September 2, 2009
Volume 11, Issue 18
Midwifery Today E-News
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Midwifery Today Conferences

Ina May Gaskin ~ Michel Odent ~ Elizabeth Davis

These are just three of the teachers you'll learn from at our conference in Philadelphia, April 2010. Other confirmed teachers include Gail Hart, Marsden Wagner, Naolí Vinaver, Carol Gautschi and Elaine Stillerman. Plan now to attend!

Learn more about the Philly 2010 conference and get a complete program.

Birth Is a Human Rights Issue

The right to have the most joyous and healthy pregnancy, birth and postpartum possible should be a human right for both mother and baby. Learn how you can help. Come to our conference in Strasbourg, France, 28 September–3 October 2010. Classes will include Mothers' Birth Rights, Babies' Birth Rights and Maternal Mortality Is a Pressing Human Rights Concern.

Learn more about the Strasbourg conference.

To receive a printed program by mail when it becomes available, please e-mail with your name and postal address.

In This Week’s Issue:

Quote of the Week

"We have a secret in our culture, and it's not that birth is painful; it's that women are strong."

Laura Stavoe Harm

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The Art of Midwifery

At birth:

  1. Use low light.
  2. Do not disturb the mother with unnecessary interruptions. Limit talking.
  3. Have the mother choose the positions that are best for her.
  4. Make the mother central. Follow her lead and do what she needs or wants. Pay attention to her sounds, body language and expression to determine her needs.
  5. Make sure the room is warm. If mom is comfortable she will birth more easily.
  6. Comfort measures for the moms also help the baby. They are a unit.

Jan Tritten and Jill Cohen
Excerpted from "Tricks of the Trade," Midwifery Today, Issue 81
View table of contents / Order the back issue

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

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According to recent research by State University of New York's University at Albany psychologists, mothers who bottle-feed rather than breastfeed are putting themselves at greater risk of postnatal depression. The researchers suggest that throughout human history, an absence of breastfeeding has been connected with the death of a child, and that the decision to bottle-feed mimics that loss. Of the more than 50 mothers studied, those who bottle-fed their babies scored much higher on a postnatal depression scale than those who breastfed. Researchers also noted an increased desire by bottle-feeding mothers to hold their babies, paralleling a similar response in nonhuman primates after the death of an infant.

The complete study can be accessed for a fee at:

University at Albany Press Release, 13 August 2009

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Consider chiropractic care for safer, easier births.

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Breech Birth Learning Opportunity—A Note from Jan

If you are interested in Breech Birth, the subject of the last E-News, you might be interested in Midwifery Today's Philadelphia conference, "Trends and Traditions in Midwifery and Birth." We have an excellent full-day pre-conference workshop on Breech Skills. We also have three sessions about breech in the conference. Please check out the program here.

The next issue of Midwifery Today (print magazine) also has an excellent article on posterior breech by Maggie Banks called "Breech, Posterior and a Deflexed Head!" Midwifery Today, the print magazine, is designed to help you be the best birth practitioner you can be! It has so much good information in it, and arrives four times per year to your mail box. Consider subscribing, as only a few of the articles go on our Web site.

Jan Tritten, Mother of Midwifery Today

Not Among Strangers

How important is the impact of the birth environment upon achieving an optimal outcome of the birth process?

The environment in which birth takes place has an enormous impact upon birth outcome. Labor progress, pain tolerance, necessity for medical intervention, fetal well-being and satisfaction with the birth experience may all be directly related to the mother's sense of "safe place" in which she brings forth her baby.

"Safe place" has little to do with physical surroundings alone. Yet for many a woman, the home in which she resides, feels loved and secure, has prepared for her baby and "nested" most clearly defines that place. "Safe place" also has to do with the people with whom the woman feels most secure and comfortable. The interaction of the several personalities which may be involved during labor and birth may either positively or adversely affect the laboring woman's sense of "safe place." As we come to understand the importance of how these personalities impact the birth environment, we, as caregivers, become more sensitive to the needs of the mother as she approaches the time of labor and birth.

