|August 16, 2000|
Volume 2, Issue 33
|Midwifery Today E-News|
“Aspiring and Apprentice Midwives”
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"After I had completed my third book about birth, I began waking up with my hands stretched out in front of me as if I were receiving babies. I have to do this. It is time."
- Nancy Wainer Cohen, 1997
2) The Art of Midwifery
Urinary tract infection: Avoid strong kidney irritants such as juniperus spp.; choose botanicals that act as demulcents, urinary astringents: zea mays (cornsilk), gallium aparine (cleavers), althea officinalis (marshmallow), equisetum spp. (horsetail), mitchella repens (squawvine), arctostaphylos uva ursi (uva ursi); urinary antiseptics include allium sativum (garlic), thymus vulgaris (thyme).
- Mary Bove, ND,
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3) News Flashes
A recent study shows a link between douching and low birth
weight babies. Data collected from 4,665 American women
showed that almost 10 percent of those who douched regularly
delivered babies weighing 5.5 pounds or less compared with
about 6 percent of women who didn't. The risk was even
greater for those who douched daily than for those who
douched monthly. Douching may push existing vaginal infections into the
reproductive organs, ultimately causing preterm labor.
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4) Aspiring and Apprentice Midwives
If you are thinking about becoming a midwife, identify your goals. Do you want to attend homebirth or do you want to make a difference in the hospital? What level of income do you need? What educational opportunities do you have near home? Are you willing to travel? Can you afford the time required of an apprenticeship education and the slower paced practice, or can you handle the expense of a university-based education? Are you aware of what financial aid is available?
Attending Midwifery Today and MANA conferences as well as ACNM conferences will provide opportunities to interview midwives from all pathways. Understanding the questions and getting answers before you make your decision will lead you to the greatest fulfillment of your dream.
- Diane Barnes, in Getting an Education: Paths to becoming a Midwife, a Midwifery Today Book
E-News asked readers: In two to four sentences, what is the best advice to give an apprentice or aspiring midwife?
Advice to an aspiring midwife: Research your options as long as it takes to find just the right package of academic learning, preceptor(s), practice style and location. Don't settle for second best. Then, enjoy the ride!
Advice to an apprentice: Be willing to express your needs and willing to hear and meet your preceptor's needs. Give as much as you get and appreciate the balance.
Extra advice to a preceptor: Give everything you have of enthusiasm and knowledge to any deserving apprentice you commit to. "Midwife" her through to the time she can confidently and safely stand on her own. Engage your clients from the beginning in your commitment to teach your apprentice. Most will be very generous in allowing hands-on.
Go slow enough in the childbirth field to be comfortable at each step (Ex. childbirth educator, labor coach, doula, birth assistant, midwife)
- Realize that the pursuit of midwifery, if you are planning to become a knowledgeable and prepared midwife, is expensive and very time consuming. Allow approximately 4-6 years to grow to the point of attending births as the mother's primary or at least 50 homebirths with a more experienced midwife.
- It is a great blessing in your life to be at a woman's birth; appreciate it and her for sharing the most intimate experience in her life with you.
- Renata Hillman, birth attendant since 1982
I encourage my apprentices to train with as many midwives as possible. We all have such different styles and flavors and I feel they will be more balanced that way. They will be able to see what their style is more naturally, too. Second, be creative with study time. I trained as a single mom of three boys and would go to the playground with my books to study while kids ran wild. If I could do it, anyone can.
- Lisa Hines, LM
As a recent "graduate" of an apprenticeship, the best advice I could give to someone beginning this path is to keep a diary. [Make entries] after every set of prenatals, every birth, every postpartum visit. It is an invaluable guide to your own "birth" in this work. It will document not only your progress, but will show you just how far you've come, and how much you have learned.
- Christina Oertel, DEM, CLC
Are you thinking about becoming a midwife? Do you have a
friend who is considering this path? Midwifery Today'
Beginning Midwives' Package is just what you need! Four
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save a lot while you learn a lot!
5) Check It Out!
AUGUST 1-7 is World Breastfeeding Week. Read "Breastfeeding: Food for Thought at
FREEDOM: Some compelling thoughts on what it means when you are a midwife:
6) Question of the Week
A primigravida with spontaneous rupture of membranes at term had an uncomplicated pregnancy. The head was deep into the pelvis and one assumed that labour would progress normally. C. wanted a homebirth more than anything, and I was very happy to manage her expectantly. Twenty-four hours later, there was no sign of labour apart from a few niggles. I suggested various homoeopathics, nipple stimulation, walking on the beach, etc. and monitored her temperature, pulse and foetal heart. Thirty-six hours after SRM, labour started courtesy of her husband suckling her nipples. On examination the cervix was a soft, stretchy 5 cm with the head well below spines. Good, I thought, we're on our way. All the time, she kept eating and drinking, resting when she felt like it, but still the contractions never became coordinated.
Reluctantly, I examined her six hours later to find the cervix 7 cm dilated. A further six hours down the track, she was still the same. I suggested it was time to consider going to hospital for oxytocin augmentation, and very reluctantly they agreed to transfer in. Three and a half hours later, she had a normal birth, no pain relief, moderate blood loss and they all went home. Postnatally, her fundus had almost completely involuted by the third day! I'm baffled as to why her uterus was so inefficient in labour, yet super efficient afterward. Any suggestions?
