I AM A MIDWIFE WHO ATTENDS TO THE NEEDS OF WOMEN BIRTHING
IN THE HOSPITAL. I find that many "modern" (i.e. dot.com)
American women and a large percentage of my Chinese immigrant women
have difficulty recognizing and validating their strength and power
in the process. I think the midwives who attend the [Midwifery Today
Eugene] conference probably identify the same problem, especially those
whose client have the good fortune of being cared for by midwives by
virtue of showing up at a clinic that midwives attend and having no
knowledge of the issues of philosophy, etc.
I would find it useful and interesting to include "ways
to inspire confidence and a sense of the inherent power and brilliance"
of women into the section on women who care for women in the hospital.
I work hard at this endeavor every day, but because our presence is
diluted by all the non-midwives who work in the "institutions,"
I find it draining.
Your conferences are restorative and invigorating. However,
I also feel a sense of disappointment or frustration because I don't
attend homebirths and the most glorious stories usually are from homebirths.
I fully support homebirth and would love to see a movement to take normal
birth out of the hospital and into the home. There are women who don't
have a home suitable for homebirth--they live in what the Chinese call
"pigeon houses" where many families share a common bathroom
and kitchen, are often alone and unsupported. I hope there will always
be midwives willing to attend these women in the hospital.
There is a strong need to remind midwives why they are midwives
and ways of bringing those midwives back to the fold.
Dear Zora, sister midwife,
Please join the movement to take NORMAL birth out of the
hospital and into the home where it belongs! That is the first step
to empowerment of your clients, by empowering yourself to autonomy.
You don't have to practice in the home to help those of us on the frontlines
of midwifery. Every person you meet and with every opportunity, tell
them how safe birth is in the home in the hands of a trained midwife.
Let your legislators know. We midwives are excellent at what we do,
and not validated or appreciated by the medical community at large.
This movement starts with the midwife in the mirror...me.
The real issue, having practiced in hospital and in home,
is that midwives lack autonomy. If we don't get a letter from a physician,
or a collaborative agreement, or signed protocols depending upon the
state you practice in, you can't legally practice! That leaves too many
of us open for prosecution and harassment every time we safely transport
a client to the hospital. It takes a strong woman to be a midwife, to
withstand the poverty, (homebirth is not volume oriented, and therefore
doesn't reap a lot of financial gain in the rural areas of our country),
the accusations, harassment from the medical community, the clerks who
file the birth certificates and keep changing the way they want a birth
certificate filed. It's disheartening! So please join us by helping
to pass legislation for midwives to actually practice their profession
so we don't have to go through "medical gates" in order to
practice our skills. I don't need a physician to tell me how to practice
within my scope of practice. I need him for my high-risk clients, for
prescriptions, etc. What good is this $30,000 master of science degree
that we've worked hard for, that we place on our walls, that we value
so much if we can't practice without "signed" physician's
And--help us win the hearts of doctors. Let's get homebirth
out in the open. The physicians in the 200 miles surrounding me are
scared of lawsuits, afraid of what their peers will think, afraid their
liability insurance will be cancelled and they won't collaborate. There
is a lot to be changed. Be a change agent; help the midwives gain their
autonomy. Help midwives, CPMs and CNMs become a cohesive group that
works together and honors each midwife's skill and trade.
- Sandra Stine, CNM
(Editor's note: Sandra's was the only response to Zora's
letter we received at E-News, despite the fact the question ran for
several issues. Hospital midwives, or homebirth midwives, do you have
something to add? Please send your thoughts to email@example.com)
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Midwifery Today's Online Forum
I would love to know why society still has such hangups about breastfeeding.