Traditionally, birth has been a very private affair in which only the most intimate of a woman's relations would attend the laboring woman. Grandmothers, aunts and wise women of the village whom the woman most trusted were the ones to be called. In today's society, women have been taught to place their trust in the medical model of childbirth and in medical professionals rather than in persons with whom they are most familiar. They are taught to accept the place of birth that the medical professional chooses (because it is the medical professional's "safe place"?). For many women this is a difficult and sometimes impossible transition, one which so impacts the sense of the familiar that patterns of labor are changed and the sensation of birth pain intensified. Outcome is made less predictable, and birth comes to be regarded as a difficult and painful ordeal, fraught with danger. Moreover, if the woman is confronted with an unfamiliar and therefore "not safe place," a survival mechanism will kick in. She will protect her baby by preventing it from being born by ceasing to contract, keeping her cervix closed and in general "failing to progress."

Those of us who are certain that a woman's home is the most suitable environment for her to give birth in must be particularly aware of the influence we may have on the woman's sense of safety. The most well-meaning midwife may nonetheless be a "stranger" to the mother and a threat to her need for privacy if she has not become at one in trust with the woman well before labor ensues.

Valerie El Halta
Excerpted from "Not Among Strangers," Midwifery Today, Issue 50
View table of contents / Order the back issue

UPCOMING "HOMEBIRTH" ISSUE: Submissions are welcome for our upcoming Midwifery Today issue on "Homebirth." We will consider articles on all aspects of homebirth, from the personal to the political, the philosophical to the technical, and everything in between! Send submissions to:

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Survivor Moms

Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse was written to help break down the isolation pregnant women and their caregivers often feel—as though they were the only ones having to cope with these challenges. You'll be able to read excerpts from 81 women's stories of birthing, mothering and healing after childhood sexual abuse. The book also includes some complete narratives, discussion of implications of women's experiences for their care, suggestions for working together during maternity care and beyond, resources to consult, and information from current research.

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Do you work with laboring women?

If you do, you need Midwifery Today's Second Stage Handbook. This book shows you how to best serve women at this crucial stage. You'll learn from expert practitioners as they reveal their observations on when to push, what works and choices available for the mother. The Second Stage Handbook is part of the Holistic Clinical Series. Order the book.

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Midwifery Today Magazine A 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Subscribe.

You'll delight in these bold images of pregnancy and birth, parent and child!

The Perceptions, Reflections and Connections DVD Slide Show features 50 photos of multi-cultural families in a variety of poses and situations. Inspiring and educational, it's the perfect DVD to show to your clients. The photos on the DVD are reprised in the companion booklet, along with inspiring and informative words. Plus, the booklet is small enough to fit into your purse or birth bag, so you can carry it with you wherever you go. To Order

Perceptions, Reflections and Connections

Web Site Update

The complete program for the Philly April 2010 conference is now online, in Web page and PDF formats. Start on our Philly gateway page.

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Question of the Week

Q: What changes have you noticed in midwifery and birth practices in the past ten years?

— Midwifery Today editorial staff

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

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Question of the Week Responses

Q: I have a friend who has been trying to get pregnant for at least two years now, probably three, without success. She is a powerful, healthy, active, spiritual woman. Her husband is a wonderful African dancer and has an individual providing spiritual guidance from Africa who has promised them that the baby will come someday. I am an RN and know the medical definition of infertility. I try to have hope for them but it is hard for me. My friend has had all the infertility tests run and has been told all is okay with her. I do not know about her husband. They cannot afford in vitro fertilization.

My friend has great faith and has, incredibly, not lost hope but I wish I had some information to give her besides the normal medical research on things that could help her get pregnant. I know this is a struggle so many other women deal with too. Any ideas?

— Maira

A: The advice I give most couples trying to get pregnant is to have sex in places other than their bedroom...have sex in every room in the house! It's a lot of fun and works like a charm.

