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In This Week's Issue:
1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Midwifery and Birth in Remote Areas
5) Check It Out!
6) Question of the Week
7) For Coming E-News Themes
1) Quote of the Week:
"A woman gives birth according to the way she is and how she feels about herself. Knowing herself and being supported by women who know her helps her go through her birth in a growing way and have more confidence about how she takes care of her children afterward."
- Leah Qinuajuak, Inuit midwife
2) The Art of Midwifery
One day I heard the head of obstetrics at our local hospital say,
"The best pelvimeter is the baby's head." In other words, a head
passing through the pelvis would tell you more about the size of it
than all the calipers and x-rays in the world. He did not advocate
taking pelvic measurements at all. Of course, doing pelvimetry in
early pregnancy before the hormones have started relaxing the pelvis
- Gloria Lemay, Midwifery Today Issue 50
Share your midwifery arts with E-News readers! Send your favorite
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3) News Flashes
Fetal behavioral states (FBS) in normal pregnancies after 41 weeks as
compared to control term fetuses were studied to determine clinical
management. All subjects underwent a behavioral study using
cardiotocography to record the heart rate, and two ultrasound
scanners to observe body and eye movements. The median percentage of FBS known
as "awake states" increased significantly from 6% in the term group to 21.5% in
the fetuses after 41 weeks. FBS "quiet sleep" and "active sleep" decreased from
92% to 78%, thus indicating increasing wakefulness in utero. The fetal heart rate
patterns showed large amplitude, prolonged accelerations that fused into a sustained
tachycardia with only short periods of return to the baseline,
resembling tachycardia with decelerations.
The study concluded that in normal pregnancies after 41 weeks, the
development of the fetal central nervous system continues, resulting
in an increasing percentage of "fetal wakefulness." The
cardiotocography patterns that result from these behaviors can easily
mimic fetal distress, and practitioners should be aware of this
- Early Human Development, Dec. 1994 as reported in MIDIRS, June 1995
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4) Midwifery and Birth in Remote Areas
An E-News reader asks: How do we help women in isolated communities birth with
dignity and freedom, trust themselves, and not be separated from their families?
Who in their communities will provide
midwifery services and how will they go about doing so? And what can
we do to help? Where do we start?
This is an issue that has and continues to affect many women in
northern and remote areas of Canada. It is difficult to attract
caregivers (physicians, nurses, midwives, etc.) to communities
outside the urban centers. The long hours on call, difficulties in
transporting in poor weather, poor financial incentives and isolation
from professional peers and backup are all factors.
If all of one's training and experience has been in a large centre
with quick access to specialized help, it is pretty scary to be the
sole responsible practitioner "north of 60" with a 28 week pregnant
teen who you think may be having an abruptio placenta. Oh, and by the
way, there's a blizzard and no transport available for a week until
the weather clears, no O.R., no ultrasound and no blood bank. So
before we condemn the caregivers for wanting to ship every pregnant
woman out of town, consider the whole picture.
Fortunately, there is an awareness of the stress to families of
routine evacuation of pregnant women "south" for their births, and
solutions are being sought. In northern Quebec the Puvirnituq
midwifery training project continues to train Inuit women to care for
birthing women in the north. Their outcomes are excellent and a
second birthing centre is now operating in the Inukjuak Health
Centre. Students from the McGill University rural medicine program
spend some time with the midwives while doing their northern
rotation. This helps spread the message that birth in the communities
can be a safe option.
In B.C., the British Columbia Reproductive Care Program recently
sponsored a Rural Obstetrics Conference with representation from
medicine, nursing, midwifery and consumers. They have drafted a
Consensus Statement supporting birth in rural and remote communities.
This is an evidence based paper that supports birth in communities
with no c-section capability for first and second time moms, among
If trying to establish or maintain a rural birth service, I would
recommend the BCRCP consensus paper as a solid tool to convince
administrators and policy makers. It was used to good effect in our
rural community (where the two midwives are the only perinatal
caregivers) to establish communication protocols with larger centres
and to support our ongoing home and hospital birth practice.
Dialogue, positive energy and respect are the keys to getting
everybody on board. Birth "in the sticks" is a safe option for women
We experience the same dilemma in the Highlands and Islands of
Scotland. It probably exists in many other isolated communities
worldwide, and there are no easy solutions.
Some thoughts for this midwife are:
- Get together with other midwives practising in remote, rural, and
isolated areas--by phone, email, newsletters, whatever--for mutual
strength and support, sharing of professional models and strategies
relevant to this type of practice (which is so very different from
city/town/large hospital practice).
- Develop skills and knowledge to be able to provide midwifery care
appropriate to remote practice. Only then go out and offer care
confidently to the women.
- Recognise and foster the abilities of women in remote areas to
evaluate their well being and that of their babies, with you as a
teacher and interpreter and not always a "hands-on" practitioner, as
hands-on is often not feasible where vast distances are involved.
Remote & rural midwifery practice in developed countries is a unique
experience. I would welcome further correspondence to enrich the
ongoing Scottish dialogue.
