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.
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.
Editor’s note: This article first appeared in Midwifery Today, Issue 82, Summer 2007. Join Midwifery Today Online MembershipWhat 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, maternal medical… 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.
Marion critiques the outcome of the NIH’s recent conference on “Cesarean on Maternal Request.”
Photo by Ali Mosavi
Marion recounts her visit to Afghanistan, arranged by her friend Siri, to volunteer as a teacher and insert IUDs
Read more…. Marion’s Message: Working in Afghanistan with Siri
A contributing editor comments on the Jennifer Williams trial in Indiana, where a homebirth midwife was arrested and charged with practicing medicine and midwifery without a license.
Associate Editor Marion McLean shares stories of the interconnectedness and complexities of dealing with birthing women and their mothers and mothers-in-law.
Read more…. Marion’s Message: Midwives, Mothers and Mothers-in-law
Marion describes three different births in which the baby began in posterior presentation. This article includes tricks for turning a posterior baby.
Read more…. Marion’s Message: Three Births in Posterior Position
Photo by Matt Walsh
At the March 2005 Midwifery Today Conference in Eugene, we sat in a circle discussing third and fourth stage problems. A young midwife with a hospital background raised a question. “When do you push the panic button?” People looked at her with interest and she continued, “What I mean is, in the hospital, they always stress that over twenty minutes from the time the baby is born to placental delivery is high risk. But people here are talking about much longer times. How do you know when you are in trouble?”
Read more…. Marion’s Message: When Do You Push the Panic Button?
Marion with an attendee of the Midwifery Today 2005 Eugene Conference
My first day at the conference, I noticed a number of Native American participants. I felt gratitude and joy at their presence. Our lives are enriched when we are able to interact with people of different cultural backgrounds. Further, the roots of indigenous cultures that have lived on the same land over centuries connect us through time to the ancient ways in a unique manner.
Marion’s Message: Unchanging Protocols: The basics of birth are unchanging; there is an elemental simplicity. Safe midwifery care during placental delivery and the hours that follow is based on physiological processes and needs that are unchanged over the years. These basic protocols can prevent serious problems for childbearing women.
In 2004 I served as midwife for a dear family. I thought a lot about the time to be born, as the due date came and went. Is there a time designated for us to come into the world? “For everything there is a season, and a time for every purpose under heaven,” says the Holy Bible. “A time to be born and a time to die.”