— Donna Harnett

Q: My 21-year-old daughter has been advised to have a LEEP (loop electrosurgical excision procedure) for moderate dysplasia due to HPV. I know this may leave scarring on the cervix or possibly pose a small risk of preterm labor when she becomes pregnant. My midwife said she would be put on a preterm labor protocol. What experiences have midwives had with this situation?

Have you seen cervical scarring or preterm labor after a LEEP? Does scarring lead to slower dilation or "stalls" in dilation? Does she have any alternatives for treatment other than the LEEP? What is your advice regarding pregnancy? Would this preclude her from using a midwife?

— Michelle

A: I have had a LEEP procedure because of "Moderate cellular changes." I had an abnormal Pap smear at age 20 and had to have biopsies and cryosurgery to remove the outer layer of cervical tissue. At 41, when this happened again, the cellular changes were more severe and complicated by HPV. I was surprised at the lack of information about HPV. Out of the many different varieties, only five are known to be associated with cervical cancer. I had one of those five, but I was never told WHICH one of the five. There was no information on how LONG I would be infected, how long I HAD been infected, how many OTHERS I had infected or how to get RID of the infection, but the fact remained that my cervix was damaged. It was explained to me that although HPV infection can just "happen," it most likely was transmitted by an infected partner. With virtually no information as to incubation period and having had multiple partners in the previous 20 years, the chances of tracking down the culprit were nil.

As I had to have other work done the procedure was done under a general anesthetic, although I understand that it is usually performed in the physician's office with a simple sedative. Let me say here and now that to have the outside of my cervix and a cone from the os removed with a red-hot wire while AWAKE was a procedure that must have been invented by someone who never owned a cervix.

I was informed that it was "a good thing I was done having kids" because after the removal of that tissue, it was likely that my cervix would be incompetent. All follow-up tests have been clear, although I have not been retested for the continued presence of HPV. It is wise to seek a second opinion or to request a retest, but please, please DO follow up. To ignore cervical dysplasia is to court disaster.

— Janean

A: I had a LEEP procedure done when I was 21 years old and was pregnant by 23. I have since had one other child and am expecting my third, and have had absolutely no problems dilating or had any other stalls in labor. As a matter of fact, my pregnancies tend to be very uneventful—which is great—and I have never shown any signs of preterm labor. I might have minimal scarring, but I'm not sure because nobody has ever mentioned seeing any scarring. As far as a long labor, I think first labors tend to be more strenuous for everyone since their body hasn't ever experienced it before, so I think it's natural that they would take longer anyway. Also, I am using a midwife for my third pregnancy, so midwives will take people who have had LEEP procedures and, from what they tell me, the risk of preterm labor and pregnancy complications due to a LEEP procedure is very small. Your doctor just has to tell you that because there is a small percentage of women who could probably suffer from these risks and he or she wants to avoid a lawsuit.

— Emily

Responses to any Question of the Week may be sent to E-News at any time. Write to Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.

Think about It

What is the soul of homebirth? How do you describe the action of choosing homebirth? For me, that action was a "Kriya," something one does on purpose, a purposeful action. Another way is to liken the soul of birth to a holy feeling, a "Darshan," or spiritual audience.

And how can one explain childbirth? Birth is truly that which cannot be explained, or "Wakan," the "great mystery." The difficulty and work of labor leading to the pleasure of birth and nursing is "Evam," the joining of negative and positive energies.

With the birth of my first child I realized that the event of birth needed to be in the familiarity of home. With the birth of each of my other three babies, this notion was only strengthened. During this time, my life as a homebirth midwife was born and grew. Now my babies are nearly grown and on their own, and that notion still holds true—birth needs to be in the familiarity of the home if at all possible, and in the event of being elsewhere, the soul of birth can be maintained by those present. I guess that is what we midwives are supposed to be doing when we assist someone with her birth, no matter where we are.

[Editor's Note: According to the author, Kriya and Darshan are Sanskrit words, Wakan is Native American and is used for the Great Spirit, and Evam is most likely Tibetan.]

Vi Sadhana
"The Soul of Homebirth," Midwifery Today, Issue 50
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