August 20, 1999
Volume 1, Issue 34
Midwifery Today E-News
“International Midwifery”
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Broaden your education in the United Kingdom and Jamaica!

Make plans now to attend one or both these conferences:

London, England, September 9-13, 1999
Evidence Based Midwifery

Ocho Rios, Jamaica, December 2-6, 1999
Birth Without Borders--Weaving a Global Future

Sponsored by:

- Mothering magazine: Mothering is in its 24th year of providing inspiration for attachment parenting. Mothering guides, nurtures, and supports while providing the latest on controversial parenting topics.

- Cascade Health Care: Cascade HealthCare Products, Inc. began business in 1979 with the primary goal to provide supplies and equipment for the emerging profession of midwifery. We have developed a complete product line that not only serves midwives, but nurse midwives, childbirth educators, lactation consultants, visiting nurses, birth centers, WIC programs, nurse practitioners, doulas, and professionals dealing with expectant parents, families and women's healthcare.

For your copy of the printed programs send your full name and postal address to inquiries@midwiferytoday.com. Please mention code 940.

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This issue of Midwifery Today E-News is sponsored by:

- Austin Birth Center
- Elite Hand-Held Dopplers
- Mark-It Television

Look for their ads below!

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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) Hemorrhage in Asia
6) Saudi Arabia
7) Aqua Natale Birthing Centre
8) Australian Birth Activist
9) Switchboard
10) Coming E-News Themes
11) Classified Advertising

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1) Quote of the Week:

"You cannot discover new oceans unless you have the courage to lose sight of the shore."

- C. Cheng

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2) The Art of Midwifery

From Japan

If during crowning the birthing woman is having a difficult time relaxing, midwives on either side of her can move her arms around in large circles to help her relax and not push.

From the Netherlands

Apply an ice pack to the abdomen to arrest hemorrhage.

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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: 800-743-0974. Please mention Code 940.

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3) News Flashes

To study the effect of delayed cord clamping on infant iron status, 69 newborn infants were randomly assigned to three groups at the time of delivery: 1) cord clamping immediately after delivery; 2) clamping when the cord stopped pulsating, at around one minute after deliver with the infant placed at the level of the placenta; 3) clamping when the cord stopped pulsating, with the infant placed below the level of the placenta. Two months after delivery, infants in the groups with delayed cord clamping had significantly higher packed cell volume values and hemoglobin concentrations. Less infants were anemic: the percentage of infants with packed cell volume lower than 33% was 88% in group 1 compared with 42% in group 2 and 55% in group 3.

- The Kangaroo, 2nd Quarter 1999, a supplement to Child Health Dialogue, Issue 15

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PROFESSIONAL MIDWIFE needed for state-licensed birthing center. RN or CNM preferred. Fax resume to 512-345-6637 or mail to:
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4) Checking In by Jan Tritten, Midwifery Today Editor in Chief

I became very interested in the exchange of international knowledge and techniques having to do with birth when as a young midwife I had a personal experience with shoulder dystocia. I ended up reading how to resolve it when I was right in the middle of a birth! It was Ina May Gaskin's description of a technique she had learned from Guatemalan midwives: simply have the woman turn onto her hands and knees. Now known as the Gaskin Maneuver, it may have saved this baby's life. It works--try it!

When we study cross culturally, we find systems and ways we may want to emulate. By learning what your colleagues from other countries are doing, you too can improve your practice and change birth. You learn of the far reaching power of women in birth when you break the shackles of your own culture. And because birth has become a medical event rather than a social-spiritual rite of passage, we are all needed as birth change agents.

Midwifery Today can help you get involved in making global connections. Our directory of birth practitioners from around the world is filled with names of people interested in making connections. You can join the 327 practitioners from 33 countries by filling out one of our international forms. You can also purchase the directory for $20, or $18 if you are a Midwifery Today subscriber. For the last ten issues, Midwifery Today has included an international section of at least 20 pages. As well, two back issues--numbers 13 and 25--are dedicated entirely to international midwifery. We still have back copies of International Midwife, a stand-alone magazine: get all seven for $25 plus shipping.

