Jan’s Corner
A Message from Marion
I am one very blessed midwife because nearly as soon as I was called to become a midwife at the time of my first homebirth (our second daughter), I met Marion. She diligently taught me midwifery (free of charge) with a deep desire that I would learn and serve well. This was in 1976. Since that time she has graciously taught many more the art, science and skill of midwifery. She has written for every issue of Midwifery Today and has become not only a mentor, but a really good friend. The blessing to you is that you get to read her words in every issue of Midwifery Today. She is now in Uganda and here we share with you, with permission, her first report back.
Hi from Marion, writing from the Teso region of Uganda.
I am staying in the small city of Soroti, in the African savannah country, northeastern Uganda. I arrived last Monday for my fifth year as a medical volunteer at Teso Safe Motherhood.
Teso Safe Motherhood is a maternity center, where 80–100 babies are born each month. We give pretty complete maternal child health services. Wednesday and Thursday I helped Sr. Joyce (our lead family planning nurse) give two well child clinics. We see babies up to 2 years old or so. We saw over 100 on Wednesday, then around 20 on Thursday at one of our village outreach clinics. The midwives have been steadily busy.
To improve our services to our clientele of subsistence farmers and fishing people, we now have an OB doctor on staff—Dr. Ouna Martin. He rounds every morning and is available an additional five or ten hours a week as needed. What a benefit as all you out-of-hospital midwives know since he is a staff physician at Soroti Regional Referral Hospital, which is in the center of town about a mile from Teso Safe Motherhood.
Our staff workers are all fully licensed and certified Ugandan health professionals and ancillary workers. We provide 24-hour emergency transport to the hospital. You can imagine what a welcomed addition Dr. Ouna’s services are!
One of my young friends asked me, why do you go to Africa? I’m curious, that’s why. I like to hang out in a different climate and culture. I like to stretch my mind and walk to work or take a bicycle taxi (riding on a padded seat over the rear tire). Most people walk here; the next most frequent mode of transportation is bicycle, then motorcycle, then cars, vans and trucks. I think the experience of living in foreign lands can make a person more open-minded. It’s a treat to travel around town and see lots of walkers, many bikes and only a few motor vehicles.
At Teso Safe Motherhood (and at hospitals here) food is not provided to the in-patients; a family member or sometimes a friend comes to stay and cook. When babies are born, it’s mostly the mother-in-law, but sometimes the mom if the woman is a single mother.
Today Petua (one of the midwives) is coming to meet me for lunch, and then I’m going to walk out to the clinic with her. She goes on night duty in late afternoon. I’ll hang out with her until the sun gets low.
— Marion Toepke McLean, CNM, attended her first birth as primary midwife in August 1971. She received her nursing degree from Pacific Lutheran University in 1966 and her midwifery and family nurse practitioner degree from Frontier Nursing Service in 1974. She had a home birth practice until 1985, when she went to work at the Nurse-Midwifery Birthing Service, a freestanding birth center. Since 2002 she has worked in a reproductive health clinic and attended an occasional homebirth. She lives in Eugene, Oregon, and is a contributing editor to Midwifery Today. Please read the rest of her bio here.
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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Featured Article
Just How Long Is “Normal” for Labour?
It was a sunny, summer Monday morning. The heat was already hazing over central London as I approached the hospital. The midwives had phoned me in transit to the birth center. It was going to be a busy day; the center was almost full. […]
The phone rang; one of our planned homebirth women, who had thought she was in labour during the night, now knew that she was. Helen, a 44-year-old first time mother, had booked a home waterbirth with one of the group practices. At 2 am Helen had called out the night on-call midwife, who had stayed with Helen for a few hours, reassured her and left her to rest. Unfortunately, Helen’s designated midwife was on study leave for the day, and the remaining members of the group were occupied with other women in the birth center. Helen was assured that a midwife would call on her soon. Since Helen had given a good history on the phone, we knew there was no hurry. She reported mild contractions about every five minutes. Her waters had not broken, her baby was active, and she felt well. We decided that as soon as our waterbirth was complete, the senior student midwife and I would go to attend Helen.
An hour later, after a lovely baby girl had been born in the pool, Rachel (the student) and I left the birth center to travel two miles west to see Helen. Rachel was excited, as she had met Helen before. Helen opened the door of her apartment wearing a lovely smile. She greeted us warmly and said she was glad we had arrived, as her contractions were getting stronger. Her partner, Tom, was already there, and Helen’s mother and Tom’s mother were on their way. This was going to be a family occasion. Helen’s dear friend, David, was also a birth supporter, and as he was a first class chef, he was doing the cooking for the day! Helen had kept a video diary of her pregnancy and had arranged for another close friend to film and photograph the labour and birth. […]
Rachel thought Helen had gone out of labour; after all, she had reported contractions from 1:00 am. It was now 6:00 pm, and Helen had had only one vaginal examination. How could we know if things were progressing? How could anybody sleep so much in labour?
