Midwifery Today
International Conferences

Midwifery Today's next international conference is scheduled for May 18–22, 2005, in Copenhagen, Denmark. Begin making your plans now!

Class topics include:

• Midwifery Techniques from Mexico
• Herbs and Natural Remedies from Two Continents
• Keeping Birth Normal
• Hemorrhage and Third Stage: How to Prevent Holistically

Conference teachers include:

• Sara Wickham
• Ina May Gaskin
• Michel Odent
• Marsden Wagner
• Cornelia Enning
• Naolí Vinaver

Go here for more information.

Do you have international articles of interest to the birth field?

What is midwifery like in your country? What techniques do midwives use? Do you have any birth stories you want to share? Have you worked in other countries? We would love your short stories!

Send your submissions to: iam@midwiferytoday.com

IN THIS ISSUE

• Quote of the Quarter
• The Art of Midwifery: Short Cord
• Country Contacts for Midwifery Today
• IAM Member Spotlight
• Tsunami Relief
• Brazilian Survey
• Guatemalan Postpartum
• Czech Republic: The State of Midwifery
• A Flemish Midwife
• Connections
• Midwifery Today Web Site Update

Quote of the Quarter

By taking responsibility for our children's births, we are not only giving the physical gift of a gentle entry into the world, we are also participating fully in an event of profound emotional and spiritual significance for us all.

— Nina Klose

The Art of Midwifery

You can confirm that a baby has a short umbilical cord by observing the abdomen. During contractions, and sometimes without them, the baby appears engaged, even though a vaginal exam reveals that she is floating. It is important to avoid interventions that force the mother's body to enter the birth process before the placenta and uterus are ready. The fundus has to descend with the baby. The process takes time. Contractions that cease despite dilation of 2 to 5 cm in a mother with previous fast births and no other complications indicate the possible existence of a short cord. Observation without intervention is important in these cases.

— Marina Alzugaray, Midwifery Today Issue 70

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.

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Country Contacts

1) Wendy Freeze, Papua New Guinea

I am a childbirth education teacher in the Highlands of Papua New Guinea at an international mission center. I also teach linguistics/translators basic midwifery skills in the event that they would be asked to help with a birthing mother in the remote villages where these translators live and work. Before serving on the mission field, I was a midwifery apprentice. I have also given birth to seven children.

I am currently involved in teaching national women how to become more effective traditional birth attendants. I teach them in Tok Pisin, the local trade language. I am also involved in helping them set up better-equipped maternity centers.

Being in a remote location, I gather birthing information from e-mail and the Internet. International midwifery puts me in touch with so much useful information, stories and other women who are passionate about good birthing! My goal is to encourage and be encouraged as well as increase my birthing knowledge.

It is fascinating to realize that many countries in the world are undergoing change that has been brought about or is currently being facilitated by women who are passionate about good birth! I share that passion and look forward to corresponding with many like-hearted women from around the world via e-mail.

Contact:
E-mail: t-w.freeze@sil.org.pg
Language: English

2) Jennifer Houston, Antigua, Guatemala

How are we involved with birth? Midwives for Midwives and Women's Health International is a U.S. non-profit organization based in Antigua, Guatemala. We are (mostly) midwives but also have members from the fields of public health, gender studies, ethono-botony, anthropology, obstetrics and complimentary medicine. We are working to improve women's lives and health through midwifery and to strengthen midwifery in Guatemala.

Historically most of us have been involved with midwifery starting from the childbirth reform movement in the 1970's. We have fought on many levels for the freedom to choose how women give birth, where and with whom. Most of the midwives on our board have years of experience in out-of-hospital birth, international midwifery and training.

We began working in Guatemala in 1997. We opened a women's health and birth center which provided full scope, comprehensive midwifery care to a diverse population until November 2005. We also began meeting with local Guatemalan midwives to get to know them, share information and provide support and comradery.

Midwives began asking us for training in improved methods and help in organizing. We began training in 2000 and have trained over 170 midwives in a 28 session course. We provide a textbook (Hesparian's Guide) and a safe birth kit that is very complete (gestational age wheel, measuring tape, fetoscope, blood pressure cuff and stethoscope, thermometer, scissors, hemostats, bulb syringe, three cotton receiving towels, gauze, and clean and sterile gloves).

After five years of training we have been recognized as the most effective NGO training midwives. We have a list of over 500 midwives who have personally contacted us for training. We have now been asked by the Minister of Health to collaborate on a national program for midwives.

