Midwifery Today Conference
“Autonomous Midwifery: The Key to the Future”
Blankenberge, Belgium • 30 October – 3 November 2013
Wednesday • 30 October 2013 • Pre-Conference
8:30 am – 4:30 pm OR 9:00 am – 5:00 pm, as noted
Choose one full-day class: A1–A5
8:30 am – 4:30 pm
Gail Hart and Tine Greve
Complications of Labor, Birth and the First Hour after Birth
You have set the stage for good births in prenatal care. Learn to identify your own risk criteria. Learn to look, listen, know and act to prevent problems. Develop ways to inform and educate your clients about complications. Learn how to handle specific complications as they arise. Stalled labor, shoulder dystocia, malpresentations, VBAC, breech, postpartum hemorrhage, the slow-starting baby and breastfeeding initiation are among the subjects that will be covered. Bring your questions and experiences for an exciting day.
9:00 am – 5:00 pm
Comfort Techniques for Midwives and Doulas
Women who are coping well with labor have some things in common: relaxation, rhythm and ritual (the 3 R’s). Debra will describe the 3 R’s and the many ways women experience them. Comfort measures for labor such as the gate control theory of pain, hot and cold compresses, music, massage/touch, acupressure, aromatherapy and the birthing ball will be discussed. Positions that facilitate rotation and descent in first stage and help to rotate and ease back labors will be demonstrated. Techniques for second stage, such as the support squat, dangle, toilet, “tug of war,” the rope, and lap squatting will be shown with time for hands-on practice. This intensive course will make us better midwives or doulas. Registrants at previous conferences have raved about it, calling it fun and informative.
8:30 am – 4:30 pm
Cornelia Enning, Carol Gautschi and Gail Tully
8:30 am – 12:30 pm
Breech Birth in Water
Join Cornelia in this part of the breech workshop to learn how to work with breeches in water. Breech birth in water is safer, in part because it improves fetal oxygenation by increasing uterine blood supply during immersion. Frank breeches need no special maneuvers because water eliminates gravity. Mobility of the mother in water allows better interaction of the baby through the pelvis and any maneuvers that may be required are easier in water. Come and fine-tune your skills at this important workshop. Cornelia uses many video clips that add dimension and understanding to her course.
2:00 pm – 4:30 pm
Carol Gautschi and Gail Tully
We will begin this part of the class with how to turn breech babies. This class will help you develop skills needed when attempts at turning don’t work, and the parents and midwife decide to do a vaginal or home breech birth. Although breech birth is not for beginners, everyone is welcome in this class because you never know when one will surprise you. We will cover palpation skills, estimating fetal weight, amniotic fluid, and how to communicate with the baby with touch and words. We will cover basic skills including the hands-off approach and how to handle problems while staying calm. Frank, footling and complete breech will be discussed, as well as cord prolapse, fetal heart tone (FHT), and recognizing intrauterine growth restriction (IUGR) and other complications of breech presentation.
9:00 am – 5:00 pm
Physiological Analgesia in Labor
Verena will present a systematic approach to pain relief, based on physiology. We need to offer women a new midwife-led service of pain relief in labor without the risks of medical interventions. Physiological hypoalgesia is a third option between epidural and medicalized painful birth and offers women a choice. We will analyze a woman’s need for pain relief and for a normal birth in different settings and offer an individualized answer to her needs through a systematic approach. Old and new techniques of hypoalgesia are analyzed and linked to the three neurological dimensions of labor pain, to the principles of Grantly Dick-Read and to the laws of physiology. You will have the opportunity for direct experience with some of these methods. We will also set the foundations for a prenatal training for coping with pain.
8:30 am – 4:30 pm
Prenatal and Intrapartum Assessment Skills
This day-long course will feature hands-on practice of the endangered arts of pelvimetry, fetal palpation, and fetal heart tone assessment (via fetoscope or Pinard), with instruction on how to use these skills appropriately during labor. Using simulation models, internal exam in labor, with guidelines for judicious use, will also be covered, as well as techniques for correcting malpresentations. Take advantage of this opportunity to develop or refine skills increasingly hard to come by in most midwifery training settings, taught professionally and compassionately by Heart & Hands instructor Elizabeth Davis. Note that pelvimetry practice requires participation in a small group setting.
