March 15, 2006
Volume 8, Issue 6
Midwifery Today E-News
“Transporting to the Hospital”
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Holistic Midwifery Volume II:
When you open the long-awaited second volume of Anne Frye's Holistic Midwifery series you'll find more than 1300 pages of detailed, otherwise hard-to-find information. Topics include basic anatomy and physiology, fetal-to-newborn cardiopulmonary transition, equipment and supplies useful at births, supporting a woman through each phase of labor, birth and examination of the placenta, newborn examination, caring for the mother and baby in early postpartum, complex and uncommon labor situations, how to handle difficulty coping with labor, problems with fetal descent, fetal or maternal demise, difficulties with the birth of the placenta, postpartum hemorrhage, understanding and treating shock, neonatal respiratory distress, and high-risk neonatal triage.Order the book.


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Attend the Beginning Midwifery Class at our Philadelphia area conference March 23–27 2006. This full-day class will show you the heart and joy of midwifery as well as the challenges, and help you decide if this is the profession for you.

Areas covered include Prenatal Care, Models of Training, Emotional Issues in Labor and Trusting Yourself to Trust Birth. Go here for info. The in-office registration deadline has passed. Walk-in registrations will be accepted at the conference.


Can you work in a hospital without compromising your values?

A hospital is nothing more than a building with people: people are the problem. How do we bring out the compassionate part of our colleagues to make a sacred space for women to work their miracle? Learn what you can do at the full-day "Humane Hospital Birth" class with Barbara Harper, Marsden Wagner, Lisa Goldstein and Debra Pascali-Bonaro.

This is a must-attend class for any midwife or birth professional who attends hospital births and is part of our conference in Bad Wildbad, Germany, October 2006. Go here for more information and a complete program.

In This Week’s Issue:


Quote of the Week

"By strengthening women we strengthen our children and therefore our communities."

Julie Brill


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The Art of Midwifery

Ninety-seven percent of postpartum problems are solved by telling the suffering mother to "get naked (just panties and a pad) and strip your baby down to just a diaper. Get to bed and stay there for a couple of days." In our culture, everyone wants to go to the mall within days of the birth like the economy will nosedive if you're not out there buying. The body puts out severe pain to get your attention and force you back to bed.

Gloria
Midwifery Today Forums


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

Passionate Midwifery Education

Become a Birth Change Agent

Most of you are very passionate about becoming a midwife; that is why I called this series Passionate Midwifery Education. Many of you are not quite ready to start formal education or apprenticeships yet. The birth world has a lot of need for passionate birth change agents, so another way you can work at midwifery while testing the waters is to become an activist—what I call a birth change agent. Consider this part of your midwifery education.

I just returned from the CIMS (Coalition for Improving Maternity Services) meeting in Boston. This is a very open organization whose membership includes anyone who shows up to meetings and wants to work. It started ten years ago at a retreat center called Mount Madonna. Fifty birth and midwifery organizations and individuals met and, by consensus, came up with and ratified the ten steps to mother-friendly care. See their Web site at http://www.motherfriendly.org/ to find out more. I would encourage you to become part of this coalition.

You might want to read my editorial from our Changing Protocols issue, "Happy Birthday, Birth Change," about what one person can do. You can read it online at: http://www.midwiferytoday.com/articles/ed_happybd.asp

Another way to become a birth change agent is to think of your community and what changes need to be made in birth care. Now think of what you can do. Meet with others willing to work on making these changes; it could be with your study group. Make a list of what to do and then do it. I am working with midwives in Oregon now on plans to change birth practices in Oregon. As we develop, I'll let you know more about our plans and accomplishments. One of the unique areas that has developed recently is birth networks. Plan to start one. Lamaze has detailed information on what they are, how to start one and some that are already going: http://www.lamaze.org/institute/birthnetworks/startnetwork.asp There may already be one in your community you can join. Activism is an important part of your midwifery education.

Keep a portfolio on all that you are involved in. This will come in handy when you apply to a school or to document your education if you apply to become certified by NARM or a state midwifery organization. The world needs your passion so apply it today.

love, Jan
Jan Tritten, Mother of Midwifery Today

To read all installments of Jan's column on midwifery education, go to our Better Birth and Babies Blog.