The question you've asked does not, it would seem, have an easy
answer. I live in a remote community and have chosen to birth here
myself as well as support birthing women. That there is a
homebirthing community in this area is a very big bone of contention
to the majority of the recognised perinatal caregivers of the
surrounding areas. A significant factor is that the closest hospital
is two hours away (unless one is flown in by helicopter). Still,
there are people who are going to birth here, and do birth here, no
matter what, as long as there are no health risks (and very
occasionally even when there are).
As a busy mother, particularly one who has had a previous homebirth,
there was no way I was able to leave my community even if I had
wanted to (which I didn't). I was, of course, very well informed
regarding my choice and the logistics accompanying it, and I see this
as a very important part of helping women here. I have also been
around the hospital system and more medicalized practitioners a fair
bit and I do understand where the concern comes from. If
practitioners in this locale don't have any concern at all then they
are living in a fantasy world.
I also see how, when one's training has consisted of the fear-based
tactics of the medical model as we know it, one could be a whole lot
more concerned than is necessary. To empower birthing women in these areas we
must be straight up about the realities, focus strongly on
prevention and on maintaining excellent health/nutrition, and truly
believe in our hearts that birth really is a normal physiological
Women providing care in these areas must be courageous and strong,
particularly if they are working outside legal parameters. We must
bridge the existing gaps, strive to build communication, and work on
making the priority the birthing community, not the political agenda.
There is so much more I could say but this conveys my general feelings.
Midwifery Today Issues 40 and 42 include an excellent two-part
article on the Inuit of Northern Canada from the perspective of a
community midwife who has worked with them. After presenting an
analytical framework that shows how some types of logic can be
supervalued while others are devalued or ignored, the author tells
the story of one Inuit settlement's attempt to reintegrate the
authoritative knowledge of the community by supporting Inuit midwives
as they choose their own criteria for decision-making in birth. Issue
40 also includes stories and articles by Inuit women.
5) Check It Out!
A Web Site Update for E-News Readers
DRUM ROLL...PUH-LEASE....(this time we really mean it!) We are proud to introduce
our online Mother/Baby/Environment Friendly Product and Services Directory! (Whew,
Say that ten times--fast!) Come give us a gander! Shop at the Birth Market!
The Birthing Ball is a fitness/therapy ball that has many uses during
pregnancy, labor and birth and life beyond! It is a great comfort
tool that can be used during pregnancy, helping relieve many
discomforts such as backaches, headaches, tension, anxiety, aching
legs and difficulty sleeping. It facilitates correct posture and
physiologic positions for labor.
It is also helpful to women, men and children who are required to be
in prolonged sitting positions. They make a unique gift for the
expectant mama, and a great addition to a labor assistant's birth
bag, expectant parents "goodie" bag or for others wishing to use them
for exercise, relief of back pain or for posture improvement. Weight
capacity of the balls is 660lbs+.
Visit my website for more information:
Are you mourning? Do you know someone who is? Read about a comfort measure that
is available to soothe a broken heart. Grieving Bags by Allie Alden:
"I am a mother of 14 children. I wanted an upright birth for my last
birth, so my husband went to work. He has a woodworking business
making gliders for the home. With some designing and input from
others he made a glider for laboring and birthing mothers. Later the
midwife (Susan Stapleton,CNM, from Reading Birth and Women's Center) had a birth
stool idea from a European trip. The glider wasn't
transportable for homebirths; would Steve make her a birth stool?
Again, with input and design from others, the birth stool came to be.
Now we want to share them with others to benefit from too!"
Ebersole Birth Stools by Steve's Woodworking:
I began Expectancy Resources to fill requests from other childbirth
educators for materials developed for my own classes. After 29 years
as an OB/GYN nurse and 28 as a childbirth educator, new ideas are
always welcome! Wishing health and happiness to you and all those whose lives
you touch, Judy O'Connor, RNC, BS, LCCE, FACCE , Expectancy Resources:
MotherLove, Inc. -Doula services, training programs and postpartum training manual:
Nurturing Beginnings is the first comprehensive postpartum training
manual. Join Debra and Jane as they take you through their journey
and into your own as you explore what it means to be "in service of a
postpartum woman and her family."
Nurturing Beginnings contain 12 modules: (These modules correspond
with our 12 module on-line course available at SUNY, but will be of
value with any doula training.)
- The role of the doula
- Home visiting
- Providing care with caution: Protecting health and safety in the home and car
- Honoring postpartum women and teaching self-care
- Easing postpartum adjustment
- Appreciating your client's cultural diversity
- Supporting the breastfeeding mother
- Newborn basics: Appearance, behavior, and care
- Offering support to partners and siblings
- Unexpected outcomes: Caring for the family at a time of loss
- Nurturing yourself
- Pursing professional development and building your practice
[Editor's Note, April 17, 2007: Stony Brook University's School of Nursing notified us that they no longer offer this program.]
