Apprenticeship
Apprenticeship learning involves the whole human being--body,
emotions, mind, spirit--and therefore is the most powerful form of learning
there is. We all learn to be full members of our cultures through this
kind of experiential learning. Pure apprenticeship learning is connection-based,
as opposed to didactic learning which can seem to take place in a vacuum,
with no apparent connection to anything.... Because birth turns out
well most of the time, apprentices attending home and birth center births
usually are not exposed early on to pathology, and have the time to
build a profound trust in the process of birth and in women's ability
to give birth. Their training gives them a much broader experience of the wide range "normal" birth can take when it is not technologically
controlled. The establishment of this kind of trust can have a great
deal to do with the relationship between the apprentice and her mentor.
I have interviewed a number of apprentices and mentors around the country,
and am always impressed by the special quality of their relationship.
Most mentors care deeply about the apprentices they take on, get to
know them intimately, become committed to making sure they obtain the
best education possible, and work to bolster the student's trust both
in birth and in herself as she learns.
The down side: Apprenticeship learning, because it is so
fluid, can be hard to evaluate for efficacy.... Pure apprenticeship
is only as excellent as the teacher and the student make it. If the
learner is not motivated, the greatest teachers cannot help her. If
the teacher is not a good teacher, the learner will be challenged to
obtain the needed education. There is the additional risk that the learner
may not be able to judge whether she is getting a quality, thorough
preparation.
Most experienced direct-entry midwives take very seriously their obligation
to mentor the students seeking to follow in their footsteps. But at
present there are relatively few experienced direct-entry midwives available
to serve as mentors. As their numbers increase, more student options
will obviously become available.
- Robbie Davis-Floyd, "Types of Midwifery Training: An Anthropological
Overview," in Paths
to Becoming a Midwife: Getting an Education, a Midwifery Today Book
The early stages of apprenticing involve a crucial letting
go of ego, a taking in, a quiet observing. Letting go implies release.
Release requires opening and in opening we become ready to receive.
Accept that you may not be at every birth. A couple's choice to have
or not have you present is not a personal ego judgment. You may know
as much as the next woman, but nothing is gained by talking the most
or the loudest. Pregnant intuition will see who you are, anyway. Letting
go of fervent desires to "be at the birth" doesn't imply apathy.
It does mean an emotional letting go of your ego involvement. Keep yourself
directed--study, learn, teach, share--with all your heart, but not your
ego.
Spiritual consumerism: "How many births have you attended?"
This is a very valid question at times, but it tends to promote a consumer
mentality--chalking up births like notches in a belt. The birthing woman
is thus depersonalized as an objective to be "won."....The
numbers game is also misleading. Most obstetricians have attended hundreds
or thousands of births but that doesn't mean I would want one at my
birth. It means they have rushed in for the last five or ten minutes
of labor of fifteen women a day for the past ten years. A midwife who
has attended only fifteen or twenty births may not have the exposure
to all the variations and complications labor can present, but I would
prefer the intensity and quality of care she may offer.
- Alison Parra, thoughts on the Apprentice's Path, in Paths to Becoming a Midwife: Getting an Education, a Midwifery Today Book
EACH ONE TEACH ONE has been Midwifery Today's motto
since Issue 1 of its print magazine. E-News readers, if you don't already
subscribe to Midwifery Today magazine and/or the Birthkit newsletter,
consider this:
Each issue of E-News provides midwifery knowledge but because
of space limitations and because the Internet and email are much better
suited to short "sound bites" of information, E-News can't
cover topics as thoroughly as our paper publications can.
Midwifery Today MAGAZINE is the definitive magazine about midwifery, and every
three months, it provides an excellent addition to your birth library.
Each issue includes a wonderful balance of experiential and research-based
articles. From prenatal care to breastfeeding, from homebirth to hospital
birth, Midwifery Today covers such important issues as woman-centered
care, informed consent, birth politics, birth technologies, and much
more. Each issue fosters an ongoing dialog among those in the diverse
community of midwives, from CNMs to CPMs to lay and traditional midwives.
It provides information on current "hot topics" in birth and
steppingstones to other resources. Its advertisers provide products
and services aimed specifically at the birth community and ties to resources
that are often difficult to find any other way. And each issue includes
a large section called International Midwife, with articles from midwives
around the world.
MIDWIFERY TODAY MAGAZINE is a must-have for every midwife,
from the student and apprentice levels to senior midwives and educators.
Midwifery Today inspires, teaches, and affirms your deep love of birth
and birthing women. Midwifery Today respects and values all midwives
and the right of birthing women to have informed choice and nurturing
support during the childbearing year. If you are not subscribing to
it, you are missing out. If you work with birthing women, you need this
magazine.
YOU CAN SAVE US$5.00 on a one-year Midwifery Today
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for all E-News subscribers. Offer ends February 15, 2001.
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Midwifery Today's Online Forum
I am 14 and doing a careers project at school. I have chosen midwifery
because that is what I want to be when I leave school. Could anyone give
me any information about the job or a good email address?
- Kirsty
To share your thoughts and experience, go to Midwifery Today's Forums.
