How We Learn
One of the hardest lessons I learned during my training as a doula was that I had to bite my tongue and listen even to harsh, antagonistic, inflammatory or extreme criticism. If I ignored every criticism that seemed at first to be completely off base, I could not function in the hospital environment at all because I could not adapt to the structures and realities of that environment. When I did bite my tongue, when I did listen, I found that I learned valuable lessons about my own assumptions.
It is entirely too easy to get on a moral high horse on any side of an argument. The problem with this is that we don't learn. The minute we become more preoccupied with proving the other person wrong than with listening to their position, we close down the possibility of any learning happening on either side. When I stopped and listened to the criticism leveled at me, even when it was patently unfair and off base, the people leveling the criticism noticed. They began to listen to my point of view more openly because I was willing to make that step and really hear them.
To collaborate successfully, a practitioner must have a "listening relationship" with the other collaborators. Doctors must be willing to hear the criticisms of midwives and other doctors, because without hearing those criticisms, there is no chance at all of doctors learning anything new. And midwives must be willing to hear the concerns of doctors. It is not until midwives are willing to acknowledge the fears that govern the practice of medicine that they will be able to communicate effectively about the safety of their practices.
In the Midwifery Today book Paths to Becoming a Midwife I talk about listening to criticism. One of the most important points is that even criticism that seems hostile and destructive can be simply constructive criticism phrased badly. Criticism is valuable and should be cherished, even if it is hard to listen to.
Those who practice in the medical model have much to learn from those who practice in the midwifery model, and vice versa. Doctors have much to learn about the importance of emotional and psychological issues in labor, the importance of caregiver presence and the importance of letting the body do what the body does so very well without interference. Midwives have much to learn about the balance between trusting birth and respecting that such a powerful event has the possibility of going powerfully wrong. It is vital that practitioners of either philosophy avoid the trap of "encampment." The instant you, the midwife, or you, the doctor get so caught up in protecting your role or philosophy that you forget to learn as much as you can to help women the best you can, your clients and patients have lost. Above all else, you must remember that your job is to serve women. You do not serve them by being blind to other perspectives.
- Jennifer Rosenberg, Eugene, OR
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We did prenatals and accompanied women to births [in Mexico] for a few years with the midwife. She had been attending births in the community for more than 25 years, rarely doing more than two prenatals on each woman, never checking blood pressure or urine, rarely having any complications. She wasn't uncommunicative, but her teaching style was simply to allow us to be at her side. I kept waiting for her to say, "Now you're ready. You do it." She never did. But one day she called me to say she wouldn't be attending any night births anymore, only those by day. And that very night three women went into labor, one after the other, and I reluctantly began to attend births on my own.
The years went by, births went on, and I realized the fantasy of The Teacher was silly. The Teacher was Life itself -- every woman, every birth... The most profound teachings I continue to receive are from Everyone. Part of the reward and mystery of doing consultations is discovering the incredible strength, wisdom and adaptability with which each of us lives out our lives. Most "regular" people, particularly those in the vulnerable position of "patient," aren't greeted for their inner wisdom, but given half a chance everyone has powerful life lessons to share. Self-taught implies that one somehow figured everything out alone, when in fact, the opposite is true. I did not go to midwifery school and I did not apprentice with a Grand Teacher.
Well, yes I did, but not in one single body. Life, illness, love, and death -- together they continue to be my great Teachers.
- Alison Bastien,
excerpted from "Life Lessons," Midwifery Today Issue 60
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A Web Site Update for E-News Readers
CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME
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COMMUNICATING MIDWIFERY: Twenty Years of Experience
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STUDENT MIDWIVES PACKAGE. If you're a student midwife, this is the package for you!
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COMFORT MEASURES FOR CHILDBIRTH, video by Penny Simkin
Physical and psychological comfort measures for women in labor.
INTERNATIONAL ALLIANCE OF MIDWIVES
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Midwifery Today's Online Forums: Pain
A woman who is due any day now complains about a shooting pain in the end of her tailbone. Is this something I should be concerned about? Her baby is not posterior -- she can feel baby's bum in the front.
To share your thoughts and experience, go to Midwifery Today's Forums.
