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THIS WEEK'S ISSUE
- Quote of the Week
- The Art of Midwifery
- News Flashes
- Omnium Gatherum
- Check It Out!
- Midwifery Today Online Forum
- Question of the Week
- Question of the Week Responses
- Share Your Knowledge: Coming E-News Themes
- Question of the Quarter: Midwifery Today magazine
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Quote of the Week:
"Whenever I am troubled by issues of great significance that will impose my choices upon someone else, I ask at least two questions: What did people do hundreds of years ago? What do people do all over the world today?"
- Lois Wilson, CPM
The Art of Midwifery
The "Ginger trick" to bring a baby down under the pubic bone [Issue
2:44] is very similar to the "towel trick" we use. Our hospital has a
75% epidural rate (30% for CNM patients). We usually let these women "labor
down" their babies rather than coach them to push when they have no urge,
but sometimes a baby just shouldn't wait. We set up the squatting bar
(which fits into our birthing beds) and tie a draw sheet around the top
bar (a towel proved to be too short). We set her feet on either side of the bar and tie a knot at the end of the sheet. During contractions, she
pulls on the knot. Her feet and hips are held wide apart and she can usually
get a better pushing effort with her hands gripping something in front
of her than she can while holding the built-in side grips. I usually end
up squatting myself, under the bar to catch the baby. As with the "Ginger
trick," babies can descend quite rapidly with the "towel trick," so be
- Ohio CNM
Doula tip of the week: My all-time favorite and most-used item in my
doula bag are my knee pads! I bought a pair of low-tech ones for $4.99
at a local hardware store. They strap on my knees with Velcro and are
comfortable to wear even when I am standing. I can kneel with no discomfort
for quite a long time.
- Judi Fitts, CD(DONA)
Share your midwifery and doula arts with E-News readers! Send your favorite tricks to:
In a Swedish study of eighty hypothermic newborns, 40 were
placed in incubators and 40 were held skin-to-skin by their mothers. After
four hours, 90 percent of the infants who had skin-to-skin contact had
reached a normal body temperature while only 60 percent of the infants
placed in incubators had done so. After 24 hours, temperatures of the
incubated infants were slightly higher than those of the held infants,
suggesting that incubated infants run a risk of becoming too warm and
developing heat stress. Skin-to-skin contact also stabilizes heart and
respiratory functions, according to the researchers.
- The Lancet 1998, 352:1115
The latest issue of E-News on doulas was timely because
I am finishing writing an article entitled " A Doula No More."
I have gone into the hospital for the last time--I will not doula any
longer. I can no longer tolerate what women are willing to accept/label
as a good birth, nor can I stand violence and abuse of women and babies
which is perpetrated in the name of "safety." I always ask,
Why would a woman go into a place to birth where she needs an advocate?!
Also, in my opinion, if a midwife cannot also provide good--actually,
superb--labor support, there is something wrong.
In my area, women choosing to homebirth have to wait for
their midwife to drive 60-90 minutes to their homes (and that's when
the roads are clear). As a doula, I can be at their home providing support
to them much sooner. If problems arise during the labor or birth, I
can continue to provide supportive care for the woman while the midwife
attends to the concerns at hand. I can explain what is going on to the
woman and provide her comfort, leaving the midwife to use her skills
to correct the problem. Even in the birth center or hospital setting,
I believe this premise holds true. I think midwives and doulas can create
a fantastic team for birthing women.
- Maurenne Griese, RNC, BSN, CCE, CBE
I would like to suggest to the doula who wrote about whether
or not doulas should be performing clinical skills that as a doula,
doing vaginal checks should not usually be necessary if you are familiar
with the emotional signposts of labor (notice I said usually).
- Kim Ray, LM
Re: damaging forceps birth [Issue 2:44]:
I'm sad to be a member of a profession where this sort of
event still happens. Of course something can be done and there are several
options but empathetic examination and assessment by a gynaecologist
who is not a misogynist would be the first step.
- Phil Watters (at the other end of the world, I'm sorry)
I recommend that you seek out an OB/GYN physical therapist.
I have one in the Chicago are who is very good. Never give up.
- JoAnne Lindberg, BirthLink
Re: Not giving Vitamin K
This person accepted a risk of around 1 in 3000 that her
baby wouldn't get fatal haemorrhagic disease of the newborn, which is
virtually untreatable and best prevented (with Vit K).
- Phil Watters
Of course there are no harmful effects to most babies not
receiving a shot of vitamin K at birth. However, haemorrhagic disease
still exists and its origins are mysterious. Nobody knows which babies
will develop the disease. There is no evidence that supplementing the
mother with vitamin K prior to the birth increases the level of vitamin
K in the newborn. There have been at least four cases in Canada of babies
born lovingly and gently at home into the hands of midwives and fully
breastfed who have developed this terrible bleeding disorder. Usually
the brain or the liver are destroyed.
