Jan’s Corner
Too Much “Help”
When I was 12 years old I raised pigeons. It was fun and exciting. I had as many as 50 or more at one time. I enjoyed watching the fathers and mothers get together and sit on their eggs; they mate for life. I would go and listen to the babies in the eggs when their time was near, pecking away to work themselves out of their egg homes. They would come out into the world featherless and quite homely.
Once, early in my pigeon raising years, as a little one was pecking its way out of her egg home, I decided to help. I just helped a little, pulling some of the cracked shell off gently. Not too much help, just a little. The baby died because, you see, like a butterfly coming out of the cocoon, it had to make its way on its own. Isn’t that a lot like technology used unnecessarily in birth?
My finger “helpers” pulling on the eggshell were actually killers. In birth our interventions are sometimes the same—they can be killers. Thankfully, most mothers and babies are resilient and come out seemingly okay. Often though, when we look deeper, they are not okay. Mothers are often left feeling robbed by our ignorance and arrogance and are sometimes too traumatized to mother at their best. If a woman is dealing with the sequelae of a cesarean, she may be as scarred emotionally as she is physically.
Babies may be prone to drug use in later life because the mom was given obstetric medication. Michel Odent’s Primal Health Database contains a number of studies on this subject, including the Jacobson studies’ “Obstetric pain medication and eventual adult amphetamine addiction in offspring.” According to the study, “A specific link was found between amphetamine addiction and the use of nitrous oxide by the mother when she was in labor.” There are other, similar studies in this database, but the point is that we are causing problems for motherbaby with our technology. It is difficult to discern when something can be life saving and life threatening. That is, indeed, the art of midwifery. Our job is to be ever so careful, to practice the true art of midwifery and “First, do no harm.”
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
Jan on Twitter: twitter.com/jantritten
Midwifery Today on Facebook: facebook.com/midwiferytoday
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Midwifery Education: Caring and Sharing: facebook.com/MidwiferyEducation
Research
Pregnancy and Radiation Exposure
According to the Centers for Disease Control and Prevention (CDC), fetuses between two and fifteen weeks are especially vulnerable to the effects of radiation exposure, even in small amounts, and can suffer a number of problems as a result of exposure, including mental retardation, stunted growth, deformities and increased risk of cancer. Fetuses exposed to radiation between 16 weeks and birth are unlikely to experience such devastating effects, though their risk of cancer is still elevated.
Research published in 2009 concluded that “fetal exposure to ionizing radiation damages cognitive ability at radiation levels previously considered safe.” The study, of 562,637 Swedes born 1983–1988, found that individuals who were in utero during the Chernobyl nuclear accident in April, 1986, (during which Sweden experienced a high spike in radiation) had lower academic performance, with the worse outcomes in those individuals who were 8–25 weeks postconception at the time of the accident, and in regions of Sweden that received more fallout.
Scientists estimate that the average person living in the United States is exposed to one-third a rem of radiation a year, 20% from man-made sources, mainly medical X-Rays and diagnostic tests.
— Almond, D., L. Edlund and M. Palme. “Chernobyl’s subclinical legacy: prenatal exposure to radioactive fallout and school outcomes in Sweden.” 2009. Abstract. Q J Econ 124 (4): 1729–72.
— Centers for Disease Control and Prevention. “Radiation and pregnancy: a factsheet for the public. Last modified May 10, 2006. Accessed March 18, 2011, http://www.nber.org/papers/expecting/w13347.
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Natural Birth Resources and Community
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NaturallyBorn.net is the go-to resource for natural childbirth information. Our directory of midwives, doulas, birth centers, and lactation experts is the largest on the web. Available directly on Facebook. Inclusion in our database is free! E-News subscribers can upgrade to a featured membership for 15% off the LIFE of their listing. Use code MWTODAY to claim your discount. Go to: NaturallyBorn.net
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Featured Article
Technology and Fear
Like fear, technology is in itself neither good nor bad. Nor is technology the way to eradicate fear, as many practitioners and patients believe. Technology is just another tool in our birthing kits. It can have advantages and disadvantages.
