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. From 1976 through 2001 she did home, clinic and hospital births, while also working as a family nurse practitioner. In 1980 she taught a year-long program for local midwives, returning to Frontier Nursing Service to teach during the summer. She had a homebirth practice until 1985, when she went to work at the Nurse-Midwifery Birthing Service, a freestanding birth center. In June 2000 she completed a BA in International Studies at the University of Oregon, with concentrated studies on Mexico. 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.
More than 20 years of efforts by maternal child health care workers has paid off with the news that pregnancy- and childbirth-related deaths worldwide have decreased substantially since the Safe Motherhood Initiative began more than 20 years ago. This information comes from an in-depth study led by researchers from the University of Washington in Seattle and published in The Lancet (1) earlier this year. Generous funding by the Bill and Melinda Gates Foundation allowed them to search out and include in their analysis data that had not been used in previous maternal mortality estimates, achieving more complete and accurate results.
Read more…. Study Shows Mothers’ Lives Saved
In January 2010, I was asked to help the Teso Safe Motherhood Project in Soroti, Uganda, develop their family planning program. Family planning is important to safe motherhood; it can decrease maternal mortality and morbidity and help people have healthier families.
Read more…. Family Planning and Safe Motherhood
This midwife is on the cusp of change. The day before yesterday, December 31, I worked my last day at Planned Parenthood. At midnight, as 2009 changed to 2010 and the younger generation set off fireworks in the barnyard, I became a retired person—social security-qualified and all!
Read more…. Changing Childbirth: The Midwife & the Phoenix
Jennifer had once told me, “I don’t do births in Africa,” leaving this to an excellent staff of Ugandan midwives. But on that lucky morning, she got a stuck baby born and saved a life. Read more…. A Difficult Breech Birth
Marion discusses the use of the partograph in developing countries.
Read more…. The Midwife and the Partograph
Marion shares her experiences as a volunteer in Uganda.
Read more…. Working in the Safe Motherhood Clinic
The author argues that midwives need to be aware that it does matter what happens during our birth so they can do the best job possible.
Read more…. Does It Matter How We Were Born?
My introduction to International Midwife Assistance (IMA) came in 2006 when I spent three weeks as a volunteer in their Community Midwife Training Program in Bamiyan province, Afghanistan. IMA offers a high level of people-to-people assistance, with almost no bureaucracy. Our services were direct, personal and highly valued by the recipients.
Read more…. Marion’s Message: International Midwife Assistance
When I was 21 years old and newly graduated from a Bachelor of Science nursing program, I had enough money left in my college fund to go to Europe for a few months. A woman friend and I went to Paris where I studied French at the Sorbonne and lived well on $150 per month. I learned about politics, philosophy and life. Some old sayings seemed more meaningful in French, like, “Plus ça change, plus c’est la même chose.” “The more things change, the more they stay the same.”
Read more…. Marion’s Message: Plus ça change…
Photo by Nathan Dumlao
Sharing our birth stories is one way of teaching midwives their trade. Marion tells the story of a frank breech presentation, describing the steps in how the birth occurred.
Read more…. Marion’s Message: The Safest Kind of Breech
Editor’s note: This article first appeared in Midwifery Today, Issue 82, Summer 2007. Join Midwifery Today Online Membership What is the ideal cesarean section rate? That rate associated with the least possible morbidity and mortality for mother/baby. This is the suggestion of Fernando Althabe of the Perinatal Research Unit, Montevideo, Uruguay, and Jose Belizan of the Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, in their recent article in The Lancet.(1) They acknowledge that the appropriate rate is debatable. One to five percent is a range for the minimum. Fifteen percent, as suggested by WHO (2), is a commonly accepted goal for a maximum rate. Althabe and Belizan are commenting on a study of cesarean rates in developing countries, reported in the same issue of The Lancet.(3) One way to determine whether 1% or more is really a minimum safe cesarean rate, look at three conditions that can be fatal without surgical intervention. The rates of these conditions are variable, depending on the population and other factors. Placenta previa at term occurs in about one in 200 births. However, it is more common in multipara and in older women, occurring in more than 1% of the time, even more frequently if the woman has had a previous cesarean. In primipara the rate may be one in 400 or less. Abruptio placenta occurrence varies between 0.5% and 1.5%. It is more frequent in women who have high blood pressure, smoke cigarettes, or are carrying a multiple pregnancy. Cocaine or methamphetamine use raises the rate dramatically. Finally, transverse lie in labor occurs about one time in three hundred and is more frequent in multipara, multiple births, and with prematurity. With these three conditions, we have a 1% or 2% population-wide rate of potentially necessary cesarean deliveries, without even considering disproportion,… Read more…. Marion’s Message: Too Many or Not Enough Cesarean Sections?
Read more…. Marion’s Message: Too Many or Not Enough Cesarean Sections?
With maternity mortality in childbirth so high around the world, Millenium Development Goal 5, maternal health, is something that we all can work toward.
Read more…. MDG 5: Something We Can Work With