Interventions—A Term That Makes Midwives Cringe
I have heard some disgusting excuses for cesareans, inductions and ultrasounds. I have also heard some great terminology from my friend Nancy Wainer who coined the term VBAC or Vaginal Birth after Cesarean. Nancy told me, “I spell Pitocin ‘Pit o’ sin.’” Isn’t that a great play on words? She also uses the word “scareprovider,” a term she heard a while back and borrowed. I had never heard that one either! It is one of the most accurate phrases I have heard in years.
Midwives and doctors have forgotten how to provide prenatal care to help prevent complications. The daughter of a friend just had an elective cesarean simply because the doctor got impatient and mom sadly gave in. The baby was little and not at all overdue, even though that was the excuse for cutting her baby out of her. A woman on my Facebook page had many ultrasounds to determine when her baby was due instead of having been asked about the length of her cycle. Why are prenatal care providers inclined to bombard a baby with dangerous ultrasound instead of using hands-on techniques? When did the medical field get so far off track? It almost seems like there is a conspiracy to convince women to quit trusting their bodies. A doctor can ruin a woman’s chance at a normal birth by just saying, “Well, we’ll see if the baby fits though your pelvis.” Many scareproviders should not be allowed within a hundred miles of a motherbaby. It is so sad that mothers are overwhelmed with nonsense that can ruin the birth for her and her baby, denying them their birth miracle.
Back to Nancy’s words: Words are so, so important. Nancy is quite an amazing midwife. She tells me she writes to let off steam when these interventions and lies overwhelm her. Here are a few of her musings:
“…a woman who was 39-1/2 weeks came to me a few months ago after having an ultrasound. She was told that she didn’t have enough fluid and her baby was IUGR (intrauterine growth restriction), and was scheduled for a cesarean, which would have been her third. Two days after she hired me, she had a fast homebirth with a wonderful, healthy baby boy.
“Eleven days after a woman and her husband hired me and thirteen days after her ‘due date,’ (which is only a ‘guess time’), she had an 8 lb 10 oz baby at home. The doctor, her scareprovider, told them that according to the ultrasound, her baby was going to be over 11 pounds. (So what if it was?) When I palpated her, I told her that she had a nice sized baby, but it was not 11 pounds. Of course she would have a nice sized baby, considering that she was 5'7" and in great nutritional health. I asked her if anyone had TOUCHED her belly, lovingly of course, to ascertain if the ultrasound was even in the ball park. Of course no one had.
“Ultrasounds and MRIs are not safe or accurate. If we are midwives, why are we not educating women to trust their bodies and be patient? If the amniotic fluid appears low (again, ultrasounds are notoriously inaccurate) is anyone palpating this mother/baby, and if it really is low, is anyone giving her suggestions to increase the fluid?”
I am waiting patiently for Nancy’s next book. We will let you know when it is ready!
— 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.
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News and Research
Midwives and natural birth advocates in Arizona are pushing to promote prenatal care for the state’s minority and immigrant mothers. According to statistics, “a quarter of all Latina women who gave birth in Arizona in 2009 went without prenatal care during their first trimester,” and three percent of these women received no prenatal care at all. Healthy Mothers, Healthy Babies, an advocacy program directed towards helping disadvantaged mothers find access to healthcare, has been working alongside midwives and traditional spiritual healers from Mexico to improve these statistics by distributing information and providing easier access to prenatal midwifery care.
— Fernandez, Valeria. “In Az., Push to Revive Mexican Midwifery.” Posted December 28, 2011. http://newamericamedia.org/2011/12/in-az-push-to-revive-mexican-midwifery.php.
Interfering or Intervening?
Does normal mean natural? Does normal mean the current practises of a particular culture/hospital/unit/midwife/doctor? Does normal mean that to the particular woman giving birth? The world we have created within midwifery practice means that any of these questions could be answered with a “yes.” So it is clear there is already conflict amongst caregivers and women about what all this means, which makes it overwhelming to find a place to start. When we have a united decision on what “normal” is, we can truly start deciding about how to deal with interventions.
But for the present, as in every aspect of our practise, our prime concern must be the woman/baby dyad and what is happening to her. Is there interference with the process from issues taking place within her or is it something exerted from outside? Is her psyche or the spiritual place she is in interfering with the process? Sometimes we can see the anxious state she is in or the fear that she has of birth or that the future has a hold over her. Progress cannot be made until these internal issues have been dealt with so that the mother can move on in her life.
Do we really know the effect of what we do or say on the process of a woman’s labour? Intervention by physical means may be commonplace—there has been much discussion in recent years about artificial rupture of the membranes, for example, and why it may not be an appropriate form of management. But what about the use of “stretch and sweep”; or the use of herbs or oils by midwives to encourage the commencement of labour; or the use of nipple stimulation to enhance contractions? Should these be discouraged because they are not “natural,” because they are “interventions”? There are also the psychological interventions. For example, the words we use or the way we use them may have a very negative effect on the way the woman responds to birth; this could intervene in the normal processes. There is also plenty of anecdotal evidence about women’s contractions stopping or slowing down when they set foot inside a hospital labour suite to suggest that the mother’s psychological processes have been interfered with through the mere action of bringing her into an unfamiliar environment.