January 2005 we are demonstrating professional midwifery in one of the public hospitals (Solola Hospital) where we will include a clinical component for those in our training. This demonstration project will allow us to prove the effectiveness of the model and encourage the government to replicate the model. Our model uses effective traditional methods and basic midwifery tenents that transcend culture as well as evidence-based ("modern") midwifery knowledge and skills.

We hope to create a cadre of skilled birth attendants who provide community based midwifery and who have the capacity to organize nationally to advocate for their own profession and positively effect public policy that strengthens the important work they do.

Contact:
Jennifer Houston, CNM MS
Executive Director Midwives for Midwives
1081 High Falls Road
Catskill, NY 12414
(518) 678-3154
www.midwivesformidwives.org
Ixmucane Clinic
32 N. Ave 4th
Antigua, Guatemala
(502) 832-5539

Editor's Note: Would you like to be a Midwifery Today country contact? Write to jan@midwiferytoday.com and tell us why you would like to be a country contact or for more information. Proficiency in the English language and access to e-mail and the Internet are necessary.

IAM Member Spotlight

Saludando Vida - Marina Limbo
Buenos Aires, Argentina

Seventeen months ago we got together and started thinking about the possibility of setting up a place where birthing women were treated and assisted safely and respectfully, using research-based evidence. All of us are registered midwives; we have been involved with births since we finished college, for approximately five years. We have been working in hospital settings where we witnessed violence, lack of safety, lies, threats and so on toward women and toward midwives as well. Wanting to better serve these women helped us get started.

Projects: We filled in an application form asking for money from some Dutch sponsors—mamacash. They liked our project and will give some support to us. Our project guarantees continuity of care during the whole pregnancy, birth and postpartum. We are available 24 hours a day. Women can choose their birth place, but we advocate homebirth or birthing centres. We have a philosophy of informed choice. We want all women (rich and poor ones, foreigners or citizens, alone or with a partner) to be able to enjoy their delivery, receive safe care and be treated respectfully. We support nursing, we counsel about birth interventions and give support to those people who were mistreated by the current care they usually get from doctors and hospitals.

In Argentina, talking about homebirths and birthing centres is like being in front of the devil—we are considered negligent, crazy, unsafe. We are pioneers. One of us is a registered midwife from Europe, I went to Canada, we learn from other midwifery models, study from textbooks such as Spiritual Midwifery, Myles, Murray Enkin, Robbie Davis-Floyd, Michel Odent, but we need guidelines to help us set up our birthing centre and organize our level of skills and knowledge, and money to invest.

Goals: In Argentina, midwives don't even know there are midwives in other countries. They have no idea of what they do, what their working conditions are like, what skills they have. We are losing our identity. We learn from books written by doctors. Most midwives in Argentina are proud of practising episiotomies (unnecessary ones), of suturing, of using IVs (on everyone), ordering c-sections; they confine women to beds and don't allow to them drink or eat. The list is too long. They dislike traditional midwives. They love overusing technology. They don't advocate for women's rights and bodies. We are losing the ancient art of midwifery.

We aim to recover our role as midwives, our place by women, our women-centred philosophy. We need to get in contact with our sisters who never lost their identity and with those who lost it before us and could recover it again (like those in the Netherlands, Canada, Guatemala).

E-mail: obstmarina@yahoo.com.ar
Languages: English, Spanish, French, German

Editor's Note: We have many new members in the IAM directory; please go have a look around and see who's there! (Log in at http://www.midwiferytoday.com/iam/login.asp then click on "Search the Directory." Select "Show newest members first" to view returns beginning with the most recent member.)

Tsunami Relief

A grass roots organization, Circle of Health International (COHI), is organizing for providers (all types of midwives included) to volunteer in tsunami-afflicted regions. They are currently applying for funding. I am sure they will take donations of money and airline points.

Those interested in going should contact:

Sera Bonds, MPH
Director, Circle of Health International
70 Brentwood
Allston, MA 02134 USA
Phone: (512) 517-3220
E-mail: sera@circleofhealthintl.org
Internet: www.circleofhealthintl.org

— Megan Bower, MPH

COHI writes:

Circle of Health International's mission is to support the empowerment of women in conflict, post-conflict and humanitarian emergencies through the provision of comprehensive women's health services. We are presently working on development projects in Tibet and Palestine, and providing emergency relief in Sri Lanka.