5:00 pm – 6:30 pm
Open to all registrants
Eneyda Spradlin-Ramos, facilitator
Christian Midwives Meeting
All are welcome.
Thursday • 31 October 2013 • Pre-Conference
9:00 am – 5:00 pm
Choose one full-day class: B1–B5
Robbie Davis-Floyd, Tine Greve and Hilde Curinckx
Birth across Cultures: Anthropological Information and Practical Skills for Facilitating Cultural Models That Work
Robbie will begin the morning segment of this all-day workshop with an anthropological overview of birth across cultures in evolutionary perspective. Tine and Hilde will continue in the afternoon with a focus on the present. They will talk about understanding the multicultural societies that we live and work in, focusing on what midwives need to know about developing cross-cultural communication skills and understanding differing health concepts, including hot/cold theories that have to do with food, showers and baths, and how to deal with female circumcision. Even when illiteracy is an issue, midwives can use simplified sign language and pictograms. Come and learn about the anthropology of birth and develop your cross-cultural skills!
Thea van Tuyl, Mirjam de Keijzer and Eneyda Spradlin-Ramos
Rebozo Techniques and Practice
The origin of these techniques and traditions from Mexico goes back thousands of years. We will learn how to use a rebozo, a useful tool in all parts of the childbearing cycle. In this amazing class you will discover simple techniques that promote healthy pregnancy and birth. You will learn many “new” old techniques you can apply immediately to your practice. Time for hands-on practice will be provided. Thea and Mirjam co-wrote the book The Rebozo Technique Unfolded, with preface by Naolí Vinaver.
Verena Schmid and Carol Gautschi
9:00 am – 12:30 pm
Pregnancy Care: Problem Solving as a Method of Informed Choice
Problem solving is the way to put the woman at the center of care and to explore her resources. It is also a way to lead prenatal classes with the goal of empowerment. In pregnancy, through the strategy of problem solving, a real partnership between women and midwives is possible and this is a safe way to provide care. Problem solving provides the midwife with a lot of information. If the woman is enabled to make her own informed choices, she is active in her care, whatever her choices. Informed choice, in the context of problem solving, is a holistic process that touches every part of the woman. In this workshop we will practice the strategies of problem solving in the context of informed choice.
2:00 pm – 5:00 pm
Don’t let technology make you lose your hands-on skills. Midwives “see” with their hands. Hands and senses are our best tools. Carol will explain the true art of hands-on care, including the why, what and how of working with women in a way that utilizes our hands, senses, intuition and the ability to observe. This part of the day will concentrate on labor, birth and early postpartum care.
Midwives of all backgrounds, doulas and other birth professionals desire more knowledge for preventing and correcting malposition in pregnancy and labor. Learn to identify the posterior position, avoid the ROA/LOP mix-up, identify flexion vs. extension, and understand asynclitism. Learn the difference between a lull in labor and actual cephalopelvic disproportion (CPD). New strategies and traditional techniques to assist fetal rotation without invasive measures will be covered. You may be surprised that there was so much more to learn about this time-worn concern.
Michel Odent and Soo Downe
Improving Your Practice with Research, Insights and Realities—First, Do No Harm
Michel and Soo will teach you how to look at birth through the eyes of a physiologist, which is a valuable skill for any midwife or doula. In an easy-to-understand manner, they will cite important findings from many areas of research and explain how this information can affect mothers and babies, not only during birth, but also over the course of their lives. Scientific data proves midwives help to keep birth safer for mother and baby. Evidence-based practices can improve birth outcome by helping mother remain the center of her birth. Learn the science which supports midwifery methods such as skin-to-skin contact, physiological pushing, optimal positions for labor, delayed cord clamping, family bonding and “the newborn breast crawl.” There will be time for questions and discussion following the presentation of leading-edge research and analysis of current problems.