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Transporting to the Hospital

It is useful for direct-entry midwives to have an idea of what we "on the inside" of the medical system expect at transport [to the hospital]. Sometimes the policies, procedures and mindsets are impossible to understand, but often with time and effort the process of transports can be made easier.

The primary ingredient for a successful transport is communication. Open and honest communication exists within a relationship that is established and ongoing between midwife, client and physician. In my case, the direct-entry midwives in my area sought me out for a cup of tea. This informal meeting turned into a question and answer session on "What would you do if...."

Another component of communication involves a prebirth visit with the client and her partner. I use this time to try to establish rapport with the client because an open relationship cannot begin in the middle of labor or after a transport. At our meeting, I ask about important birth issues, allow time for questions to be raised, and give them a handout about the policies and procedures at our hospital. I also encourage a visit with a staff pediatrician, a tour of the birthing center, and preregistration, to head off middle-of-the-night client-partner separations for paperwork.

An added feature of these visits is that they allow both the client and me to decide whether or not we will be able to work together should a transport occur. On the basis of a prebirth visit, I have refused backup to several clients for various reasons, including hostility or adversarial behavior.

After the [transported] birth, it is important that the midwife debrief with the transport physician, both with and without the couple present. The questions we try to answer are, What went right? What can we learn from this transport? The birthing couple also often needs our help in processing the birth. A clear explanation of events and decision-making helps them to be at peace with a transport—something they obviously did not want or plan for.

Anne E. Stohrer, MD, excerpted from "Transporting," Midwifery Today Issue 38


For our clients' sake, we need to set aside any negative thoughts or feelings we have about hospitals, and adopt a good attitude toward them. They can be a lifesaver. They are a backup unit—a safety net—that can be used very appropriately when needed to reduce any risk of a bad outcome to mother and/or baby.

During prenatal visits we must reassure parents [hospitals] are an integral part of the decision-making process. It is their birth; we are in attendance as facilitator, interpreter and friend. As the birth draws near, you might want to discuss the "what-ifs" in a matter-of-fact manner. You might express your thankfulness for cesareans that save mothers and babies, but also note how seldom they are truly needed. And of course, always reiterate your confidence in the couple and their birth.

When we transport laboring women, our work begins all over again. We need to keep the transfer from being traumatic by helping interpret the technology that is being used. And we must protect our clients from wrong, or unnecessary, technology. Unless we are blessed with hospital privileges where we can continue the birth, we become a go-between for our clients and hospital staff. We can help preserve what is important in birth: good physical and emotional outcomes. It is important for moms to know they are helping make the decisions regarding what is happening to them. For their emotional health, they need to be able to continue with their birth in a manner that is not adversarial. Birthing women need to feel the people around them are helpers.

It is also important that you do not feel like a failure should it be necessary to transport a client. If you feel like a failure, the birthing parents will feel like failures. When you are blessed with a healthy mother and baby and you acted according to protocols you knew to be correct, you were successful. In fact, you have fulfilled the reason for being at the birth: you protected the family with your love, knowledge and good judgment.

Jan Tritten, excerpted from "Early Preparation Is the Key," Midwifery Today Issue 38

MIDWIFERY TODAY Issue 38 can be ordered


Transport route: If a transport during labor, birth or postpartum should become necessary, how will you remove the mother from her home? Note the location of stairways, doors, 90-degree angles, narrow halls and passageways, and so forth. Make a mental note of your best route of exit. Some midwives insist that the mother give birth on a first floor to avoid difficult or impossible transports in the event that the mother cannot walk to the transport vehicle herself. Be sure that the partner or some other person who is sure to be present knows the route to the nearest hospital and to the hospital of choice (if these are not the same). Have them drive the routes to make sure they are aware of how to get there from her home. Don't assume you know the best routes from a multitude of different locations unless your community is quite small. In addition, maps and directions should be posted by the phone in case the person who knows the route cannot be there to help. Another alternative is to have copies of the hospital directions in the mother's chart as well.

Anne Frye, excerpted from Holistic Midwifery Vol. I: Care during Pregnancy, Labrys Press, 1995

Holistic Midwifery Vol. I: Care during Pregnancy can be ordered from Midwifery Today.