We are midwives, OB/GYNs, trauma specialists, public health professionals, infectious disease specialists and activists. COHI field workers are competent, capable, compassionate, patient, and committed. COHI field workers are often required to respond immediately and creatively to life or death emergencies and must be comfortable in this environment. If you think this is you, then please provide the following:

1. Your curriculum vitae (CV) with relevant field-related experience and licensing
2. Precise availability for travel (city of origin), a list of current vaccinations and passport information (exact spelling of name, country, passport number, expiration date, place of issuance) and emergency contact information
3. A brief letter describing why you want to join COHI's field team.

Due to the nature of our field assignments, you should know that upon accepting assignment with COHI you will be expected to sign a waiver releasing COHI of all liabilities in regard to your health and safety when in the field. We do not presently have the funding to provide general health or travel insurance. COHI will do all we can to ensure that your health and safety are not threatened, but we work in dangerous places and cannot be held accountable for your absolute safety when on the ground. In addition, when accepting an assignment, you may be expected to provide your own funds to secure the medicine and field equipment required for your placement of no less than $250. Again, COHI aims to support its volunteers to its utmost capabilities, but due to lack of funding is not always able to do so and depends on the volunteers to sometimes provide their own monetary support in this way.

Through the generous support of individual private donors, COHI has already begun to respond to the unfolding disaster. We already have our first team coordinator, epidemiologist Johnny Lee Park, MPH, on the ground in Colombo, Sri Lanka. Mr. Park will be conducting the First Assessment Phase of securing critical information, logistical support, grassroots community partnerships and primary needs assessments of the affected populations, focusing on the essential needs of women.

With further financial support, COHI will send two more relief teams in two stages. Funds will secure transportation and per diem for skilled professionals, the essential relief supplies that they will require, yet to be identified, and compensation for local staff.

Editor's Note: More reports on the tsunami-devasted areas and relief efforts are available on our Web site: www.midwiferytoday.com/news/news_tsunami.asp

Brazilian Survey

International Association of Midwives has received news of a Brazilian survey designed and distributed by The Federal University of Rio de Janeiro, Brazil Center of Philosophy and Human Sciences, Institute of Psychology, and Post Graduate Program of Psychology. The questionnaire, which is directed toward psychologists, family therapists, midwives, doulas, childbirth educators, nurses, physicians, etc., whose work deals with natural childbirth, is designed to help determine if there is a general profile typical of children whose parents were conscious of the idea that their way of being, and their behavior from the time of conception onward, would influence the physical and mental health of their children. In other words, do children conceived consciously and born by natural childbirth present differentiated patterns of development?

Parents must have all the following characteristics:

1. Prior to conceiving, parents possessed either scientific or spiritual information that made them intend to conceive in a conscious manner, under conditions they thought appropriate for the birth of a healthy life.
2. Knowing that a conscious pregnancy with reduced stress is important, parents were careful with their diet and took part in creative activities, bearing in mind the quality of life of the child they were gestating.
3. They chose a natural childbirth because they thought it would be better for their child.
4. The mother breastfed for at least six months, understanding that this would be better for her child.
5. The mother dedicated to her child the maximum time possible during the first three years of the child's life because she understood that her presence was the most important factor for the healthy development of her child.

The survey includes 32 simple questions about the child's physical health, social behavior, sensitivity, tolerance, expression of emotions, ability to accept guidance, response to frustration and more.

To learn more about the survey and to receive a copy, e-mail Eleanor Madruga Luzes, MD, PPSYC, Jungian analyst, PhD candidate at: eleanorluzes@uol.com.br

Guatemalan Postpartum

After birth, Berta [midwife] watches the woman's vital signs, and once they are stable, she prepares the temascal, the traditional sweat bath. The most important part of the temascal is the herbs Berta puts in the water. These include eucalyptus (Eucalyptus spp.), salvia santa (Verbenaceae), rosemary (Rosemarinus officinalis) and chamomile (Matricaria courrantiana). The herbs are put in a pot of water on the fire to boil, and the steam fills the temascal. The wonderful smell and the steam help the lungs relax, and the water, when used for bathing, goes into the pores and adds nutrients to the blood. In addition to the herbal water, the famous jabón negro (black soap) is an important part of the bath. "All the women use it," Berta explains. "The midwife uses the jabón negro to wash and massage the woman's entire body – her belly, back, arms, everything. The jabón negro is special because it's all natural, it's very smooth and it comes from the community. The women make it themselves." In the past, swomen used to do the temacal every day for a week, beginning on the day of birth, and then every other day for the second week. Now they do it less, about four or six baths, every other day.