Why is it that, as a breastfeeding mum of a 12 month old, people feel
compelled to come to me and tell me "isn't it time to wean him and
get your life back." It is a perfectly natural method of nurturing
your child and has been done for hundreds of years. The time we spend
nurturing our children in this way is really such a small time in their
life; does it really matter if we prolong it as long as we can? It's my
choice and it is my life right here right now--I don't need to get back
a life I already have! I know I won't be doing it forever; why can't people
realise that and mind their own business? I think there are a lot of people
out there who need to get a life and keep their noses out of everyone
else's. Anyone else out there have any thoughts/experiences on this? Cheers.
- Jeannine RN/CM "MUM"
To share your thoughts and experience, go to Midwifery Today's Forums.
Question of the Week
The news article on HIV testing and false positives [Issue 2:44] was
really frightening. Do all midwives require an HIV test?
Send your responses to:
Coming E-News Themes
1. PRECONCEPTION COUNSELING: What do you tell the aspiring parents who
ask you for preconception services/advice?
(Thanks to Sarah, an E-News subscriber, for this topic.)
2. CHARTING CAN BE AS UNIQUE AS EACH MIDWIFE'S CARE. Do you have charting
methods you would like to share with E-News readers?
Send your responses to:
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!
QUESTION OF THE QUARTER for Midwifery Today magazine
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001
Send your response to:
Some of Connie, Filipina/author, apprentice midwife San Jose,
CA 's ideas on placental physiology are a bit reversed. The placental
maternal circulation is an arteriovenous shunt (ie no capillaries) thus
it is a very low resistance region. The blood volume, cardiac stroke volume
(i.e. amount pumped each beat) and pulse must all increase to compensate
for this, not the other way around.
And still bashing those poor meddlesome doctors for their third stage
management????? I hope they'll still be there when you really need them.
- Phil Watters
In response to Nikki Lee's question regarding infant mortality and morbidity
rankings [Issue 2:51]:
- She should find all the information she requires on the World Health
- UNICEF has a publication called The State of the World's Children 2001
that provides this information. You can view it at:
- Anita Jaynes, RN, SNM
For Ana Montero, I applaud her wonderful work in Peru [Issue 2:50]. I
bless her efforts. I think this is a fairly important correction to make
regarding Varney. I believe Varney states to NOT massage the fundus before
the placenta is delivered. I have not gone back to look it up to be absolutely
certain what Varney has actually stated in the latest edition.
Ana, you were right in your assessment to NOT massage the fundus prior
to birth of the placenta. Massaging the fundus prior to detachment and
delivery of the placenta can exacerbate postpartum hemorrhage and create
improper detachment of the placenta. So save your massaging until afterward.
Whether Varney is clear on this subject or not, I am glad that your heart
knew not to follow this advice.
- Sandra Stine CNM
[Re: Peru story] There are many paths that all lead to the same conclusion....Congrats
to a brave new midwife with extremely limited resources.
- Phil Watters OBGYN
I was always taught years ago that Pitocin should NEVER be given before
the placenta. So I was quite surprised when my consulting OB suggested
I run Pit very slowly in her IV to help a placenta that still wasn't out
after an hour (she wasn't bleeding). After another hour he came and manually
removed it with great difficulty. But everything was OK. So years later
when I encountered another stuck placenta I went ahead and did the same
thing. After waiting a while I tried to manually remove it and found the
cervix had closed down to a tight 5 cms. I called the doc in and he manually
removed the placenta with success. I remember realizing with surprise
at how quickly the cervix closed down and what would have happened if
it would have completely closed? Anyway, I would give Pit only very judiciously
in the future for that reason.
- Mary Ann Durbin
I would welcome the responses of my fellow readers:
I am a doula who specialized in working with women who wanted VBAC. I have suspended my practice because of the brutality I witnessed by a doctor
at the last birth I attended. All VBACs in this area are in-hospital births.
The last one was "successful" in that the baby was healthy and
the mother did have a VBAC after having had two c-sections. However, the
treatment she received at this doctor's hands was horrible and unnecessary.
After sharing information with the husband (during the labor), I was told
that if I made any more comments, I would be ejected from the hospital.