Ask for what you want, or enlist your midwives' assistance in doing so. You have only one birth of this baby; don't hold back! The hospital can be an intimidating place, but just because the routine runs a certain way doesn't mean it can't be altered. For example, you can definitely refuse 1) to wear a hospital gown; 2) people running in and out of your room continually; 3) attendants talking during contractions; 4) bright lights in the labor or delivery room; 5) routine IV; 6) routine episiotomy; 7) stirrups for delivery; 8) baby not given to you immediately (barring emergency complications).

If you must stay in the hospital, activate your postpartum support system immediately. Don't think you can wait until you get home—you need it now! Have fresh fruit, vegetables, bread, cheese, water, etc. brought in daily, as hospital fare is inadequate in quality and quantity for a breastfeeding mother.

Don't hesitate to ask for privacy or to be left alone for a while. Routine checks on mother and baby occur on a regular schedule, but unless they are truly necessary because of some specific concern, refuse this constant monitoring or you will never get any rest. You may also find that as shifts change and new nurses appear, each will have some suggestion about wrapping, feeding or caring for the baby. Cheerfully thank them, but explain that you'd rather figure things out for yourself. If they press you, reassure them that you are fine, and they needn't worry. Otherwise, you'll go crazy with input and could lose confidence in your natural mothering abilities.

Elizabeth Davis, excerpted from Heart & Hands: A Midwife's Guide to Pregnancy & Birth, Berkeley, CA: Celestial Arts


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Research to Remember

In their search for a treatment for stroke or diseases such as Alzheimer's, researchers at the National University of Singapore and Singapore General Hospital confirmed that fetal cells, known to remain in the mother's body for long periods of time and sometimes the mother's lifetime, may migrate to the mother's brain and develop into new nervous system cells. The maternal brains of laboratory mice were found to have one to ten fetal cells per 1000 maternal cells capable of transforming into neurons; astrocytes, which feed neurons; oligodendrocytes, which insulate neurons; and macrophages, which ingest germs and damaged cells. Following chemically induced injury to the maternal brains, nearly six times as many fetal cells were found in the damaged areas than elsewhere, seemingly responding to molecular distress signals released by the brain.

The researchers speculate that the fetal cells travel through the capillaries separating the brain from the blood system by means of interaction between biomolecules such as proteins or sugars on the fetal cell and the blood-brain barrier.

Scientific American, October 31, 2005


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Web Site Update

Read this editorial from the brand-new issue of Midwifery Today (Number 77): "I was in the midst of writing a book about my homebirth practice when God said to me, "No, do a magazine for midwives.""

This article about Guatemalan midwife Anciona Juarez Arrozco is now online in Spanish. It is the story of a traditional Mexican midwife who has practiced for more than 30 years and how she continues the ages-old traditions of care for women and babies around birth. Taken from the book, Voices of the Maya Midwives, by Sarah Proechel, the article relates some of the traditional herbal and other practices of midwifery that have been in use for many years. Let your Spanish-speaking friends know! If you're studying Spanish, read it alongside the English version which appears in the newest issue (Number 77) of Midwifery Today magazine:


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Contact our Advertising Director today at: ads@midwiferytoday.com


Think about It

Today, several competent midwifery schools offer a strong didactic program yet ignore the necessity for educating students in the technique of breech delivery, declaring that these deliveries pose such great risk they should never be attempted by the midwife. They seem to assume that by teaching this art, the midwife is given a sense of "permission" that would be inappropriate. I sincerely disagree with this philosophy, as I believe that the aspiring midwife should be schooled in every possible contingency of the birth process.

The day will come when a midwife encounters that "surprise" situation in which she finds herself powerless to act—much to the detriment of the mother and her baby, whom she is sworn to help. Walking into a labor at 3 am, 40 minutes away from the nearest hospital, and finding the baby out to its armpits, affords no time to get out the books or to regret one's lack of knowledge.

"Oh but that will never happen to me!" you may say. Don't count on it; it has happened to me! You will never harm the mother or baby by having an overabundance of knowledge, and you will never regret having it.

Indeed, complications may ensue in the process of labor and delivery, and in no way do I wish to disallow them. Yet I believe that many of these complications may be avoided with competent knowledge of the mechanics of the breech labor and appropriate delivery technique.

Valerie El Halta, excerpted from "Normalizing the Breech Delivery," Birth Wisdom: Tricks of the Trade Vol. III, A Midwifery Today book


What do you think about breech birth? E-mail Midwifery Today E-News and share your opinions and experiences at: mtensubmit@midwiferytoday.com. Please include "Think about It" in your subject line.