Why do we use technology in obstetrics? Physicians and midwifery training in the biomedical model may answer, “To predict and to intervene so that we can prevent death and disability.” Some medicos and midwives really do trust technology for their patients and to augment their “life-saving” skills. Why else are midwifery, nursing and medical students expected to manage so many machines during their obstetrical rotations?
What does technology really help predict? Do technological interventions help us determine labor and birth outcomes? Why do we want to predict and intervene in the first place? Do we need to “stem the tide” of technology? Or, do we need technology to “stem the tide” of fear? Perhaps instead of trusting the unknown and transformative process of birthing, pregnant women and the people who attend them tend to trust technology to reduce their fears of the unknown. What do some midwives and doctors fear most during labor, birth and postpartum? Loss of control. Death or disability means that we, the professional authority figures, lost control of the situation. After all, women and families trust us, our authoritative knowledge and our use of technology, especially during fear-filled situations.
How do some doctors and midwives promote trust? They start prenatal sessions with lessons on fear. You know the type. The care provider begins with a litany of things that could go wrong in a pregnancy/birth/postpartum period and how he or she can successfully intervene, with all the knowledge/skills/technology available.
Why else would anyone want an ultrasound? To predict. Does the fetus have Spina bifida or no brain tissue? Does the placenta lie over the cervical os? Is the baby a boy or a girl? Yet, what do you do with this information? What would you do if you didn’t have an ultrasound and the baby was born with no brain (anencephaly) or Spina bifida; or, if during labor, you detected the placenta over the cervical os; or if the baby was a girl in a family that already has five daughters and no sons? We all know that now, after years and years of scientific evidence, ultrasound does absolutely nothing to predict outcome. Ultrasound only gives us information, information that we will have eventually anyway.
Of course, technology can be advantageous. For example, to determine preeclampsia, we use a sphygmomanometer to measure blood pressure, along with chemically enhanced test strips to measure the presence of protein in urine. Notice we cannot predict eclampsia; we can only determine the presence of high blood pressure and protein in urine. After such a determination, we have various means of intervention, some of which involve technology and some that don’t. More frequent vigilance with the sphygmomanometer and urine sample testing is one intervention that relies on technology. A change in diet, use of herbs or acupuncture, or changing other daily habits are other interventions not based on technology.
— Ann Davenport
Excerpted from "Technology and Fear," Midwifery Today, Issue 85
View table of contents / Order the back issue
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Web Site Update
Read this article excerpt from the current issue of Midwifery Today magazine, Spring 2011:
- Time in a Bottle by Beth Bailey Barbeau
Excerpt: Time first becomes an issue in medically attended pregnancies when the due date is established. Early ultrasounds are now the routine authority on when a baby is “due,” regardless of a mother’s personal sense or determination of her dates. This date is critically important, as it is the basis of medical expectations of when birth should occur. Perceptions of the normal window of birth have narrowed from “two or three weeks on either side of your due date” to “let’s schedule your induction if you haven’t birthed by 40 (or even 39) weeks.”
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Make the vision of natural birth available for all to see.
Ask your library to order natural birth and midwifery books for you. When a mother has more information about natural birth available to her, she can make more educated decisions about how she wants to birth her baby. Making requests is easy; here’s how.
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Question of the Week Responses
Q: How do you facilitate good midwife-doula relationships?
— Jan Tritten
A: Since the doula phenomenon is very new where I practice (Iceland), I always make sure every time I work with a new midwife that she knows my role in the birth, my limitations and my sincere desire for pleasant cooperation.
In my opinion, this really sets the tone and clears many worries the midwife may have. Also, creating a welcoming atmosphere is essential. I feel it’s my role make sure that everyone involved with each specific birth is and feels welcome—there is room for all of us! Doing these things every time, I have never had a negative doula-midwife experience at a birth.
— Eydís Hentze
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.
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You want to be a midwife, but where do you start?