— From Voices of Maya Midwives: Oral Histories of Practicing Traditional Midwives from the Mam Region of Guatemala, by Sarah Proechel. Excerpted in Midwifery Today Issue 72.

The Spanish version of this article (only a few paragraphs of which ran in print in Spanish) is online. Read about the fascinating life of this Guatemalan midwife: www.midwiferytoday.com/articles/berta.asp

Czech Republic: The State of Midwifery

In April 2004 a new law was passed that allows midwives to carry out their work without professional supervision after three years of practice in the field of care for women during pregnancy, birth and postpartum. The law recognizes the midwifery profession as one that provides healthcare, ensures necessary supervision, care and advice for women during the childbearing year, as long as these are physiological, and includes conducting a normal birth and providing care for newborn. Care in gynaecology is also included. Furthermore, a midwife in cooperation with a doctor participates in providing preventive, therapeutic, diagnostic, and emergency care.

Nevertheless, as Czech Association of Midwives member Zuzana Stromerova reports, efforts continue to prevent midwives from working independently and without doctors' supervision. Those opposed to the law are attempting to make it impossible for midwives to become certified and work independently. Without certification, midwives can work only under a doctor's supervision. Physicians argue that the medical model of birth is the only legitimate model, conducted according to "lege artis" rules set by the gynaecologists. Also, to be registered as an independent midwife, a woman must have her own practice with formulary equipment. This makes it financially inaccessible for the majority of midwives. For those who want to offer only postnatal visits and home consultations, it would be also useless. Physicians also maintain that the WHO recommendations regarding care in normal birth were made only for developing countries and have nothing to do with obstetric and midwifery care in the Czech Republic.

Public Healthcare Insurance law only recognizes birth activities prescribed by medical doctors. The work of independent midwives cannot be covered by the insurance unless prescribed by a gynaecologist. Many midwives think twice before starting an independent practice because it is tremendously difficult to survive economically.

Conducting a normal, physiological birth out of hospital is "non lege artis" according to the Czech Gyn.-Obs. Society. This eliminates choice for women who would like to use alternative care during pregnancy, birth and postpartum. Because members of the Czech Gyn.-Obs. Society are recognized as the professional experts in negotiations with any institutions in the Czech Republic, they have the greatest influence on healthcare policy, making it nearly impossible for midwives to ensure the professional care of women in the childbearing year. Influenced by the medical lobby, the health insurance offices do not want to make contracts with the midwives. It is a paradox that free informed choice of care during natural birth has such minimal support among the doctors, while elective caesarean section is supported more and more.

At the last national congress of the Czech Gyn.-Obs. Society in May 2004, its chairperson stated that the Czech Republic has enough private gynaecologists and therefore only very limited space for midwives. He did not recommend that public health insurance cover midwifery work because it would waste money available from insurance offices.

At the moment there is no other way out than to wait to see how the new law will be implemented in practice, when midwives will start to ask for registration and permission to work independently.

Because the Czech midwives have no place to appeal their case, present their complaints or ask for help in their own country, we address the international institutions and ask them to explain to the Czech Ministry of Health of the Czech Republic and the Czech Gyn.-Obs. Society what women's basic rights are and what are the obligations of the Ministry of Health and the Gyn.-Obs. Society in ensuring professional care for women, even if it represents minority opinion.

A Flemish Midwife

I am a midwife in pre-retirement from being coordinator of midwifery education for more than 30 years; as such, I have worked both in hospitals and in homebirth settings.

I have always been convinced of the normality of childbirth. For the past ten years I have been editor-in-chief of the Flemish Journal for Midwives. I strive to include articles about the physiology of giving birth rather than about technology. Midwives indeed are gardeners of this uniqueness. After I left midwifery education, the curriculum changed to a medical program of treating complications in pregnancy and childbirth so that Flemish midwives serve the medical profession (to meet the needs of the work-field) and work as obstetrical nurses. About 5-10% of midwives are struggling to keep birth normal.

During the past three years I have tried to integrate the findings of prenatal and perinatal psychology in midwifery practice. We midwives are not only caring for the mother and the family, but the child as well. In Western obstetrics (medicalised birth) we focus only on the mother and don't realize the impact of these interventions on mother-child bonding. All the (technological) interventions result in separation of mother from child, which basically disturbs the attachment process. Now I am giving lectures about having a good birth from the point of view of the newborn baby, making parents aware of their rights and not allowing their child to be taken away after birth for whatever reason.

