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Volume 2 Issue 33 August 16, 2000
Aspiring and Apprentice Midwives
Code 940

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

- Birth Works Inc.
- Moon Willow Herbs
- Natural Medicine Newsletter
- Waterbirth Website

Look for their ads below!

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Learn what you have in common with your practitioner peers around the world at Midwifery Today's international conference in New York City in September!

For all the information you'll need:
www.midwiferytoday.com/conferences/newyork2000

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.

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Send responses to newsletter items to mtensubmit@midwiferytoday.com

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Aspiring and Apprentice Midwives
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
8) For Coming E-News Themes
9) Switchboard
10) Classified Advertising

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1) Quote of the Week:

"After I had completed my third book about birth, I began waking up with my hands stretched out in front of me as if I were receiving babies. I have to do this. It is time."

- Nancy Wainer Cohen, 1997

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2) The Art of Midwifery

Urinary tract infection: Avoid strong kidney irritants such as juniperus spp.; choose botanicals that act as demulcents, urinary astringents: zea mays (cornsilk), gallium aparine (cleavers), althea officinalis (marshmallow), equisetum spp. (horsetail), mitchella repens (squawvine), arctostaphylos uva ursi (uva ursi); urinary antiseptics include allium sativum (garlic), thymus vulgaris (thyme).

- Mary Bove, ND,
The Birthkit Issue 20

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To subscribe to The Birthkit, Midwifery Today's between-issues quarterly newsletter, go to: www.midwiferytoday.com/birthkit Save $3 if you subscribe to both The Birthkit and Midwifery Today magazine. Please mention Code 940.

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Share your midwifery arts with E-News readers! Send your favorite tricks to mtensubmit@midwiferytoday.com

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3) News Flashes

A recent study shows a link between douching and low birth weight babies. Data collected from 4,665 American women showed that almost 10 percent of those who douched regularly delivered babies weighing 5.5 pounds or less compared with about 6 percent of women who didn't. The risk was even greater for those who douched daily than for those who douched monthly. Douching may push existing vaginal infections into the reproductive organs, ultimately causing preterm labor.
(American Baby, July 1999)

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4) Aspiring and Apprentice Midwives

If you are thinking about becoming a midwife, identify your goals. Do you want to attend homebirth or do you want to make a difference in the hospital? What level of income do you need? What educational opportunities do you have near home? Are you willing to travel? Can you afford the time required of an apprenticeship education and the slower paced practice, or can you handle the expense of a university-based education? Are you aware of what financial aid is available?

Attending Midwifery Today and MANA conferences as well as ACNM conferences will provide opportunities to interview midwives from all pathways. Understanding the questions and getting answers before you make your decision will lead you to the greatest fulfillment of your dream.

- Diane Barnes, in Getting an Education: Paths to becoming a Midwife, a Midwifery Today Book

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E-News asked readers: In two to four sentences, what is the best advice to give an apprentice or aspiring midwife?

Advice to an aspiring midwife: Research your options as long as it takes to find just the right package of academic learning, preceptor(s), practice style and location. Don't settle for second best. Then, enjoy the ride!

Advice to an apprentice: Be willing to express your needs and willing to hear and meet your preceptor's needs. Give as much as you get and appreciate the balance.

Extra advice to a preceptor: Give everything you have of enthusiasm and knowledge to any deserving apprentice you commit to. "Midwife" her through to the time she can confidently and safely stand on her own. Engage your clients from the beginning in your commitment to teach your apprentice. Most will be very generous in allowing hands-on.

- Anon.

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Go slow enough in the childbirth field to be comfortable at each step (Ex. childbirth educator, labor coach, doula, birth assistant, midwife)

- Realize that the pursuit of midwifery, if you are planning to become a knowledgeable and prepared midwife, is expensive and very time consuming. Allow approximately 4-6 years to grow to the point of attending births as the mother's primary or at least 50 homebirths with a more experienced midwife.

- It is a great blessing in your life to be at a woman's birth; appreciate it and her for sharing the most intimate experience in her life with you.

- Renata Hillman, birth attendant since 1982

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I encourage my apprentices to train with as many midwives as possible. We all have such different styles and flavors and I feel they will be more balanced that way. They will be able to see what their style is more naturally, too. Second, be creative with study time. I trained as a single mom of three boys and would go to the playground with my books to study while kids ran wild. If I could do it, anyone can.

- Lisa Hines, LM
South Carolina

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As a recent "graduate" of an apprenticeship, the best advice I could give to someone beginning this path is to keep a diary. [Make entries] after every set of prenatals, every birth, every postpartum visit. It is an invaluable guide to your own "birth" in this work. It will document not only your progress, but will show you just how far you've come, and how much you have learned.

