Media Reviews – Issue 147

Midwifery Today, Issue 147, Autumn 2023.
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Uterus: A New Perspective by Jessica M. Koren. 2016 (Hogeschool ZUYD, 44 pages, $28.00, paperback and kindle)

This 8×11-inch book of illustrations of the uterus and its elements and placement is helpful for birth professionals who want to visualize and understand a woman’s anatomy. It will help with her pregnancy, birth, and postpartum life.

Only 40 pages long, the first half is full of anatomy illustrations and the second half of abnormal uterine issues and treatment illustrations. From the talk I heard about it on a podcast, I had honestly expected more from the book than anatomy illustrations, but I do appreciate the beautiful drawings and explanations.

The book starts with artwork of the uterus and its surrounding organs, explaining that the non-pregnant uterus is about the same size as a woman’s fist and it sits in the pelvic cavity like a person bent over at the hip. In the illustration, the person’s arms are pointed back at their hips and are holding balloons, which signify the fallopian tubes and ovaries. The upper chest of the person is the uterus, the hips the cervix, the legs the vagina, and the feet the vulva. This posture more clearly shows us that the uterus is in a prone position, rather than an up and down one as often depicted in textbooks.

The text is helpful, explaining about the different muscle layers, the uterine lining, the circulatory system, the ligaments holding the uterus, and more. One odd point the author made was that she discussed the different types of uteri in mammals and says that the human uterus is a “modified” version of a bicornuate type found in animals, which would be an evolutionary perspective on biology. Farther down on the page, she describes the “design” of the amazing double layers of muscle types in the uterine wall, which implies a designer of our bodies.

In the second half of the book, the author illustrates many of the common uterine pathophysiologies: fibroids, adenomyosis, endometriosis, prolapse, and more. These illustrations and short, but thorough, explanations are helpful when needing to show a client a quick picture of a problem they have or when educating one’s own teen daughters or granddaughters.

This author also has a website where her digital illustrations can be purchased:

The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel Van der Kolk. 2014. (London: Penguin Books, 464 pages, Hardback $19.39, Paperback $11.40, Kindle $14.99.)

As midwives, we come into some of the most intimate spaces in people’s lives. We see how the women we serve interact with their families, how they react to stress or joy, hear their concerns and try to make sense of the way they view the world to help them through their pregnancy and labor. Sometimes a woman’s reaction or actions seem out of place. “What is going on here?” we wonder. “Why is this issue creating tension in her, causing her anxiety or fear or anger?” Sometimes we can broach the subject and the woman can explain why, and sometimes we can’t or she can’t. Either way we learn to have empathy and compassion for these women and want to help them work through their situation if we can.

In The Body Keeps The Score, Bessel Van der Kolk, a neurosurgeon, shows us how the brain and the body interact during traumatic experiences, and while the mind may forget, rationalize, and try to move on, if the trauma is not resolved, the stresses remain in the body and can cause havoc over time. “Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past.” He gives examples of war veterans, abused children, and other people who have gone through traumatic experiences, whether prolonged or just one extreme instance and their reactions and the way the trauma played out in their lives.

I can remember a woman I helped to care for during my student training who never looked my midwifery partners and me in the eye during her prenatals, and no matter how we tried, we didn’t feel like we were connecting with her. We wondered if she had some abuse in her background. During her prenatals, we had even encouraged her to consider a hospital birth because she expressed such concerns over the pain of labor, but she was adamant that after her first birth in a hospital, she would never go back again. During most of her labor the mother acted much like a frightened, caged animal, hiding in the corner, refusing any comfort measures we could give during her contractions. After the baby was born, she snuggled into the farthest corner of the bed and cuddled her baby, showering her with sweet words and kisses. During her postpartum visits, no longer having the impending fear of labor, she was like a different woman, laughing and telling stories of her new little one, although still remaining somewhat separate from us. Something had a deep hold on this mother, something we couldn’t reach to help her.