For more information about how to register for our on-line postpartum course, please contact:
Valerie DiGiovanni, School of Nursing, State University of NY at Stony Brook
Office: (631) 444-3481, Fax: (631) 444-3136
Visit us at www.uhmc.sunysb.edu/nursing
Orders now being taken for your copy of Nurturing Beginnings for $69.00 plus shipping at:
P.O. Box 2672
Eugene, OR 97402
Why learn about global midwifery? Find out at Midwifery Today's international conference in New York City in September!
For all the information you'll need:
Thank you to the following businesses for sponsoring the New York conference:
- 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.
6) Question of the Week (Repeated)
Q: What can you tell me about a tear in the placenta? A doctor diagnosed my friend with that three weeks ago, and told her to "take it easy." She is still spotting (off and on) and they don't seem to be too concerned about it.
- Stacy Watson
Q: A pregnant mother is expecting her fourth child. She says she loses a lot of hair after the birth of each of her babies. She wonders if there is anything she can do or take to prevent this from happening again.
Send your responses to email@example.com
7) For Coming E-News Themes
1. Who most strongly influenced the way you practice, and in what way(s)? (July 26 issue)
2. How do you counsel pregnant women about nutrition, especially in these fast-paced days of stress, little time, and junk food? (August 2 issue)
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so, please forward this issue of Midwifery Today E-News to one or two
of your friends or business associates. Thanks so much!
More on meconium aspiration syndrome:
Babies not infrequently pass meconium in the womb. Sometimes we can never find a reason, but sometimes it's a response to the stress of labor, a pinch in the umbilical cord or some other problem that causes a drop in oxygen levels. It used to be thought that this only became a problem if the baby breathed it into her lungs with her first breaths after birth.
For several decades a great deal of energy was focused on methods to
prevent meconium aspiration syndrome by developing better suction
methods after the birth of the baby's head. It was a great
disappointment when the incidence of MAS did not drop! Further
research showed that meconium aspiration *occurs in the womb* and not with those
first breaths (unless inappropriate resuscitation blows
meconium into the lungs). A baby born with MAS has already suffered
damage before he is born--our suction efforts have little effect.
Babies do normal breaths while in the womb. Under deep distress they
take deeper breaths--a sort of "last gasp"---and take fluid (or
meconium) deeply into their lungs. Our efforts to prevent MAS should
focus on the prevention of fetal distress in labor and on correct
suctioning/resuscitation techniques for the depressed newborn. Little
can be done to prevent MAS. It is a result of a serious problem in
labor--it occurs before anyone can prevent it.
The baby whose MAS started this discussion was born by emergency
ceserean. The deep fetal distress that prompted the cesarean also
caused the meconium aspiration. Being six days past the due date is
an entirely irrelevant factor. The baby passed meconium and breathed
it in *because* of fetal distress--he aspirated meconium before he
was born, not after. It was no one's fault--it could not be
prevented. Great medical treatment is providing the necessary support
while his lungs heal. He should recover without problems.
- Gail Hart, midwife,
Regarding pain at the pubis symphysis [Issues 2:26, 27, 28]: I
learned the following in a prenatal massage class:
With the woman reclining at a 45 degree angle, place her feet flat on the floor (or massage table if you have one). Start with her knees
slightly apart. Place your hands on the outside of her thighs and ask
her to press against your hands while you resist for five seconds.
Repeat this three times, each time allowing the knees to fall open a
little more. Then cross your arms and place your hands on her inner
thighs. Once again, ask her to press against your hands for five
seconds as you resist, and repeat three times. This is a passive
adjustment of the sacroiliac joint, then the pubic symphysis. There
should be little movement, but she should feel better. This can be
repeated if necessary.
- Teri Brickey, LMT
St. Louis, MO
When my daughter was born a year and a half ago, I had what seemed to be unusual,
uncontrollable pushing contractions (more than an urge)
starting fairly early in labor, I think at 3 cm or so. She was in a
posterior position and I had pretty severe back pain through the
whole labor, so my specific memory of elapsed time is a bit fuzzy.
What I most remember about the labor was how incredibly difficult it
was to pant through and try to hold back these very strong pushing
movements for hours, until I had dilated "enough." By the time I
reached 8 cm, my muscles were so fatigued from fighting the urge to
push that I had a lot of trouble getting them to cooperate to push
the baby out, which took another 2 1/2 hours. I have never read
anything about this pattern of labor, and the approach we took seemed
to contradict the "trust your body to know what it's doing" message.
Does anyone have an explanation? I'm expecting my second, and hope
not to have a repeat performance.
I haven't had any experience with Trisomy 18 in my midwifery
practice, but did care for a couple of women while I worked as an L&D
nurse. In both cases, the mothers needed a tremendous amount of
support and would have benefited emotionally by being in their own
home, in a loving, supportive atmosphere. My concern is that both
these women became very sick with toxemia. One wound up in intensive care with
central lines and the works, and almost died. I know that women who have babies
with chromosomal differences are more likely to have toxemia. If your mom wants
a homebirth, watch her very carefully to keep her safe.
- Joy Wayman
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