a hospital in Illinois. Don't give up to soon. These things can take a long time and a lot of persistence.

- TD

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9) Coming E-News Themes

Coming issues of Midwifery Today E-News will carry the following themes. You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to these themes:

- CIMS (May 7)
- drugs in labor (May 14)
- premature rupture of membranes (May 21)
- doulas (May 28)
- induction (June 4)
- educating the public (June 11)
- Group B Strep (July 9)
- episiotomy
- epidurals
- breastfeeding
- waterbirth
- breech birth
- nutrition
- homebirth

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.


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