Question of the Week Responses
Q: Has anyone had a mom who bleeds
excessively? This mom has done many herbal/vitamin supplements to build
her blood and still has a history of excessive bleeding prior to delivery
of the placenta. As her uterus clamps down to deliver the placenta, there
is a significant gush of blood. Pitocin has been the only thing her previous
midwife used that was effective, but I am looking for an herbal remedy.
- Robe
A: Read Midwifery Today Issue 48--it's the best book on hemorrhage I've ever seen.
- Jan Tritten, Founder/Mother of Midwifery Today
A: When I go to a birth I make a tea for after
the birth made of shepherd's purse (Capsella bursa-pastoris), cranesbill
root (geranium macalatum), beth-root (trillium erectum) with a touch of
cayenne. I mostly don't use it, but I know I have it there in case.
- Kusum
A: Shepherd's purse has been used medicinally
since the Middle Ages (Phillips and Foy, 1990). It is valued for its ability
to stop bleeding. The Eclectic publication "King's American Dispensatory"
refers to the plant's applications for chronic hemorrhages and menorrhagia
(Felter and Lloyd, 1992). It is particularly useful for childbirth hemorrhage
and excessive menstruation because it stimulates uterine contractions
as well as promoting vasoconstriction of the capillaries, stimulating
prothrombin production, and tightening tissue structure (Newell et al.,
1996). It is also valuable for treating varicose veins (Bartram, 1998)
and bleeding hemorrhoids (Belew, 1999). It was used in the First World
War to stem hemorrhage when nothing else was available (Blumenthal et
al., 2000). The British Herbal Pharmacopoeia (1996) attributes shepherd's
purse with the ability to stimulate smooth muscle and treat hemorrhage.
The active constituents of shepherd's purse include diosmin, the flavonoid
rutin, oxalic acid, and tannic acid (Duke, 1992a). According to Duke (2000),
the organic acids and rutin are hemostatic, and diosmin has been attributed
with capillary strengthening and antimetorrhagic properties.
Though shepherd's purse has a long history of use in treating postpartum
hemorrhage and excessive menstrual bleeding, clinical studies have not
been conducted (Blumenthal et al., 2000). Because of its purported ability
to cause uterine contraction, it is contraindicated in pregnancy and labour,
and is used only after the placenta is delivered (Belew, 1999; Campion,
1996). Excessive doses can cause heart palpitations (McGuffin et al.,
1997). There are no other known contraindications, and frequent dosing
is believed to be safe (Belew, 1999).
Shepherd's purse is a popular herb in contemporary midwifery. When discussing
postpartum hemorrhage, the authors of some articles prescribe shepherd's
purse and Pitocin (oxytocin) interchangeably (McLean, 1998; Toepke, 1998).
Apparently, it is a matter of personal preference on the part of the midwife.
Goldstein (1995) notes that shepherd's purse is gentler than Pitocin,
resulting in less postpartum cramping. Pitocin is not hemostatic; it stems
postpartum bleeding by encouraging the uterus to clamp down.
Most herbalists recommend a tea or tincture made from the whole fresh
plants, including the flowers and seeds. The tincture loses its potency
after a year or two (Belew, 1999). A typical dose is two drops of tincture
under the tongue or one dropperful (about 1 mL) in 30 mL of water as needed
(Goldstein, 1995). Its action is very quick; Susun Weed (1986) reports
that a dropperful of tincture under the tongue can stop postpartum hemorrhage
in five to thirty seconds.
References
Bartram T. Bartram's Encyclopedia of Herbal Medicine.UK: Robinson, 1998.
Belew C. "Herbs and the childbearing woman." Journal of Nurse
Midwifery 1999; 44:231-252.
Blumenthal M, Goldberg A, Brinckmann J, editors. Herbal
Medicine- Expanded Commission E Monographs. Texas: American Botanical
Council, 2000.
British Herbal Pharmacopoeia. British Herbal Medicine Association, 1996.
Campion K. Holistic Herbal for Mother and Baby. London: Bloomsbury, 1996.
Duke JA. Dr. Duke's Phytochemical and Ethnobotanical Databases (www.ars-grin.gov/cgi-bin/duke).
Agricultural Research Service: USA, 2000.
Duke JA. Handbook
of Phytochemical Constituents of GRAS Herbs and Other Economic Plants.
Florida: CRC Press, 1992a.
Felter HW, Lloyd JU. King's American Dispensatory, 1898 version. Oregon:
Eclectic Medical Publications, 1992.
Goldstein L. "Remedies. to file for future reference." Birthkit,
Dec 1, 1995.
McGuffin M, Hobbs C, Upton R, Goldberg A. Botanical
Safety Handbook. Boca Raton: CRC Press, 1997.
McLean MT. "Hemorrhage during pregnancy and childbirth." Midwifery Today 1998; December 1.
Newell CA, Anderson LA, Phillipson JD. Herbal
Medicines; A Guide for Health Care Professionals. London: Pharmaceutical
Press, 1996.
Phillips R, Foy N. The
Random House Book of Herbs. New York: Random House, 1990.