Midwifery Today also brings birth practitioners together for wonderful international conferences. Our next one is in London on Sept. 9-13, 1999, and is titled Evidence Based Midwifery. You can still register and walk-ins are welcome. Our Jamaica conference is Dec. 1-6, 1999. The full program is in your Midwifery Today catalog, mailed this summer; email inquiries@midwiferytoday.com if you don't have one. At international conferences you have the opportunity to learn and share in depth from a cross cultural perspective as well as make friends from all over the world. Midwifery Today brings you teachers and classes from this perspective at our domestic conferences as well. The next one is in Philadelphia, March 23-27, 2000. The program is ready and you can email for it as well.

This letter from Venus Mark from Trinidad describes what we are trying to achieve: "We cannot demonstrate our appreciation enough to the Midwifery Today staff for what we, the midwives of Trinidad and Tobago, received from you in October 1996 [at the Midwifery Today conference in Orlando, Florida]. We cannot stop talking about the warm reception, in-depth education received from you and your lecturers, the midwifery stories that were shared, the film clips and slides that brought us to tears. We will always be grateful for this wonderful gift.

"Your midwife lecturers made midwifery come alive--we lived the birth process through their lively discourse. Dr. Michel Odent and Dr. Marsden Wagner renewed our faith in ourselves by giving us the clear message that midwifery is alive around the globe and is oriented to the benefit of women and will not be led to destruction by medical technology. Although the Midwifery Today staff was busy, you made time to welcome us into your fold as if nothing in this world were more important."

Next year come to our European conference in Aachen, Germany, September 28-October 2, 2000!

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5) Hemorrhage in Asia by Robin Lim

During my six years of catching babies in Indonesia, I never saw a fatality from hemorrhage in Indonesia (we were able to control them), but I saw far too many women bleed excessively after birthing. Speaking with elder healers who used to catch babies in Bali, I discovered what they believed was the cause of so much postpartum hemorrhage: In the early 1960s US government aid organizations introduced "Green Revolution" hybrid rice to Asia. This rice matures in three months rather than six, so it was supposed to end hunger. But because it is also a weak variety, it is susceptible to fungus and pests and must be heavily sprayed with herbicides, anti-fungals and pesticides.

Overnight the people went from eating organic red rice as their staple food to ingesting a hybrid, sprayed rice that was polished down to white. Even the rats won't eat this rice. This is handy---it makes it easy to store.

According to Mangku Liyer, a healer priest in Pengo Sekan, Bali, "Within the first season of the new rice I saw women dying, so many dying, bleeding too much after childbirth. Before, when a woman would bleed too much, I could stop the bleeding with herbs and young coconut water. After we began to eat the new rice, I could no longer help the women. I only could help bury them."

In June 1998 we arrived at Baguio, Philippines, the home of my mother. I immediately began to catch babies for the marginalized mountain people. I was astonished to find that these Filipino women, unlike the Indonesian women I had helped, were not hemorrhaging after giving birth. Their secret seemed to be in their food. They were eating organically grown red rice and sweet potatoes. Unfortunately women living a more modern lifestyle (in either the Philippines or Indonesia) in the city and eating commercially grown white rice and fast foods, had higher blood pressure and more postpartum blood loss.

So let me take this opportunity to say what we all already know: sound nutrition equals healthy mother, healthy baby and better birth outcomes. Please, if you're pregnant or helping pregnant women, choose organic foods. It makes a tremendous difference.

Note:
The family health clinic I raised funds to build in Bali is now open and being run by two wonderful Balinese midwives. Thanks to everyone who helped in so many ways. Some gave their time, books, used baby clothing, equipment, birth supplies, money, etc. Your generosity has gone a long way.