Friday • 1 November 2013 • Conference
9:00 am – 10:20 am
Opening general session
Jan Tritten, Cornelia Enning and Elizabeth Davis
Autonomous Midwifery: The Key to the Future
One of the keys to joy in midwifery practice is autonomy. Autonomy is important in protecting the mother from the devastating experience of medicalization in birth. It is essential that midwifery be an autonomous profession. Learn specific ways in which autonomy can help birthing women reduce unnecessary and risky intervention in birth and keep joy in midwifery practice. As autonomous midwives we are free to modify practices when new evidence is learned about different areas of practice. Without autonomy we often end up stuck in protocols that are not evidence-based because they are standard of care.
10:20 am – 11:30 am
Soo Downe, Debra Pascali-Bonaro and Robbie Davis-Floyd
Birth Is a Human Rights Issue
Women’s and babies’ human rights have been violated in today’s birth environment. We need to take a long hard look at our practices and protocols and make sure we are putting motherbaby first. Join us to discuss how we can establish good birth practices that respect human rights. It is way past time. We will review the many different ways we can be with women, giving them respect, dignity and informed choice. First, do no harm.
1:00 pm – 2:30 pm
Choose one: C1–C5
The Tipping Point
Asynclitism is a common cause of failure to descend. Some years ago, in her talk about Occiput-Posterior (OP) Myths, Penny Simkin said we need more techniques for asynclitism. I listened and practiced and now feel I have something to share. Learn why this happens and what to do about the tipped head. Slides will help you visualize what is happening. There will be time to practice techniques presented.
Michel Odent and Verena Schmid
Demedicalizing a Physiological Process
The common element for disturbing birth through the millennium, which was accelerated in the past century, is human interference. Let’s explore how to mammalize birth while keeping the spiritual dimension. Birth for humans is a mammalian event—one where the primitive brain must take center stage.
How do we get a long labor to progress? Long labors may be associated with complications ranging from social or emotional issues to physical problems. We will learn different reasons for prolonged labor, as well as methods for helping women move along in labor. Analysis of myth and reality will also be discussed. Learn prenatal factors that may help allay looooong labors.
Hilde Curinckx and Els Hendrix
Implementing Innovations in Midwifery Practice
Implementing innovations based on evidence-based guidelines in practice is not easy. Major difficulties arise when introducing evidence and practical guidelines into routine daily midwifery practise. What’s the best practise to implement those innovations? During this class we will discuss best practice for those difficulties.
Journey Dance for Birth
Journey Dance is about moving our bodies, opening our hearts, awakening the wisdom within for a safe, satisfying birth. Debra will take you through the elements of earth, air, fire, water with dance and share simple techniques to encourage pregnant women and their partners to release their fears and open to the miracle of birth. Debra states, “I am really enjoying adding movement and helping to address our fears.”
2:45 pm – 4:15 pm
Choose one: D1–D5
The importance of positioning, maternal sense of control and flexibility to approaches will be shared as well as how to do an early diagnosis. Many cesareans occur due to posterior presentation. Prevent cesareans by understanding how to diagnose, prevent and fix posterior presentations.
Cornelia will explore the many benefits and ways of using water in birth and will discuss its unique properties—psychological as well as physical. Waterbirth is not only an option for a woman to give birth undisturbed and in dignity, but it has medical advantages for mother and child. Breech births, OP births or twin births benefit from waterbirth. Breech waterbirth needs no hands, no extra warming for the newborn’s body or other interventions. The ease of attending births in water is a joy. Cornelia will show aqua-midwifery with photos and a video sequence.