USDA, NRCS. The PLANTS Database (http://plants.usda.gov/plants).
National Plant Data Center: Baton Rouge, 1999.
Weed S. Wise
Woman Herbal for the Childbearing Year. New York: Ash Tree Publishing,
1986.
Coming E-News Themes
1. INTERNATIONAL MIDWIVES: Tell us about your practice, birth customs
and culture in your country, arts and techniques for the birthing year,
your struggles and triumphs!
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
Mamatoto: Motherbaby
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001
Send your response to:
Switchboard
More on transverse lie [Issue 3:4]: After ruling out physical
symptoms, I would inquire why is this baby not ready to be born? My preferred
way is for the woman to go deep inside to find the answer by asking the
question and waiting for the answer in the silence.
- Kusum
I would like feedback from other U.S. midwives who live in states where
licensure is required. I live in a state that does not require licensure.
A midwife in the community did some "illegal" activities and
now the state may pass legislation. This is the first case in the history
of my state. Midwives have practiced traditionally without any problems
for hundreds of years. This midwife injected meds that were illegal in
my state. I would rather practice legally without regulations than go
for licensure. I would like to hear pros and cons. I have never talked
to a midwife who supports her particular state's legislation. I am concerned
about traditional midwifery and wonder at times what is happening that
we have to be licensed to catch a baby. Does everyone use drugs out there?
- Anon.
Nona [Issue 3:4], I feel like the most fortunate woman on the planet
when I think of my mother delivering all of my children. I cannot imagine
doing it any other way. There is nothing more special or more soothing
and reassuring than having my very own mother there for me and for my
baby. What a gift she gives me and gives the kids each time she comes
to help walk us through our labor. It's a beautiful thing seeing her hold
and cuddle the babies after the check-up. Your daughter is really lucky
to have you.
- Allie
I had two very successful VBACs, totally natural. I wonder what is going
on with this sudden fear of rupture? It seems that inductions and Pitocin
play a huge role, and many, many, women are subject to these interventions.
Also, a midwife friend of mine said that doctors are not sewing up the
incision as well to save time and that they rupture easier. She works
in a hospital and has first-hand knowledge. Has anyone else run into this?
If ruptures are happening because the doctor doesn't sew up the incision
as well, it just becomes a vicious circle of more cesareans! Do doctors
realize they are sabotaging future VBAC births by being rushed or sloppy
surgeons?
- Mary A. Owens
Richmond, IN
I'm 36 in March, have a four-year-old daughter born via c-sec (first
pregnancy, no prior history of miscarriages). We've been trying to conceive
a second child for the last six months with no luck (although I am pretty
sure I was pregnant for about a week, and then had a very early miscarriage).{Regarding
the study reported in E-News in Issue 3:4] I am concerned that the original
c-section is causing me to have difficulty conceiving and to have had
that miscarriage. I'd like to know if your readers have any experience
with c-sections causing these problems. I am also interested in any ideas
for herbal/nutritional/lifestyle support for these issues.
Another concern: I exercise regularly and wonder how much truth there
is to the belief that pregnant women should avoid exercising heavily because
they might raise their body temperature and damage the fetus. My naturopath
seems to think it would be pretty hard to raise your core body temperature
enough to cause damage or miscarriage. But I get really hot when I exercise,
even moderately, and the one miscarriage I had occurred while I was at
the gym. I would like to know where I can find more information on this
topic.
- Sharon Cooper
Midwifery Today Issue 57, Spring 2001, is due out in mid-March, and it
will be packed with information about VBAC birth and cesarean prevention.
The issue includes articles by childbirth activist, filmmaker and photographer
Suzanne Arms; Nancy Wainer, the midwife who coined the term VBAC; CPM
Judy Edmunds, who describes seven ways to prevent VBAC; Dr. Marsden Wagner,
who writes about ethics and cesarean choice; Dr. Heidi Rinehart, who delves
into technical issues of VBAC; surgical veterinarian Gretchen Humphries,
who writes about suturing a cesarean wound; CPM Robin Lim, who addresses
what happens to the baby in a cesarean birth; CNMs Marion Toepke McLean
and Sharon Glass Jonquil who write about women's choice, and many others.
Non-subscribers can purchase the issue for $12.50 plus shipping of $4.00.
====
I would like a minute by minute video of the actual birth of a child
until the cord stops pulsating and has completed its transfusion of blood
into the rightful owner, the infant.
I would also like to have a video of any delivery that has had the approval
of the mother to do immediate cord clamping, even before the baby was
breathing, if that can be approved by a court order and a trust fund is
in place for the risk of compromise to the infant, in the event the parents
are seeking to bank the infant's cord blood for the sake of the infant
to have that same blood, sometime in the future, should the infant get
sick in that time.
Can anyone tell me the amount of blood in ounces that the newborn infant
is most likely deprived of due to immediate cord clamping?
- Donna Young
Reply to: Box 504, Dawson Creek, BC V1G 4H4, tel/fax: 250-782-9223,
email dyoung@pris.bc.ca
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This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.
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Midwifery Today: Each One Teach One! | 