Birth Wisdom: Tricks of the Trade Vol. III can be ordered.


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Forum Talk

Has anyone had the question of whether or not the entire placenta was delivered after giving birth? I am wondering how to know for sure. Is there a sure way of knowing on your own that the entire placenta was delivered? I have ovarian cysts, so I am not sure if that is causing my discomfort.

Ricki


Go to our forums to share your thoughts and experience.


Question of the Week

Q: (repeated) Has anyone out there had any experience with the autoimmune disorder, morphea, and pregnancy? I currently have a client who has it and it has been very difficult finding any information about its effect on pregnancy and pregnancy risk. As I understand it, and this is mostly from being educated by the client herself, morphea is a sister disease to scleroderma but does not affect the internal organs, just the skin. My client has an area of hardened scar-like tissue on her lower back but otherwise she has no problems. She is an acupuncturist and very well educated about her condition.

At first I didn't think much of it, but I decided to run it past my backup OB just to make sure she would be low-risk. Once he heard that it was related to scleroderma he said that even he wouldn't take care of her, he would refer her to a perinatologist. Apparently he had a woman with scleroderma who ended up dying at 35 weeks or so because a blood vessel popped in her brain. I tried to explain to him that this condition was different because it doesn't affect the internal organs. So he recommended a perinatologist consult.

The first perinatologist I sent her to had no idea what morphea was but nonetheless recommended a whole slew of coag studies and genetic tests. I decided to get a second opinion and phoned a perinatologist in my area. He hadn't heard of it, but when I described my understanding of it to him and he did some quick research, he said that my client is right and it should pose no problems with the pregnancy or birth. I'm much more inclined to go with his assessment, but I'm wondering if anyone out there has ever dealt with this before and what the outcome was.

— Corina Fitch, LM, RN
Miami


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


Question of the Week Responses

Q: What do you do to encourage women to trust birth?

Midwifery Today E-News staff

A: I encourage women to trust themselves—their bodies. Sometimes they are absolutely amazed at how it was designed to work. Sadly, socialization of birth in the United States is a frightening factor, and it is hard to overcome the fears and years of brainwashing women receive.

— Amy V. Haas, BCCE
Fairport, New York

A: To trust in birth is to trust in one's own body and its natural innate ability to bring forth life. When discussing the issue of trust, I like to stress the importance of not only trusting the forces of birth, but also all the forces that come together during that most intense experience. Trust and confidence in your own body and mind to sink into birth and let your body navigate with all its power, letting the pains of birth come, clean and thorough, to assist in the miraculous event.

We are taught as children to cover our bodies as if the naked form is something to be ashamed of. Bringing an understanding to the expectant mother that she should feel at ease in her own skin is of great importance. It will allow her to flow with the currents washing over her and let her float through each contraction with ease and determination.

Instead of distracting the laboring mother, I try to help her focus on what the pains are doing, using mental imagery and most important, as the wise Penny Simkin has taught many in the doula community, to find her rhythm and help her keep it as ritual, all the while reminding her what an amazing job she and her body are doing as one whole entity. Not to separate oneself from the pain, but to unite with it and let it flow freely.

— Marianthy Karantzes, doula

A: I suggest talking to other women who have had good birth experiences; usually the positive energy is contagious! I also recommend "tuning out" the horror stories that people seem compelled to tell pregnant women.

— Debby Gedal-Beer, CNM


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Feedback

I am scheduled to have my sixth c-section on April 20. In 1993, the doctor took my baby by c-section after a long labor that seemed to be going nowhere. I was only 19 at the time and was much relieved because I was in so much pain! The second time they asked what I would like to do, and I said another c, because it was so much easier.

Well now I am questioning if I could possibly have a safe vaginal birth. My last baby was born on 12-20-04, so my body has had a year to heal.

My doctor says it is a very bad idea, but if that is what I want, then that is fine. But he has scared me so much with the talk of rupturing and possibly never being able to have another baby. Is he right? Is it too risky for me?

Bridgette Silvas


A colleague recently told me that on average, 12 hospital newborns will be given to the wrong parents daily. I don't know if that is in the United State or internationally. Does anyone have facts to corroborate this information?

— C.M.


Editor's Note: Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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