If women learn more about what’s going on in their bodies, options for caregivers, the risks of interventions, etc., they will be able to make informed choices. We need to listen to their fears and help them understand their options. We can teach them the words to refuse unnecessary interventions. Communication is so important! Marlene will explain how we can help women communicate with doctors and midwives, communicate as a couple, and communicate with the little wonder in their womb. We need to teach them why some things happen and how to cope. We, as midwives, can respect the woman as an invaluable human being, to empower her and to make society healthier. We can be women’s advocates for their needs regarding governmental health care policies. “Woman and midwife” can be a strong partnership! Together we can make the difference.
Elizabeth Davis, Els Hendrix, Verena Schmid and Soo Downe
The diverse experience and approaches these midwifery educators bring from around the globe will enhance your knowledge in this area. The way we educate midwives has everything to do with the way they will someday practice. A majority of instructors are satisfied with their performance, but many students are not happy with their educational experience. How can we bring the two together? What is needed for the next generation of midwives to survive in the current circumstances of practice?
Birth Models That Work
What is a birth model that works, and how do you know that it is working? Come and listen to Robbie present the criteria she developed for identifying birth models that work. She will describe some effective models from all over the world. She will also describe low-cost, immediate ways to bring humane birth in current hospital settings in the developing world—rapid ways to create new “models that work.”
4:30 pm – 6:00 pm
Biological Nurturing (BN) – More Than Laid-back Breastfeeding
Although laid-back breastfeeding is central to the concept of biological nurturing, BN is much more than a position. Learn more about the other components or active ingredients in this new breastfeeding approach. Find out about Suzanne’s original PhD research and the ideas that have revolutionized the field of breastfeeding support. Stay on top of leading-edge research. The video clips that support the BN concept challenge the very foundations of breastfeeding management. Think outside the box and study the supporting evidence for biological nurturing.
7:30 pm – 8:30 pm
First, Do No Harm
Missed the Mid-Pacific Conference? You’ll get the cream of the presentations in this class. Michel will present a summary of information from the Mid-Pacific Conference that occurred in October 2012 in Honolulu, Hawaii. He will detail really simple things caregivers can do or should not do that will set up a critical foundation for the future lives of the mother and baby.
8:30 pm – 10:00 pm
Jan Tritten and Eneyda Spradlin-Ramos
Tricks of the Trade
Share the techniques you’ve perfected in your practice or bring your questions to this roundtable of tips on a wide variety of topics. Previous sessions have included facilitating effective contractions, dealing with prolonged labor, preventing perineal tears, helping the slow-to-start baby and holistic first aid. This is always a much-appreciated session, for its sense of sisterhood and inspiring information.
Saturday • 2 November 2013 • Conference
9:00 am – 10:00 am
Global Trends in Midwifery: The Postmodern Midwife
Robbie will describe eight global trends in midwifery and how "the postmodern midwife" is actuating those trends. She defines the postmodern midwife as one who takes an informed and relativistic approach to different ways of knowing about birth and who strives to practice autonomously. Recognizing the limitations and strengths of the biomedical system and of her own, the postmodern midwife moves fluidly between them to serve the women she attends. She is a shape-shifter, a bridge-builder, a networker and a traveler. Through her connections with other midwives around the world, she works to create a global and increasingly shared culture of midwifery as well as to preserve and carry forward the best of her own cultural traditions around birth.
10:15 am – 12:15 pm
Choose one: E1–E5
Physiology of Second Stage
Verena will discuss maternal positions, various methods of “pushing” and effects on the mechanism of labor. This workshop is designed to help you understand the pathway through the pelvis and the transformation of the perineum as the baby makes his or her way into the world.
In medieval times, placenta powder and essences were part of holistic care by midwives in cultures around the world. If stored correctly, the placenta can be used after birth to prepare baby creams, cream gravidarum or labor-inducing preparations. This is a very helpful medicine for postpartum depression. Teach families you care for how to make the most natural remedy from their placenta. Learn how to dry placentas. Come learn about this important modality. The book Placenta: The Gift of Life by Cornelia Enning makes a perfect resource for this important class.
Birth and Beyond
Michel offers his theories and insights on pregnancy and birth and explains how these experiences affect the child for a lifetime. Birth must be empowering for women because it sets the future for child and family. Michel shares the conclusions he has drawn from his extensive study of the research.