The hormonal interaction (orchestration) is designed by Nature. We midwives know that mother and baby need each other at birth: mutual dependence makes the child very vulnerable in his/her adaptation to life outside the uterus. Symbiosis (physical and affective uniqueness) must be restored immediately after birth (bodily [skin-to-skin] and affective contact).

Midwives must be more conscious about the affective and emotional needs of the newborn: because babies remember their birth, we can assume that the way we are born affects our life. This is crucial to our attitude about life: positive experiences in the uterus and a good birth with undisturbed attachment experiences are necessary to build relations for a lifetime. Newborns do need a basic feeling of safety, security and self-trust. Only the mother can take care of the basic needs of safety, care and security.

Focusing on the child's point of view: asking what the child expects from his/her birth might be a way to react against the medicalisation of childbirth for a better future society. Poor and disturbed attachment because of mother-child separation in the first hours of life due to interventions) causes babies to cry, sleeping disorders, reflux, colic, avoidance of eye contact, failure to thrive. If we convince (real) midwives and future parents about the importance of this approach, successful breastfeeding will be a logical consequence.

— Lisette Geerdens
E-mail: avlg@skynet.be

Connections

Midwifery Needs in Iraq

I have been in touch with a midwife/project manager in Northern Iraq who is working on lists of needs. For now, primary needs are teaching materials and financial support. She suggested setting up an adopt-a-book program. At their request, all financial contributions should be made to International Affiliated Missions and will be forwarded by our group to theirs. Those making a donation should note that the gift is for the Iraq Maternal Care Ministry. The address is:
International Affiliated Missions
134 W. South Boundary
Suite JJ
Perrysburg, OH 43551

— Katie Hileman
E-mail: khileman_2000@yahoo.com

Quebec

I have a particular interest in serving French-speaking women because most sites/forums/magazines are published only in English. It's quite complicated for the average woman to find information about natural/alternative birth.

Quebec midwives obtained the right to practice homebirths only a few months ago, and the first group of 11 midwives graduated last year from the university. So as you can see, it's a service that only concerns a small minority at this point. Officially, I don't think there are more than about 700 births done by midwives annually in a province with a population of nearly 7 million!

— Chantal Ann Dumas
E-mail: chantalanndumas@sympatico.ca

Midwifery Position in Guatemala

We have a position open for the right person to join our training team in Guatemala. Our project in Guatemala working with traditional midwives is growing. After seven years of diligent work training, organizing and advocating for midwives, the current administration is paying attention to the health needs of women and midwifery.

Our training is: holistic, culturally relevant, skills-based and includes critical thinking skills, equipment and organizational capacity building. The position we have open is for a qualifed midwife to head the hospital based clinical component. We are looking for a clinically strong midwife with excellent skills, a strong heart, proficient in English and Spanish who has good people skills.

Job begins Feb 2005 and lasts until May 30th with possibility for renewal. Competitive salary, health insurance, travel stipend and an experience of a lifetime.

Contact:
Jennifer Houston, CNM MS
Executive Director Midwives for Midwives
1081 High Falls Road
Catskill, NY 12414
(518) 678-3154
www.midwivesformidwives.org
Ixmucane Clinic
32 N. Ave 4th
Antigua, Guatemala
(502) 832-5539

Midwifery Today Web Site Update

"Reclaiming the Joy of Midwifery and Birth"—The Midwifery Today Conference in Copenhagen, Denmark: Extensive travel and accommodations information is now online. You may also view the complete program and registration form. Go here.

Read these excerpts of articles from Midwifery Today Issue 72:

• The Tree and the Fruit—Routine versus Selective Strategies in Postmaturity—by Michel Odent
• A Timely Birth—by Gail Hart

The Midwifery Today country contact list is now online. View the list by logging in here then clicking on View Country Contacts. Remember, membership in IAM is now free! If you are not already a member, register here.

All questions and comments submitted to The IAM Newsletter become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.

Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

This publication and any information provided are not intended to constitute the practice of, or furnishing of, medical, nursing or professional health care advice, diagnosis, consultation, treatment or services in any jurisdiction. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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The content of The IAM Newsletter is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may print a single copy of each issue of the newsletter for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

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