Question of the Week (Repeated): Herbs for Hemorrhage
Q: What are your favorite herbs (and amounts) for postpartum hemorrhage? What has not worked? Have you ever felt that you could not keep a hemorrhage under control with herbs and bimanual compression until a mother could be transported to a hospital?
- Amy Kieffer, student midwife
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International Midwives Day is May 5
Tell E-News how your community or your community of birth practitioners and/or parents is celebrating International Midwives Day.
- The Metropolitan Doula Group of New York will be hosting a party to celebrate International Midwives Day on Thursday, May 9, from 4-7pm. Over 600 New York-area midwives have been invited. Contact email@example.com for more information.
Question of the Week Responses: VBAC
Q: Does anyone have information about or experience with successful VBACs with an extended uterine scar (8 in. vs. 4 in.)? A woman is interested in homebirth who was attempting an unassisted homebirth with her last baby. Upon SROM she found a foot presenting. She and her husband went to the hospital and the doctor on call did a c-section but had to extend the incision to get the baby out. He assured and reassured her that she had a perfectly good chance of delivering vaginally next time, given she has a care provider.
A: Having just completed reading in order to assist at cesarean sections I feel that to say a single closure on the uterus is not as strong is not entirely accurate. There are many who feel the single layer produces less strangulation of the tissues and less damage, which would actually make the scar stronger rather than weaker. The more important piece of information is where the scar is located. If the incision was extended upward toward the fundus of the uterus, it is similar to the classical and would have a higher chance of rupture. A VBAC in the wrong hands can turn disastrous. It plays both ways: doctors who ignore the scar and use induction techniques or homebirth midwives who don't recognize a stalled or arrested labor as a possible problem.
- Peg Bowning, CNM
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!
In response to the question about abdominal pain and mood swings [Issue 4:16]: I recommend the book Fertility, Cycles and Nutrition, by Shannon, M. (Cincinnati: Couple to Couple League International, 3rd ed., 2001). She has good advice for handling possible causes of those types of problems.
- Charity Bailey, student midwife
I really enjoyed the shoulder dystocia issue [Issue 4:16] and passed it on to friends. I wish people would put their full names and where they live when they want questions answered or make statements. It helps put things in a better context. Most of the ones with "Anonymous" are not outlandish or embarrassing -- time to identify yourselves.
- Gloria Lemay
[Editor's note: Most anonymous writers are people who either choose not to include their names or who overlook doing so. Most often they do not sign their letters with "Anonymous" -- that's added by the editor. Writers, we'd love it if you identified yourselves!]
Thank you for writing about shoulder dystocia. My third birth was complicated by this event. My daughter was 9 lbs 6 oz, and I have been told I have a narrow pelvis. I spent most of my labor, especially transition, on all fours, though I chose to deliver on my side. I had no interventions, certainly no epidural or Pitocin. I was attended by an unusual European-trained obstetrician and an experienced midwife in a large teaching hospital in Regina, Saskatchewan. My daughter's shoulders locked after her head was delivered, and her blood supply was cut off because the cord was around her neck. Within a frantic few moments the doctor, midwife and I all worked together to get her free, with the midwife directing me when to push, when to stop, and applying pressure first in back and then in front. The obstetrician tried several maneuvers while saying some foul words in several languages. He finally succeeded with the corkscrew maneuver. Baby's Apgar was 4 at 1 minute and she required resuscitation. By 5 minutes her Apgar was 9.
In those frantic few moments there was absolutely nothing any of the high-tech equipment could have done for us and my daughter would have been born dead by time they prepped me for a c-section. Instead, by using hands, minds and clear direction so I could cooperate, my daughter was saved. Her resuscitation was accomplished only by skilled hands and a small hand-held bulb. The midwife took care of that because I started a sudden very severe and heavy hemorrhage as soon as baby was born. The obstetrician was too busy delivering the placenta and stopping the hemorrhage to deal with the baby. They shot me full of Pitocin, but that came after the bleeding was pretty much stopped. The midwife decided to postpone sending my baby to the NICU (standard practice with such a low Apgar) until after she had a chance to nurse to help my uterus contract. In the end, we were both fine. I had no episiotomy or tear and she suffered no lasting ill effects (she is now 15.) After it was all over, the doctor and midwife stayed with me much longer than usual, congratulating themselves and me.