Midwifery students, and even midwives and nurses, will enjoy this basic class on perceiving fetal position through your fingers. Bring your tips…not only at the end of your fingers, but the tips on palpation you'd like to share with the next generation. Pregnant volunteers will be sought out for class, but be ready to palpate one another, too, if need be.
Lieve Huybrechts, Marlene Reyns and Carol Gautschi
Homebirth: Research, Safety and How to Do It
Explore the many benefits of homebirth and the skills required. Our teachers present different ways to provide the homebirth client with the highest standard of care. They will explore the homebirth model and why it is best for mothers and babies. They will explain how to go about setting up and maintaining a homebirth practice.
1:30 pm – 3:00 pm
Choose one: F1–F5
Language of Birth
Clear communication and an awareness of the power of words are key elements of good practice in midwifery. With a focus on birth, let’s examine our language—verbally, visually, physically—and, by interacting in small groups, better understand how and where this language is rooted. Learn how words, gestures and signs contribute to and affect the birth process and how to solve difficulties communicating with others who speak different “birth talk.” Reword birth language so that it is gentle, potent, warm and connected.
Fear in Midwifery and Birth
Fear in pregnancy and birth can have many consequences for both the family and health care provider. This class will help you define, understand and move through the fear that confronts us. Learn several ways of helping women, including midwives and doulas, turn fear into trust.
Hemorrhage: Prevention and Management
Many episodes of excessive blood loss are either preventable or foreseeable and easily controlled. It is important to facilitate the delivery of the placenta with patience. Learn techniques and approaches that render the need for pharmaceuticals rare. You will learn how to assess and deal with bleeding in a way that will increase your confidence.
Birth and Breastfeeding Are One
The fourth stage of labor (welcoming the baby) is intricately linked to everything that happens for mother and baby during birth. There is a biological argument suggesting that the baby experiences strong but somewhat conflicting imperatives during labor. One is to be born, another is to suckle and a third is to survive and feel secure. What we do as midwives, doulas and lactation consultants in the moments and hours after birth can either enhance or hinder their needs—even with a gentle birth. This session will explore the physiologic basis for immediate and continuing mother-baby contact, introducing some biological nurturing variables that have traditionally been overlooked in the mainstream literature. “First, do no harm”—a concept that is a recurring theme in this conference—applies to breastfeeding as well as to birth.
Carol Gautschi and Eneyda Spradlin-Ramos
Birthing Woman, Sacred Ground
We will share stories and ideas that express why birth is such a profound, intimate and deeply remembered experience for women. We will discuss the emotional and spiritual factors important to all birthing women and babies. We will explain how birth practitioners can learn to understand and respect the holy ground upon which they walk whenever they are caring for a mother, baby or family. Birth is not only a physiological process and a rite of passage, birth is also sacred. If it were respected as sacred by everyone, we would not be suffering the current crisis in birth care. We would see birth as the gift it is: a teaching gift to all involved.
3:30 pm – 5:00 pm
Marlene Reyns and Lieve Huybrechts
Midwifery in Belgium: Challenges and Opportunities
Belgian law provides midwives with everything they need. They can legally attend homebirths (though few do), they are generally well paid and have excellent insurance coverage that empowers them to attend births autonomously. Yet more than 90% of the time, midwives serve only in an assisting role during birth, with the doctor attending the actual delivery. The Belgian midwifery mentality is not one of autonomy but one of dependence on obstetricians to take responsibility for the birth. What is the problem? What do mothers want, and how can Belgian midwives advocate more for the mother?
5:15 pm – 6:45 pm
Open to all registrants
Jan Tritten and Eneyda Spradlin-Ramos
Brainstorm with us and your peers on how we can really effect changes in midwifery and childbirth on the global level. This will be an interactive session, learning from the midwives present from the many different countries represented. Learn about the midwifery and birth movements going on around the world and how you can help. We can make changes for the better with knowledge of global possibilities. We will share techniques, systems, political and educational ideas that will help you further the midwifery model in your sphere of influence.