Are you an aspiring midwife who’s looking for the right school? Or maybe you’re trying to decide if midwifery is the path for you. Visit our Better Birth Education Opportunities page to discover ways to start or continue your education.
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Birth Wisdom from the Web
Editor’s Note: From the pages of Facebook to our favorite blogs, news bits and videos, this new E-News column brings you the best bits from the birth-related Web.
Does the moon really affect fertility, labor and birth? Many midwives share anecdotal evidence suggesting that it does. However, it’s not just the moon that might affect female hormones, but also frequent exposure to artificial light. The studies below might help to spread some light on the subject.
http://www.ncbi.nlm.nih.gov/pubmed/21364464
http://www.ncbi.nlm.nih.gov/pubmed/7348448
Over 20 years ago, I got a call from a sista midwife—she said her client had had a placenta in her for 16 hours and she couldn’t get it out. I came over, catheterized her and the placenta fell out! Moral of the story…empty bladder before pushing!
An elder African midwife said she had tried to deal with a retained placenta years ago. A tribal woman came over after she had heard of the midwife’s dilemma, shook a load of pepper on the woman’s bare chest and she proceeds to sneeze it out! Moral of the story… bring lots of pepper if you work in Africa!
— Carol Gautschi, Facebook, on waiting for the placenta
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to mtensubmit@midwiferytoday.com.
Think about It
You must yourself take responsibility for your own birth, including the decision to have technology used on you and your baby. Remember, technology is not good or bad. How technology is used can be good or bad. Airplanes can be used to carry you to visit your family or can be used to drop bombs on women and children. How technology is used on you during pregnancy and birth is of great importance because it can help you and your baby or harm you and your baby.
— Marsden Wagner
Excerpted from "Technology and Birth: First Do No Harm," Midwifery Today Web site
Letters
Hello Jan and Midwifery Today,
I am loving the new MT E-News on doulas and so appreciate your comment “in support of doulas,” which I am about to post on my blog! Keep up the great work; we all appreciate MT so much here in the UK.
— Adela Stockton
Gentle Birth Companions
www.adelastockton.co.uk
Dear Friends and Colleagues,
As some of you might have heard, the Dean of the University of São Paulo (USP) has threatened to close the Midwifery course in 2012. This is because the Brazilian Federal Nursing Council refuses to accept the registration of midwives (although they have their rights guaranteed in the court of law to register as professionals). I have many friends who are nurses and I have great respect for their profession; many of them disagree with this attitude of their professional board and think that nurses and midwives should be united in the struggle for improving the quality and safety of labour and birth care that respects the rights of women.
As activists and researchers in the field of health care and women’s sexual and reproductive rights, we know that what Brazil needs today is to invest in the capability of health care professionals to facilitate physiological birth, fostering a respectful birth, and reducing the unacceptable high rates of episiotomies, labour inductions, Kristeller manouvers and other obsolete interventions, which are aggressive, risky and painful. This scenario, coupled with the institutional violence and disrespect for the right of women to have companions during labour and birth, causes many women to escape violence, preferring an unnecessary caesarean, with all the risks for mother and baby. That is, we have a conflict of interests: keeping things as they are—a “worsened birth” which favours those professionals who benefit from this violent model, so that the “model of routine cesarean” can be imposed on women as the “best birth” alternative.
The midwife is the university-level professional who assists healthy women to give birth in many developed countries, and this model is associated with better maternal and neonatal outcomes. Brazil needs midwives urgently, working in a comprehensive care system, especially now that we are asking the “whys” and “hows” of increased rates of maternal mortality and morbidity, and the reasons why there is so much violence in childbirth.
If you care about changing this scenario, I ask you to sign the petition calling for the maintenance of the direct entry midwifery course in USP at http://www.abaixoassinado.org/abaixoassinados/8452. Visit our Facebook page for more information: http://www.facebook.com/event.php?eid=202473466447962&index=1
Warmest Regards,
—Simone Diniz
sidinizg@gmail.com
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