I will be returning to the Philippines in November to open a free-standing birth center in cooperation with Good Shepherd Convents and the Dept. of Health in Baguio. We hope to encourage traditional birth attendants and help them get the supplies, supplementary training and networking they need and want. Many women have been trained in college as midwives but there are no jobs for them. Right now 30% of the reported births in Baguio are unattended homebirths. As fatalities are not reported, Mary Fernandez of the Baguio Dept. of Health can only imagine how many births actually still take place at home. Our shared dream is that if low cost or free homebirth services could be made available, birth outcomes could be much improved.

What I need: Books to help improve midwives' knowledge (most Filipino college trained midwives speak English. They can help the Ilokano and Tagalog traditional birth attendants learn from the books as well), birth supplies, funding--every centavo helps. All can be sent to me in the US before I depart on Nov. 1st. Robin Lim, 501 North C. St., Fairfield, Iowa, 52556; e-mail: robinlim@kdsi.net
Thank you, Salamat po!

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6) Saudi Arabia

I am a direct entry midwife, qualified for three years after 20 years as a birth partner for whomever wanted my company during birth. I have a dream to live and work in India with village women. To finance the fulfillment of this dream I am working as a midwife in Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. I have completed four months of a one-year contract. The salary is tax-free, lots of overtime is available and we are provided with accommodation including electricity, gas, etc. The sun shines every day and it is very dry and bearable.

Midwifery here is out of the Dark Ages, however, mainly because of hospital policies. It is policy to continuously monitor everyone in labor even if they come in fully dilated and pushing. Almost everyone has artificial rupture of membranes, fetal scalp electrode, IV fluids and everyone has to lie on a bed. Vaginal examinations are done for everyone even if they come in with a stubbed toe or broken fingernail! Active pushing is the order of the day. Physiological third stage--what's that? As for alternative positions, if you are lucky you might get away with catching a baby with mum in the left lateral position but such things are frowned upon.

All women with breech presentations must have epidurals, and here they are of the old variety which turn women into beached whales--when they work! All breeches are delivered in the lithotomy position; forget the hands off approach. Breeches are dragged and cork screwed out. I honestly don't know how some of them survive.

It must be said that some interventions are necessary. There are many complicated cases here. Cardiac problems are seen almost every other day. It's not uncommon for women with transplanted organs or on renal dialysis to be pregnant. Congenital abnormalities are frequent, as consanguinous marriage is common. At least 1 in 3 babies has meconium stained liquor. Many women are dehydrated or ketotic when they come in and need IV fluids. They won't eat or drink because they don't want to get fat or their husband might find another wife. Or they have abandoned their traditional healthy way of eating and have become huge, courtesy of McDonald's, KFC and Coca-Cola, rendering them prone to gestational and true diabetes.

What keeps me here besides financial gain to fulfill my dream? The Arabic women, who are adorable. They have an absolutely wicked sense of humor. Even though my Arabic is very limited and they speak no English, I have such fun with them (and I hope they do with me). They are very gentle women; so sweet and grateful for any kindness shown to them. Unfortunately some of the midwives and support staff have been here a very long time and are very much in the 70s mood of "just do as you are told." They can be very rough. Consequently many women are very afraid when they come into hospital. I don't hold out much hope for changing things on a grand scale but if I can make a difference for individual women I am privileged to care for during labor and birth, I am willing to persevere, and I'm slowly developing a repertoire of tricks to help women avoid unnecessary interventions.

There is so much more to say about midwifery in Saudi Arabia. If anybody would like to discuss it more or offer me inspiration, I'd love to hear from you. Email me at rama1105@hotmail.com. Yours in the service of women, Rama--your sister in the desert!

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7) Aqua Natale Birthing Centre

The Aqua Natale Birthing Centre will open in September 2000 within the Quiet Healing Centre in Auroville, South India. It will be the second centre of The Gardens, a global visionary project of healing through the art of midwifery.

A natural health centre, Quiet is set on a beautiful seven acre beach front on India's Coromandel coast. Therapies at Quiet include classical homeopathy, physiotherapy, polarity, pranic healing, metamorphosis therapy, yoga and meditation. It is also the first place in Southeast Asia to also offer aquatic body and aqua natale work.