Re: serving Jehovah's Witness families (excerpts)
Besides not taking blood products, another thing I have
noticed is my Witness clients have been unusually able to make informed
choice decisions. They often have grown up with the experience and shared
stories of their fellow Witnesses taking an active role in their medical
care because of the blood issue. Even the 18-year-old clients have been
fully able to listen to medical recommendations and assertively ask
questions and make choices that their medical caregivers would not prefer.
They do not seem intimidated despite the rude and abusive comments often
directed their way by medical staff.
Once, a young Jehovah's Witness client of mine accompanied
her Witness friend to an external version. When the attending OB told
the mother that she (the doc) had the legal right to give blood products
without the mom's consent, this young observing Witness reached into
her bag and brought out Supreme Court documentation and handed it to
the doctor with a polite comment: "Excuse me doctor, but actually
you don't have the legal right to do that--here's the documentation!"
Rhogam is a blood product so they do not use it.
- Karen Kohls, CCE, CD(DONA)
Besides not accepting blood, there are no particular rituals
we Jehovah Witnesses have. We accept medical interventions as long as
they do not go against what we are told in the Bible.
If a Witness mother refuses any other form of treatment
or medical intervention [besides receiving blood products], it is based
on her own personal decision and not based on her religious beliefs.
We have literature designed to address the issue of blood transfusions
and the medical field. You can receive it at no cost by contacting a
While working with Jehovah's Witnesses, you will find they
probably would not participate in rituals. A ritual is something done
as a rite, religious or otherwise. Before performing a ritual they would
want to know its origin and purpose, and then they still probably would
not participate. They are very concerned about keeping their religious
practices clean in the eyes of their Creator. They seek good care for
their health and their families and many choose homebirths and alternative
forms of healthcare because they value life and want good health.
What happens when they might need a blood transfusion? Often
simple Ringer's solution, saline solution, and Dextran can be used as
plasma volume expanders, and these are available in nearly all modern
hospitals. Actually the risks that go with the use of blood transfusions
are avoided by using these substances. The Canadian Anaesthetists' Society
Journal, Jan 1975, pg. 12 says "The risks of blood transfusion
are the advantages of plasma substitutes: avoidance of bacterial or
viral infection, transfusion reactions and Rh sensitization." But,
Jehovah's Witnesses have no religious objection to the use of non-blood
If you ever work with them, just ask them why they do or
don't do certain things. They will reasonably explain, and it won't
be hard for you to understand.
- Annette Lewis, CPM, LM
While they do object to blood transfusions, Witnesses do
not object to medical treatment in general and seek to find alternatives
to blood transfusions. Prevention is the best approach and thus I've
had many JW women seek midwifery care in order to avoid interventions
that may actually increase the chances of hemorrhage. I myself encourage
proper nutrition and seek to ensure a good blood count by the end of
pregnancy so that they can handle a blood loss better. In our practice
we would also watch carefully and be ready to take action quickly (whether
that be herbs, medication or other treatment and/or transport) if blood
loss seemed inappropriate.
- Karin Barasa, midwife
MANA Board Proposes to Make MANA an Exclusive Organization for CPMs and CNMs
by Terra Richardson, wisewoman midwife and healer, midwifery educator
Years ago I wrote an article for the MANA News called "The Circle
of Midwives," a paradigm for midwifery to honor many types of midwives,
all with the common bond of serving birthing families. By honoring the
diversity of methods and philosophies, the intermingling of these would
better keep midwifery vital and adaptive, just as a diversity of species
keeps an ecosystem adaptable to changes of climate. The current move by
the MANA board to exclude non-CPMs/CNMs from voting runs totally counter
to this vision.
We midwives have created many structures to promote and protect direct-entry
midwifery as practiced by homebirth midwives: MANA has grown and stabilized
as an organization; MEAC was created to claim the right of direct-entry
midwives to accredit direct-entry midwives; and NARM has taken on the
charge of a national certification program that can be and is becoming
recognized by governments as legitimate. These are fantastic accomplishments!
We celebrate and honor all involved!
And now we must maintain MANA' s biodiversity as a national organization.
We must not fall into the mere maintenance of what we have created by
excluding (and yes, eventually deriding) those who have historically been
a part of the process. Being a non-voting member of an organization is
second-class status and exclusionary. It will encourage people who are
now MANA members to leave and discourage others from ever joining.
It may be a developmental stage--it seemed to happen so easily in Colorado.
As soon as we won the right to be legal, it became politically expedient
to divide ourselves from those who still weren't legal--they aren't "up
to standards." It became more difficult to talk with and learn from
each other. Anyone with philosophical differences became suspect, especially
if they had not embraced the legal mantel to practice under. This was
in spite of the fact that WE HAD ALL BEEN PRACTICING ILLEGALLY AND ACCUSED
OF THE VERY SAME BY MANY CNMS (who were legalized previous to us) JUST
This defending of the territory of a title--"CPM" or "RM"
or "midwife" or whatever--does not allow much room for dialogue,
cross-breeding of ideas, and creative diversity in the midwife species.