As I read your article on shoulder dystocia all I could think of was that we need people who are well trained to attend birth. Our emergency could have been handled as easily at home as it was in that hospital. It was the experience and cooperation of skilled people using skilled hands that changed that particular delivery from a disaster that could have killed both mother and child into a normal one with just a few tense moments.
In a previous edition of E-News, a comment insinuated that physicians c-section woman because they get paid more for doing it. I cannot believe that this statement appeared in print! I, like most readers of Midwifery Today, do not believe that the c-section rate in this country is justified. There are many reasons for the increase in c-sections that are well documented in the literature, such as increased use of epidurals, increased use of electronic monitoring, etc. We must also keep in mind that many physicians are forced to practice defensive medicine as a result of rising malpractice claims. To assume that we are the only profession that cares about the well being of women, just because we are midwives, is ludicrous and will be our downfall. To bring about change, we must stick to the facts and not make inflammatory statements that have no merit. Unsubstantiated claims serve only to hurt the profession of midwifery.
- Robin Centner, CNM
I am 4'11" and was told that because of my height some midwives do not believe I can deliver a baby completely by myself (i.e. no episiotomy, etc.). In my first pregnancy I delivered a full-term baby that was just slightly more than 2 kgs, and I didn't even have any tearing. But I wonder if there is a correlation between a woman's height and her ability to give birth to a child. I'd like to hear about studies so I can present them to the midwives if problems occur in the future. These studies can either show a correlation or, preferably, that there is none.
I am a junior entering the University of Kansas bachelor of science degree program at KU Med this fall. I've dreamed of becoming a midwife all my life, so this is the exciting first step to pursuing a master's degree in midwifery. Does anyone know of any scholarships/grants/internships that are specifically geared toward aspiring midwives? I love receiving E-News and reading the phenomenal wisdom of midwives worldwide. It's very exciting to know that I will soon be in a beautiful profession with such a supportive network of colleagues. Thank you for all the inspiration your newsletter has given me.
- Stephanie Bohling
Reply to: firstname.lastname@example.org
The International Cesarean Awareness Network celebrates 20 years of education, support and advocacy for women, renewing its steadfast commitment to lowering cesarean rates and promoting vaginal birth after cesarean (VBAC). After the fourth consecutive rise, U.S. cesarean rates have skyrocketed to 22.9%, an alarmingly higher rate than the 15% average recommended by the World Health Organization. In response, ICAN has stepped up efforts to supply information and support to women who are challenging the current return to outdated "once a cesarean, always a cesarean" policies.
ICAN, founded in 1982 as the Cesarean Prevention Movement by Esther Booth Zorn and other concerned parents, forged a new frontier by putting decisions about childbirth back into the hands of women who had experienced surgical birth. Consumer pressure successfully brought VBAC into the mainstream. Within two years of ICAN's premiere, the American College of Obstetricians (ACOG) issued its first guidelines for VBAC. As VBAC rates rose, the number of unnecessary cesareans declined. However, recent medico-legal trends threaten to unravel decades of work by ICAN and other organizations committed to maternal and infant health.
ICAN does not oppose medically necessary cesareans, but seeks to reduce the proportionately large number of cesareans that are performed for nonmedical reasons. ICAN believes that women are entitled to receive accurate, evidence-based information from their physicians about the considerable risks of repeat surgical birth. ICAN believes that informed consent is not a privilege, but a right of all birthing women.
Approximately 40 chapters in the US and Canada will be celebrating ICAN's 20th anniversary and conducting community awareness campaigns during April, which is Cesarean Awareness Month. For information on chapter locations and events, contact ICAN at www.ican-online.org
EDITOR'S NOTE: Only letters sent to the E-News official e-mail address, email@example.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
Hands of Light - Summer Intensives on the Southern Maine Seacoast: Postpartum Doula June 12-15, Do I want to Be A Midwife? June 17-21 and Advanced Medical Skills Training June 24-28 - Elizabeth Mazanec 978-343-7384, http://www.holcenter.com
DID YOU HAVE AN EPIDURAL?
Midwife wants to hear from women experiencing problems after epidural, please share your story. Anonymity guaranteed. Write: Mo at Epicomps, 8657 Douglas #261, DSM, IA 50322 or e-mail firstname.lastname@example.org
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