Dr Van der Kolk explains that, “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.” And that “For real change to take place, the body needs to learn that the danger has passed and to live in the reality of the present.” He does this through various therapies, one being EMDR. He describes another type, “Visiting the past in therapy should be done while people are, biologically speaking, firmly rooted in the present and feeling as calm, safe, and grounded as possible. (“Grounded” means that you can feel your butt in your chair, see the light coming through the window, feel the tension in your calves, and hear the wind stirring the tree outside.) Being anchored in the present while revisiting the trauma opens the possibility of deeply knowing that the terrible events belong to the past.”

A big part of what Dr Van der Kolk explains as helpful to the people living with trauma is having a safe space and control—two things that midwives work strongly toward creating or keeping for their clients. He writes, “Being able to feel safe with other people is probably the single most important aspect of mental health.” And later explains, “Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart. For our physiology to calm down, heal, and grow we need a visceral feeling of safety.” We midwives have learned to listen to what women say, how they ask their questions, we wait and ask for permission before touching a woman, and work to make sure she understands the options she has and doesn’t feel coerced. The safe places the author describes are what we desire and are attuned to holding already.

The mother that my midwifery partners and I cared for did not ever feel safe enough to share her deeper issues with us (and those may very well have been beyond our scope of care), but she did feel safe enough with us to be able to birth her baby. We weren’t able to understand her assumed past trauma or even really understand how to connect with her, but we were able to help her labor without numerous exams and interruptions and gave her space to labor how and where she could and in the manner she could without pushing her to do what looked normal to us. And, while not our ideal, that was the safety we could provide and the control we could give to our client, and help her to have a safe and, hopefully, healing birth.

As midwives, we work so intimately with people, and reading The Body Keeps the Score will give us more insight into the human mind and heart to help us serve our clients and their families a little better.

A Woman of Firsts: The Midwife Who Changed the World by Edna Adan Ismail. 2019. (HQ, a branch of HarperCollins, 336 pages, paperback $15.29, Kindle $9.99.)

Scanning a list of books on Mercy In Action’s booklist for their post-graduate diploma in International Midwifery and Maternal/Child Health, the title A Woman of Firsts caught my eye. I wondered what this woman was first in, related to midwifery and the international community, and found in this story a well-written, enjoyable read about the life and works of Edna Adan Ismail. Edna is a Somaliland nurse and midwife, although those titles are just a few of the many she has held in her long and varied life.

Edna, now in her 80s, grew up the daughter of a doctor during a tumultuous time in Somaliland (not Somalia, as she many times has had to point out during her diplomatic travels) and had the opportunity to train as a nurse and midwife in London in the 1950s. She describes these years as some of the happiest of her life and would have stayed longer except that her family called her home. Her father wanted her help in the hospital he worked in since Islamic law in their country only allowed women caregivers for women patients, and the small, fledgling country had very, very few women trained in health care.

This book describes political changes and upheavals in Somaliland, Edna’s experiences as a health worker in several hospitals and clinics, and how she won the confidence of local traditional midwives and helped them to give safer care to the women and infants they served. For several years while her first husband was the prime minister of Somaliland, Edna would return to working as a midwife when she was home. While we in Western culture value this down-to-earth aspect in our leaders, Somalilanders felt that the prime minister’s wife was shaming them in doing such “servile” work during her husband’s years of service. Edna listened to few, though, and always held her health work as her first priority, as her father had. This aspect was helpful to her patients, but not to her three marriages.

Along with the day-to-day midwifery work, Edna fought valiantly for an end to female genital mutilation, a practice she describes clearly in the book, for she herself was held down as a young girl and had her outer genital organs cut off and the remaining tissue sewn together, leaving only an opening the size of a pea for urine and menstrual blood to pass through. She intimately describes how this later affected a physical exam she had for nursing school and her first wedding night. As a midwife who trained among British women who had no such treatment, she was shocked to find the difficulties that the tight resewing of tissues had with women’s abilities to give birth in her own country. Edna was able to make some headway among professionals in trying to change this tradition in their culture.

This book will give the reader a picture of a world outside our Western world and inspire each midwife to see what area in her own community she can help to improve or change.

About Author: Joy Hearn

Joy Hearn, RN, BSN, CPM, lives in Kathmandu, Nepal, with her family. She has had articles published in The Journal of Christian Nursing, Women of the Harvest, and Midwifery Today. She is working on a website on childbirth education in Nepali to help Nepali families make informed choices in their pregnancies and births.

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