A small maternity section with two rooms and tubs available for waterbirth will be the heart of the Aqua Natale Birthing Centre. It will offer a retreat-like setting for pregnant women and their families who want to spend 2-3 months preparing for and giving birth in a peaceful and sacred atmosphere.

Intercultural learning and understanding in the field of holistic childbirth is another aim of the project. Students and midwives are welcome to stay and work at the site.

For more details, please contact Sabine Neumann, phone /fax: +49 561-103220; e-mail: zapdawoed@aol.com.

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8) Australian Birth Activist

Australian natural birth advocate Henny Ligertmoet, known the world over for her tireless battle for birthing rights over the last fifty years, is very ill with cancer. Friends and supporters who may wish to see Henny one more time should do so now. Letters, faxes, emails and cards would be greatly appreciated and should be sent soon so energy can be given as quickly as possible.

Henny is our grandmother of birthing rights. She has been working internationally for homebirth and natural birth for most of her life. She worked with Grantly Dick-Read, author of "Childbirth Without Fear," and was instrumental in making his work internationally known and in making sure it had an impact on the medical establishment. She has written two books, and newspapers worldwide regularly receive her letters to the editor. She spoke at the last international conference on homebirth and at the last national homebirth conference in Australia. She is the bane of the medical establishment in her relentless fight for birthing rights and her endless letter campaigns.

At this stage there is no conventional treatment for her condition; Henny is hoping to use alternative methods to both heal and to help ease her discomfort. This of course takes money, and Henny has little savings and no health insurance, which means she has to rely on the public hospital system and waiting lists. Henny would appreciate any kind of support or financial donation. It's time to give back, and Henny is believing that miracles happen.

- Sam Weinstein

Send postal mail to PO Box 286, Melville, Western Australia 6156, Australia; fax to 08-9339-5630; email using her son's address at dlanor@albanyis.com.au.

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Mark-It Television offers a full range of midwifery training videos covering breastfeeding, home birth, exercise and massage. Our programmes are endorsed by leading figures in the medical and healthcare professions. Websites: www.omikron.demon.co.uk/markit or www.markittv.com

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9) Switchboard

[In response to the request in last issue's Switchboard]: The highlight of a day spent in Dublin was the time I spent with Katherine MacQuinllan, director of the maternity ward at the National Maternity Hospital in Dublin where the Dublin experiment of active management of labor (AML) began.

I had been so appalled at our interpretation of the study that when we in the US began to 'follow their lead' in active labor management I looked into the original information a bit further and found then what Katherine stressed to me: there was more to active labor management than Pitocin. According to Katherine, there are five main principles to AML: 1) antenatal education; 2) personal attention for all women in labor; 3) correct diagnosis of labor; 4) early correction of inefficient uterine action; 5) audit your results.

Only when the cervix was completely effaced and dilation started were the women admitted and constantly and consistently given care by a midwife and Pitocin used only if there was a minimum of an hour of failure to progress. When that occurred, Pitocin was administered earlier rather than later when the uterus was tired and wouldn't respond to the augmentation appropriately.

Their statistics: out of 850 births per month they had a 11% c-section rate with a 50% epidural rate that was on its way down. All had the consistent, constant attendance of a midwife. Hospital stay is 4-5 days for a vaginal birth and a day or two longer for a surgical birth. Maternity care is free to the patient.

Primip rate for oxytocin is 50%; multip rate is 11%; overall rate is 29%.
Epidural rate for primips is 65% and 40% for multips; overall rate is 50%.

- Linda Jenkins, RN

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Share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com

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10) 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:

- Postpartum hemorrhage (Aug. 27)
- Herpes (Sept. 3)
- Circumcision (Sept. 10)
- Preeclampsia (Sept. 17)
- Breastfeeding (Sept. 24)
- Vitamin K (Oct. 1)

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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11) CLASSIFED ADVERTISING

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