We should also take into account social and cultural implications—that where a mother lives or who she chooses to have with her may very well have an effect on the process. I am talking here of situations where the woman is living in fear of partners who are present but showing no interest in the event. There could also be birth supporters who have controlling tendencies who may try to take over or disempower her. Often when we encounter women in labour areas, we have no idea of the difficult or painful situations in which they live or how that impacts the way they are approaching the birth. These situations could certainly be regarded as negative and interfering. Are we also right to insist on our expectations for the woman during labour because it is “evidence-based,” when it may be totally against her cultural expectations? If we suggest something that may be “unnatural” or against her beliefs, we are interfering in her natural processes. We should also recognise the spiritual issues—that attitudes, forms of pain relief or mechanical interventions may have a detrimental effect on her ability to find meaning and purpose within the event (Hall, 2001). The process of giving birth naturally leads to a transformation within herself (Bergum, 1984; Rubin, 1989). Are we right to intervene here? We have no real way of knowing what effect we really have on a woman’s whole life.
- Bergum, V. 1989. Woman to Mother: A Transformation. Bergin and Garvey, Inc.
- Hall, J. 2001. Midwifery, Mind and Spirit: Emerging Issues of Care. Butterworth Heinemann.
- Rubin, R. 1984. Maternal Identity and Maternal Experience. Springer Book Co.
— Jenny Hall
Excerpted from “Interfering or Intervening?,” Midwifery Today, Issue 63
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of the births
The Midwife’s Journal has room for you to record the essentials of up to 100 vaginal births and 20 cesareans. There’s also a section for addresses and telephone numbers and an appendix of forms and charts. Plus, the one-of-a-kind freestyle index lets you compile statistics or quickly find complicated cases or other significant events. Durable enough to be carried in your birth bag and subjected to the rigors of daily use, this unique organizer is ideal for midwives, physicians, doulas, nurses, and other childbirth professionals.
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Question of the Week Responses
Q: I have a doula client who is eight months and was diagnosed with PUPPP (pruritic urticarial papules and plaques of pregnancy). Aside from early delivery, can anyone give me some suggestions as to how to help her? She is miserable and says nothing she has tried has given her any relief.
— Jennifer L. Moyer
A: Refer her to a traditional Chinese medicine acupuncturist for the best results. In addition, milk thistle and dandelion will help to assist the methylation process of the liver with phase 2 detoxification. PUPPP is not an indication for inducing preterm! Without help, this can follow her right into postpartum (for up to 8-10 weeks), so she doesn’t need that along with caring for a preemie.
— Vicki Gervais
A: Turmeric in capsules—one or two capsules two times a day.
— Kim Stanford
Q: My wife is 14 weeks pregnant and still having morning sickness and vomiting. Is this normal? Is there any home remedy that can help?
— Reuben Zaninge Zimba
A: I had this same problem. Acupuncture worked the best for me. Along with ginger, lemon drops, Sea Bands, peppermint oil and oyster crackers. I lost 13 pounds but delivered a healthy 8 lb 10 oz baby boy.
— Kelly Janz
A: Morning sickness during my current pregnancy stopped around 20 weeks, although I’m still very sensitive to smells. High protein intake and foods such as sharp cheddar and chicken have helped.
— Natalie Consolo
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Birth Wisdom from the Web
Many midwives also downplayed the centrality of monitoring and resuscitation equipment setting them off to the side, or placing them under baby blankets during labor so women would not be reminded of the technology in the room. Mothers and babies were still monitored closely, but the monitoring was not made the central focus.
— Melissa Cheyney, an assistant professor of medical anthropology at OSU, commenting on midwifery practices and rituals.
It took me months to recover physically after the [hospital] birth and I would say that even after almost three years, I am still recovering emotionally. If I had the chance to do it again I would choose a midwife so that my chosen care provider could be with me when I needed her.
— Megan Brooke, mother and midwifery advocate, reflecting on her traumatic hospital birth.
The number one quality of a good midwife, in my opinion, is patience. Labor takes time and a laboring mom deserves just that.
— Donna Ryan, blogger and natural childbirth educator
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 firstname.lastname@example.org.
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Bad Wildbad, Germany, 17–21 October 2012
We thought we might be going to Latvia and Ghana next year. We have postponed those conferences for now, and instead we will return to Bad Wildbad, Germany, for our next international conference. This is one of our favorite locations for a conference because of the beautiful setting, wonderful spas, nice meeting rooms and the great hospitality of the town. They roll out the red carpet for the Midwifery Today conference and treat all the registrants so graciously. Many countries are represented at our conferences in Germany—there were 38 last year and 43 in a previous year. With so much diversity, you can be sure to increase your international knowledge just by talking with other registrants. You can also make midwife and doula friends from all over the world. This is the place where the world comes to us!
I have just finished the conference program and it should be online soon after you get this note! http://www.midwiferytoday.com/conferences/Germany2012/ The theme is “Midwifery: Birth Care for a Global Future,” and it is an excellent program. Many teachers are joining us, including Ina May and Stephen Gaskin, Elizabeth Davis, Gail Hart, Carol Gautschi, Sharon Evans and Lisa Goldstein (who has over 50 years of practice!). In addition, Angelina Miranda Martinez from Mexico, Tine Greve from Norway, Katerina Perkhova from Russia, Cornelia Enning from Germany, Eneyda Spradlin-Ramos and I will be there as well! I look forward to seeing you in Bad Wildbad—let’s meet in the spas!
— Jan Tritten
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We literally take the African phrase that says; “do not insult the traditional midwife if you still want to give birth” seriously. This is so because they are our messiahs here [in Chikombedzi, Zimbabwe]. We do not rely on the nurses for birth.
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