“Observe her,” I said. “See how every few minutes her abdomen moves slightly under the water?” Helen was perfectly relaxed and totally in control. She decided at 6:30 pm that it was time to eat, have a walk and be examined. She relaxed in the garden, ate some light pasta, and then I found that her cervix was 8 cm dilated with the head flexed at the spines. Things were moving on. Helen spent an hour out of the water and then needed to go back, as the contractions were too much. […]
Helen had defied traditional knowledge:
Traditional care would consider Helen, having her first baby at 44 years of age, high-risk. Traditionally, under these circumstances, homebirth would be considered very risky and waterbirth as a pain reliever inadequate.
Helen had a slow labour. Contractions were never more than five minutes apart, and her cervix did not dilate at even 0.5 cm an hour. Such a slow labour may mean a large baby, shoulder dystocia, postpartum haemorrhage, perineal damage. In fact, William was an average 3.2 kg (7.04 lb).
Helen had no complications, but she did have a 24-hour labour that was neither exhausting nor debilitating.
If we analyse this, I think we have a key to the value of individualised care and real advocacy for child-bearing women. The facts are, Helen was a physically fit and healthy woman, regardless of her age. Her pregnancy had progressed without any complications. She had planned a homebirth with her group practice midwives, who supported her decision. Decision-making was shared throughout and was based on the confidence of the midwives who knew Helen.
Thanks to Helen, Tom and William for allowing me to tell their story.
— Astrid Osbourne
Excerpted from “Just How Long Is ‘Normal’ for Labour?” Midwifery Today, Issue 72
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Website Update
Read this article excerpt from the newest issue of Midwifery Today, Issue 104, Winter 2012:
- A Birth Doula for Every Mother by Allie Chee, with excerpts from New Mother
With information taken from her new book, New Mother, author Allie Chee clearly outlines the benefits of having a birth doula and provides helpful details regarding such things as cost and the selection process.
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Birth Q&A
Q: Have you had a prolonged labor either yourself or as a midwife? With your prolonged labor, do you feel it was emotionally related (labor took long because your mind was not at peace)? Tell us about it.
— Midwifery Today
A: Oh was it ever! My first son was lost to adoption five years earlier. One thing that amazed me many years into my service as a midwife was the overwhelming connection of my service in birth and the day I birthed that baby. Every time I received a brand new baby, I handed her/him into the hands of her/his family. It was like giving my son away all over again and over again and over again! Once I realized this, my heart double-flipped and I no longer walked away from births with that same melancholy ever again! And the next time I gave birth it was fast and easy!
— Patricia Edmonds
A: I had a 12-hour easy labor with my first birth, 3 hours easy breezy with my second birth and a 24-hour long labor (after spontaneous rupture of membranes) with fever, meconium and brow presentation. I tried every trick and, yes, I think it was partially the different pregnancy environment. With my second baby it was summer and I was living on my grandmother’s organic red raspberry farm, walking a lot every day and squatting to look at whatever my one-year-old daughter was showing me (a rock, a leaf, a frog) and eating fresh red raspberries, veggies, concord grapes and watermelons and making tea from the red raspberry leaves. I had my grandmother with me to support me. With my third baby we had moved to my in-law’s house in town (my mother-in-law had passed—she was very supportive of my pregnancies and births and had her first baby at home) and I had two toddler girls. We didn’t go out much in my last trimester as it was a long New England winter when it is painful to the fingers, toes and face to be outside. I ended up with a general anesthesia cesarean in the wee hours of March 2001. The day I was in labor for 24 hours was February 29. Somewhere in my mind I knew my son would only have a birthday every four years if he was born on that day!
— Ann Noviello
A: First labor: no fear, lovely planned homebirth, did all the “right” things. It was long, long, long and ended with cesarean. Second labor: tons of fear, was sure I couldn’t do it, fought the process the whole time. It was long, long, long, but baby came out. Third labor: I threw out all the books and advice that told me my long labors were my fault for bad thoughts or not manifesting a short labor or not doing whatever the cool thing was. It was still long and baby came out, but this time I accepted that this is just what my body was meant to do and it wasn’t wrong.
— KJ Cornish
A: I have attended long births. One was four hard days (and nights!). It may have been partly emotional since the father of the baby left her when he found out she was pregnant. It was at least partly physical, too (can you say “cervix of steel”?). She was awesome, worked hard and never once mentioned the possibility of going to the hospital. Very stoic and willing to work as hard and long as it took.
— Marlene Waechter
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My year anniversary with Midwifery Today was January 4. What a wonderful year it has been! I didn’t realize that with taking on the position of managing editor, I was also enrolling myself as a student of midwifery! No, I am not technically on the path to becoming a midwife, but the nature of my job, which requires hours of reading well-written articles from the best minds in natural childbirth, has broadened my knowledge about gentle birth. I am amazed by the wealth of information each issue brings to subscribers. If you haven’t committed to a print subscription, I urge you to do so. The information is rich and the organization of Midwifery Today truly has motherbaby’s best interests at heart so you will be supporting a very important resource for birth workers all over the globe.
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Stories
In the middle of my homebirth, my neighbor’s CB radio broke through the Doppler while my midwife was checking me. I was in the pool in my bedroom pushing and it sounded like a grown man was in my uterus.
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