- Sharon Weir
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7) Question of the Week Responses
Q: At a recent birth we could not hear fetal heart tones with a fetoscope once the head was on the perineum (approx. 35 minutes). Although the scalp was always pink and mother reported fetal movement approx. 3 minutes before birth, baby was born limp and made no respiratory effort. His color was pink at birth and heart tones were always over 120 bpm. We initiated neonatal resuscitation and called EMS and baby was subsequently transported to hospital. Baby was off respirator and breastfeeding by day two and home by day six. Parents informed us that ultrasound, EEG and CT scan on day three were normal. A complaint was subsequently filed by the College of Physicians which stated that "the baby is brain damaged as evidenced by the CT scan."
1. Is there any literature/research out there to justify or
confirm that a pink scalp along with fetal movement when the
head is presenting is an indicator of fetal well-being?
A: First, with the parents' permission, I would find a friendly and midwife-supportive M.D. and have him analyze all the test results or have them analyzed. In my experience, some are still on a witch hunt and overly zealous about it. And I must wonder if they could or would have done any better for this baby during the birth or afterward.
Your question inspires more questions: Is the baby really brain damaged? Did they do their job well? Are you certain of your timing--how long was baby without oxygen (leaving the cord intact until no longer in use is always helpful), and did the EMS administer it promptly? Was the baby ever not "pink"? Did the hospital delay oxygen while intubating (always a tricky question)? Did they administer harmful drugs or vaccinations too early (can cause brain cell damage very quickly.) Who handled the baby after he/she was in medical care? Were they gentle? How does baby seem now?
8) For Coming E-News Themes
1. What have you learned both by research and experience
about the effects of labor drugs on the baby? Midwifery Today has just learned of a newborn death due to morphine
having been given the mother for pain.
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"There is sort of a chemical 'combination lock' that starts labor. Everything has to be lined up just right to 'unlock' a good labor pattern. When we interfere with that, it can be as frustrating as using the wrong combination of numbers to open a locked safe." -Gail Hart, CPM, The Birthkit, Autumn 2000 (Midwifery Today)
In this issue of The Birthkit there is an article on postmaturity by Dr. John Stevenson of Australia. In l,l90 bookings for homebirths (eight-year period) he had l06 babies with a longer gestation than 42 weeks. Three went to 48 weeks, "a few more" went to 46 weeks, and lots went to 44 weeks. All the 106 past 42 weeks fared very well. This was a well fed, healthy, motivated group of women.
The other thing Dr. S. says in this article that is interesting in light of recent discussions in E-News is, "I should also mention that I tend to disregard meconium as a supposed sign of foetal distress, because of other possible causes, for example, if the mother took laxatives." I recommend ordering this issue of Birthkit from the Midwifery Today website (www.midwiferytoday.com ).
- Gloria Lemay
More on nutrition:
In counseling pregnant clients I often tell them that eating well is the single most important thing they can do for themselves and their babies. It's more important than the prenatal vitamins they are so conscientious about. It is more important than virtually any other thing they have control over. I encourage them to carry good, high protein snacks and a bottle of water with them everywhere. I always have clients fill out a diet sheet. More often than not, our homebirth clients are very tuned into their bodies. It is only rarely that we need to do intensive counseling; more often it is reviewing the things they already know.
- Christina Oertel, DEM, CLC
[Nutrition] is a growing problem with our clients, most of whom are recent arrivals from South and Central America. It's like they've arrived in burger & fries heaven. Added to that, most of the employees at the fast food places in this general area are now Hispanic, so there's lots of "take home" by well-meaning friends & relatives. And we wonder why we're seeing more GDM & "pre-eclampsia." We also get frequent complaints about the baby not moving "all day," and then learn that she hasn't eaten anything in the past four or five hours (and nearly all our mothers are receiving WIC, by the way).
Also, these mothers tend NOT to drink much water or other fluids, so we frequently see urine the color of apple juice when a woman comes in complaining of cramps. Two or three pitchers of water later, she's "cured." Not surprising, considering what I've been told about the water in some of their countries.
I try to keep it simple for all of us (with my broken Spanglish) and emphasize "two eggs and two litres of water every day," and that they MUST eat something every two hours.
I was under considerable stress and time constraints during my last pregnancy, with three other children and my dh out of town for several weeks. My midwife suggested I order out from good restaurants, using them much like fast food restaurants. I used the salad bar at my local grocer and ordered take-out from several local restaurants with quality menus, thus avoiding the drive-throughs, and at times, ordering double items and freezing it for future meals.
- Anita W.
Surely Jennifer is joking in her question about not using rhogam [Issue 2:31]. Anyone who has ever seen what can happen to the fetus of an RH negative mother would never suggest it might be avoided. I have never seen any information about the negative aspects of use and would suggest that she talk with women who had babies in the time when RhoGam was not available or to the care providers for these women. Not all advances in obstetrics over the last 40 years have been bad ones!
Obviously the only time RhoGam is not indicated is when both parents are documented as Rh negative. There are some who feel that if there is any question regarding paternity, give it anyway.
- Maggie, CNM
For information regarding anti-rhogam try looking at articles written by Sara Wickham, a lecturer in midwifery in the UK and also Midwifery Today's UK contact. [Also] try the UK journal, The Practising Midwife.
- Vicky Everitt, 1st yr direct entry student
[Editor's note: Please refer to articles by Sara Wickham in
Midwifery Today Issues 46 and 53. To order, go to:
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