8:30 pm – ?
Robbie Davis-Floyd and Tine Greve, Mistresses of Ceremonies
Tell Robbie or Tine your plans for skits, songs, dances, stories and poems and they will make a program for us. Please come prepared with any props or costumes you will need. PowerPoint, microphones and music audio will be available. Michel Odent will present one of his original plays! Let’s entertain each other and have a ton of fun!
Sunday • 3 November 2013 • Conference
9:00 am – 11:00 am
A New Model of Care for Midwives: The Need for an Independent Theory for Midwifery Care
Salutogenesis is a new approach to midwifery care, based on resources. It is the difference between a risk-centered approach and a resource-centered approach, salutophysiology opposed to physiopathology. What changes are implicated in care, in risk selection? In this workshop Verena will work with clinical cases and analyze them with the normal, risk-centered approach and then with an approach where we look to signs of health and resources. From there we can change the approach to risk selection and substitute it with a process of clinical reasoning.
11:15 am – 12:45 pm
Choose one: G1–G5
Reducing the Effects of Interventions
We will cover interventions such as such as listening to fetal heart tones, vaginal exams, episiotomy and the support of the perineum. We will discuss what the alternatives are. Always ask the question in pregnancy, during labor and postpartum: what am I doing, what do I want to know or to attain, how do I reach that target, what are the side effects on mother and child and how can I reach better results or know more through listening, looking and trusting physiology in mother and child? The less I do, the better.
Belly Mapping: A Prenatal Bonding and Teaching Moment
Mothers often know their baby’s position by late pregnancy, even without help, but may need words and concepts to recognize the position through the bumps and wiggles they feel. The midwife, doula or childbirth educator introduces positive messages while teaching families about Belly Mapping. Mothers enjoy Belly Mapping as a bonding tool or to apply Optimal Fetal Positioning as proactive childbirth preparation.
Special Massage for Restarting Stalled Labor
This is a fantastic tool to get labor restarted. You will wonder how you practiced without it. “I saw this work at a birth in Mexico where Verena and I were present. This labor had stopped entirely at about 7 cm. Verena did this massage and the labor restarted. The woman had her baby a couple hours later,” says Jan Tritten.
Carol will explain and discuss the causes and resolution methods of shoulder dystocia. She will describe symptoms and signs used to predict it, and will cover aspects of shoulder dystocia, including causes, incidence rates, prevention and solutions. It doesn’t happen often, but when it does, you need to be ready.
Authentic Midwifery in Hospital Practice
Learn how to create a nurturing environment for women at hospital births. Study the issues, obstacles and concerns. Plan strategies that will protect and nurture women. Learn how to protect motherbaby from unnecessary interventions.
2:00 pm – 4:00 pm
In this well-loved Midwifery Today format, you’ll sit in on three interesting and inspiring roundtables of your choice. Roundtables will include:
Midwifery Around the World
Debra Pascali-Bonaro and Jan Tritten
Balancing Home and Work
How to Begin Working with Salutogenesis in Your Practice
Getting Moms Ready for Waterbirth
Mobilizing for Our Birthrights
Positions in Labor and Birth
How to Improve Midwifery and Birth in Belgium
Working with High-Risk Women
Breastfeeding in Norway
Midwifery Education for Autonomous Midwives
Mirjam de Keijzer and Thea van Tuyl
4:00 pm – 5:30 pm
Closing general session
Debra Pascali-Bonaro and Robbie Davis-Floyd
The International MotherBaby Childbirth Initiatives (IMBCI)
Join Debra and Robbie for a trip around the globe to the IMBCI demonstration sites in Brazil, Quebec, Austria, India, South Africa and Mozambique to learn about their challenges and successes in creating optimal MotherBaby Care. If they can do it, you can, too! At the closing of this important class Robbie and Debra will lead us in song and dance! Be sure to stay to the end so you can participate in this wonderful closing!