- Christina Oertel, DEM, CLC

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Are you thinking about becoming a midwife? Do you have a friend who is considering this path? Midwifery Today' Beginning Midwives' Package is just what you need! Four audiotapes (Ina May Gaskin, Mabel Dzata, Elizabeth Davis, Valerie El Halta), one year of Midwifery Today magazine, and the Midwifery Today Book, Paths to Becoming a Midwife. You save a lot while you learn a lot!
Paths to Becoming a Midwife

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5) Check It Out!

~~~WWW.MIDWIFERYTODAY.COM~~~
A Web Site Update for E-News Readers

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AUGUST 1-7 is World Breastfeeding Week. Read "Breastfeeding: Food for Thought at
www.midwiferytoday.com/articles/foodforthought.htm
A NEW GLOBAL ORGANIZATION FOR MIDWIVES? Read about it at:
www.midwiferytoday.com/articles/worktogether.htm
www.midwiferytoday.com/articles/globalalliance.htm

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FREEDOM: Some compelling thoughts on what it means when you are a midwife:
www.midwiferytoday.com/articles/freedom.htm

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6) Question of the Week

A primigravida with spontaneous rupture of membranes at term had an uncomplicated pregnancy. The head was deep into the pelvis and one assumed that labour would progress normally. C. wanted a homebirth more than anything, and I was very happy to manage her expectantly. Twenty-four hours later, there was no sign of labour apart from a few niggles. I suggested various homoeopathics, nipple stimulation, walking on the beach, etc. and monitored her temperature, pulse and foetal heart. Thirty-six hours after SRM, labour started courtesy of her husband suckling her nipples. On examination the cervix was a soft, stretchy 5 cm with the head well below spines. Good, I thought, we're on our way. All the time, she kept eating and drinking, resting when she felt like it, but still the contractions never became coordinated.

Reluctantly, I examined her six hours later to find the cervix 7 cm dilated. A further six hours down the track, she was still the same. I suggested it was time to consider going to hospital for oxytocin augmentation, and very reluctantly they agreed to transfer in. Three and a half hours later, she had a normal birth, no pain relief, moderate blood loss and they all went home. Postnatally, her fundus had almost completely involuted by the third day! I'm baffled as to why her uterus was so inefficient in labour, yet super efficient afterward. Any suggestions?

- Sharon Weir
New Zealand

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Send your responses to mtensubmit@midwiferytoday.com

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7) Question of the Week Responses

Q: At a recent birth we could not hear fetal heart tones with a fetoscope once the head was on the perineum (approx. 35 minutes). Although the scalp was always pink and mother reported fetal movement approx. 3 minutes before birth, baby was born limp and made no respiratory effort. His color was pink at birth and heart tones were always over 120 bpm. We initiated neonatal resuscitation and called EMS and baby was subsequently transported to hospital. Baby was off respirator and breastfeeding by day two and home by day six. Parents informed us that ultrasound, EEG and CT scan on day three were normal. A complaint was subsequently filed by the College of Physicians which stated that "the baby is brain damaged as evidenced by the CT scan."

1. Is there any literature/research out there to justify or confirm that a pink scalp along with fetal movement when the head is presenting is an indicator of fetal well-being?
2. Can a CT scan tell if a baby is brain damaged?

- Anon.

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A: First, with the parents' permission, I would find a friendly and midwife-supportive M.D. and have him analyze all the test results or have them analyzed. In my experience, some are still on a witch hunt and overly zealous about it. And I must wonder if they could or would have done any better for this baby during the birth or afterward.

Your question inspires more questions: Is the baby really brain damaged? Did they do their job well? Are you certain of your timing--how long was baby without oxygen (leaving the cord intact until no longer in use is always helpful), and did the EMS administer it promptly? Was the baby ever not "pink"? Did the hospital delay oxygen while intubating (always a tricky question)? Did they administer harmful drugs or vaccinations too early (can cause brain cell damage very quickly.) Who handled the baby after he/she was in medical care? Were they gentle? How does baby seem now?

- Anon.

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8) For Coming E-News Themes

1. What have you learned both by research and experience about the effects of labor drugs on the baby? Midwifery Today has just learned of a newborn death due to morphine having been given the mother for pain.
2. What do you know and/or suspect concerning the use of rhogam, that is outside the medical paradigm?

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**Take part in E-News! Sound Off-Give Advice-Share Your Knowledge!**

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Send your responses to mtensubmit@midwiferytoday.com

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Know a strong woman? Helping empower one? If you haven't already done so, please forward this issue of Midwifery Today E-News to one or two of your friends or business associates. Thanks so much!