I vowed never to attend another birth at that hospital, but have found
that I cannot effectively practice anymore. I cannot separate my feelings
sufficiently from my client's, to where I risk infecting her with my anger
and mistrust. Has anyone else had a similar experience and what did you
do about it?
Is it routine for epidurals to be administered for a cerclage, the procedure
where the cervix is stitched shut in order to halt preterm birth?
- Amy Jones
I am curious about fibroids during pregnancy and what to do after the
baby is born. A friend is in her sixth month and has fibroids. After the
baby is born they plan to remove the fibroids right away. Is there any
way to manage the fibroids and/or herbs that will help dissipate them
Don't make your laboring mums take giant steps [Issue 2:51] if they feel
it is too hard to do. It's not good for the labor. First of all we learn
FROM the women.
- Claire, home midwife FWI
I am a midwife who suffers from Hashimoto's thyroiditis and am wondering
if anyone has had the experience of caring for a woman with Hashimoto's
antenatally and postnatally. What sort of neonatal care was necessary?
Re Issues 2:45 and 2:50 about hemorrhage: I came upon the very beautiful
and wonderful book "Creating a Joyfull Birth Experience" by
Lucia Capacchione Ph.D., A.T.R., and Sandra Bardsley R.N, F.A.C.C.E.,
that presents a very creative way of dealing with complicated situations
(hemorrhage, failure to dilate, etc.) through prenatal "creative
journal work." It is a method that works to get the mother (and father)
in touch with inner physical and mental processes, and it gives a special
creative place to discover and heal fears, pain, problems, and emotional
strife about birth. With hemorrhage, for example, there is a very simple
exercise that the mother does: every time she squeezes the liquid out
of a sponge, towel, washcloth or whatever, she thinks, This is what I
am going to tell my uterus to do after the birth of the baby. For preventing
perineal tears, there are several visualizations as well as an exercise:
run fingers/thumbs along the perineum, and along the thick ligament as
well, using vegetable oils (olive, vit E, etc.) or a water-based lubricant,
applying slight pressure until the point of slight burning sensation.
This should be done often, every day, by mother or father, as part of the preparation ritual, and very positive results (stretchy flexible perineum)
are seen in a few weeks. I strongly recommend this book to parents and
all birth practitioners!
- Megan Aiyana
I am a student midwife. I would appreciate your readers' comments on the following:
1. Relationship between lunar cycles (full or new moon) and the initiation
of childbirth. I did a comprehensive literature review, and found that
a) many published empirical studies have poor methodology; b) the results
from different studies contradict each other. From my reading it appears
that lunar cycles could indirectly influence the initiation of birth through
the moon's effect on the weather and therefore on the barometric pressure
which has been frequently found to correlate with the rates of childbirth;
also through the effect of light on the release of hormones. Most of the
studies were carried out in teaching hospitals in large cities, but the
relationship--if there is one--should be much stronger in rural/nonindustrialised
I would very much like to hear practising midwives'/other experienced
professionals'/mum's etc. observations and opinions on the subject.
2. Does anyone have experience of using hypnosis and/or music therapy
in maternity care, especially--but not only--as a method of pain relief
I'm not sure what to make of [the comment on a vertical cesarean incision
(Issue 2:51)]. Not all cesarean sections were "classical" even
44 years ago. The VBAC debate today is about transverse incision ops.
The risks for VBAC after vertical uterine incision are just too great,
and I think most mothers would agree. But it shouldn't come up as CS is
(with VERY rare exceptions) transverse (ie lower segment) these days.
- Phil Watters
Although vitamin C may make tissue stronger and decrease the chance of
stretch marks in pregnancy [Issue 2:51], it can also cause miscarriage.
Vitamin C is a strong emmenagogue and an implantation inhibitor, therefore
taking vitamin C can prevent conception or cause a miscarriage. I would
ask that women seriously look into the side effects of any foods or herbs
before using them during pregnancy. So many things that are deemed safe
can be dangerous to the baby.
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