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9) Switchboard

"There is sort of a chemical 'combination lock' that starts labor. Everything has to be lined up just right to 'unlock' a good labor pattern. When we interfere with that, it can be as frustrating as using the wrong combination of numbers to open a locked safe." -Gail Hart, CPM, The Birthkit, Autumn 2000 (Midwifery Today)

In this issue of The Birthkit there is an article on postmaturity by Dr. John Stevenson of Australia. In l,l90 bookings for homebirths (eight-year period) he had l06 babies with a longer gestation than 42 weeks. Three went to 48 weeks, "a few more" went to 46 weeks, and lots went to 44 weeks. All the 106 past 42 weeks fared very well. This was a well fed, healthy, motivated group of women.

The other thing Dr. S. says in this article that is interesting in light of recent discussions in E-News is, "I should also mention that I tend to disregard meconium as a supposed sign of foetal distress, because of other possible causes, for example, if the mother took laxatives." I recommend ordering this issue of Birthkit from the Midwifery Today website (www.midwiferytoday.com ).

- Gloria Lemay
Wise Woman Way of Birth Courses
http://www.birthlove.com/pages/wise_woman.html

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More on nutrition:

In counseling pregnant clients I often tell them that eating well is the single most important thing they can do for themselves and their babies. It's more important than the prenatal vitamins they are so conscientious about. It is more important than virtually any other thing they have control over. I encourage them to carry good, high protein snacks and a bottle of water with them everywhere. I always have clients fill out a diet sheet. More often than not, our homebirth clients are very tuned into their bodies. It is only rarely that we need to do intensive counseling; more often it is reviewing the things they already know.

- Christina Oertel, DEM, CLC

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[Nutrition] is a growing problem with our clients, most of whom are recent arrivals from South and Central America. It's like they've arrived in burger & fries heaven. Added to that, most of the employees at the fast food places in this general area are now Hispanic, so there's lots of "take home" by well-meaning friends & relatives. And we wonder why we're seeing more GDM & "pre-eclampsia." We also get frequent complaints about the baby not moving "all day," and then learn that she hasn't eaten anything in the past four or five hours (and nearly all our mothers are receiving WIC, by the way).

Also, these mothers tend NOT to drink much water or other fluids, so we frequently see urine the color of apple juice when a woman comes in complaining of cramps. Two or three pitchers of water later, she's "cured." Not surprising, considering what I've been told about the water in some of their countries.

I try to keep it simple for all of us (with my broken Spanglish) and emphasize "two eggs and two litres of water every day," and that they MUST eat something every two hours.

- Gabrielle
Westchester County, NY

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I was under considerable stress and time constraints during my last pregnancy, with three other children and my dh out of town for several weeks. My midwife suggested I order out from good restaurants, using them much like fast food restaurants. I used the salad bar at my local grocer and ordered take-out from several local restaurants with quality menus, thus avoiding the drive-throughs, and at times, ordering double items and freezing it for future meals.

- Anita W.
AAMI student, Missouri

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Surely Jennifer is joking in her question about not using rhogam [Issue 2:31]. Anyone who has ever seen what can happen to the fetus of an RH negative mother would never suggest it might be avoided. I have never seen any information about the negative aspects of use and would suggest that she talk with women who had babies in the time when RhoGam was not available or to the care providers for these women. Not all advances in obstetrics over the last 40 years have been bad ones!

Obviously the only time RhoGam is not indicated is when both parents are documented as Rh negative. There are some who feel that if there is any question regarding paternity, give it anyway.

- Maggie, CNM

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For information regarding anti-rhogam try looking at articles written by Sara Wickham, a lecturer in midwifery in the UK and also Midwifery Today's UK contact. [Also] try the UK journal, The Practising Midwife.

- Vicky Everitt, 1st yr direct entry student
Essex, UK

[Editor's note: Please refer to articles by Sara Wickham in Midwifery Today Issues 46 and 53. To order, go to:

http://www.midwiferytoday.com/Magazine/backissues.htm#backissues

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Unless otherwise noted, share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com. If an e-mail address is included with the letter, feel free to respond directly.

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10) Classified Advertising

Birth, Breastfeeding & Beyond: 8th Annual BEST Connection Conference October 5-6, 2000 in Lewiston, Maine Four speakers, including Ina May Gaskin and Ellie Daniels For complete brochure, e-mail: best@wtvl.net or call (207) 877-9109

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