Those with "proper" credentials could and will be called upon
to testify in courts of law and legislatures against the "other"
midwives who don't have the correct credentials. This breeds distrust,
lack of communication and further alienation and misunderstanding--an
unhealthy climate for maintaining the strength of midwifery in the long
I know some wild midwives could be dangerous. Ladies (and gentlemen),
do you think anyone can truly put up with practicing midwifery if they
are not truly dedicated to the common ideal of serving birthing families?
Excluding people discourages further education for those who need education;
it discourages normative changes in behavior and protocol of those who
are already out of the loop. Remember, honoring diversity is not the same
as condoning malpractice, AND excluding uncertified midwives is not the
same as preventing malpractice! It only reduces the chance that we can
learn from each other's experience just as those who promote separation
between CNMs and direct-entry midwives, and midwives from OBs, have effectively
reduced the real exchange of information that would most truly serve birthing
Let me give you one example of how renegade midwives have contributed
to midwifery in the last 20 years. In Boulder, Colorado a "renegade
midwife" did waterbirths before anyone else did them. She was considered
wild and bizarre ("If babies were meant to be born in water, God
would have given them gills"). Yet several years later, all of the
"more legitimate" midwives were open to waterbirth because other
people had tried it long enough and now they felt safe with it, sure that
it was statistically proven. BUT if no one had been weird and wild enough
to try it with people, it wouldn't have been proven safe. Now it's acceptable
even in many hospital settings.
I put forth that by excluding non-CPMs from MANA, this kind of healthy
diversity and communication will be discouraged. MANA will be insulting
Jeannine Parvati Baker, who has put endless hours into promoting gentle
and loving birth. MANA will insult me--I won't become a CPM at this point
in my career, although I encourage students to do so. MANA will lose the
voices of many, many other wild and wonderful and even whacky midwives
and future midwives. I believe that we can find a way to promote and honor
the structures we've created without losing those voices.
None of us were CPMs when MANA began and many were illegal. We could
have been certified as midwives if we went to CNM school. We could have
practiced legally in all the states if we had done that. BUT we wanted
to have another way open. Are we going to now negate those who don't choose
CPM, in effect saying, "Now we did it right and if someone wants
to be legitimate they should do it OUR way and join the club?" How
is this truly different in process from what we were up against earlier?
Midwifery needs to maintain, honor and even promote diversity. CPM is
a great credential, and I pray that some day the very women who have,
in the past, been insulted by being called traditional birth attendants
rather than midwives by the ACNM will not turn around and do the very
same thing to other practicing midwives by excluding their legitimacy
as MANA members.
Check It Out!
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I'm a senior in high school and I'd like to get in contact with a nurse-midwife or midwife so I can get to know what it's all about.
Question of the Week
The baby of a woman who is due in two weeks has been trembling or shivering
quite hard several times a day for a week. It lasts about a minute or
at most two, and is unpredictable as to when it occurs. She saw her OB
several days ago and he has no idea what it might be. The baby's heartbeat
was in the 140s and she was not shaking during the appointment. The OB
did not seem overly concerned about it. The mother thinks the baby is
having seizures. She is certain it is not hiccups because the baby also
gets those daily and the mom can identify them. As a doula I have worked
with many women over the last 17 years but I have never run into this.
- Eileen Ryan Maryland
Send your responses to:
Question of the Week Responses
Q: I have a client who had urinary
retention between her ninth and 12th week with her first pregnancy. She
is pregnant again and she recently, again during her ninth week, developed
urinary retention. She has been treated by catheterization both times.
She is fearful that she will develop a UTI as she did the first time.
The urologists have no idea why this happens to her. Has anyone else had
clients with urinary retention? Does anyone have a theory as to why it
occurs in some women? Are there any prevention measures?
- Cindy Schierlinger
A: Depending on the individual woman's anatomy, the uterus may
be pinching off part of the urethra in between itself and the pubic bone.
I have dealt with one woman who experienced the same thing later in pregnancy
twice. The first time she was catheterized and the second time we tried
200c of homeopathic Sepia and that worked extremely well.
A: Displacement of the uterus may be the problem. A retroverted
pregnant uterus can completely fill the pelvis. The cervix is then drawn
up toward the pelvic brim, the anterior vaginal wall is stretched and
so, at the same time, is the urethra. The urethra becomes narrowed and
the mother is unable to pass urine. As the fetus grows, possibly the cervix
is lowered, taking the pressure off the urethra. The UTI may happen because
of poor aseptic technique when catheterisation is carried out.
A: It might be an incarcerated uterus, caused by having an enlarging
retroverted uterus. I understand that this tends to happen a little later
in pregnancy. Maybe she has fibroids. If this is the problem an OB should
know how to fix it by shifting the uterus back into place, and possibly
placing a pessary to keep everything in place till the uterus becomes
too large to become incarcerated again.
- Angela Cross
A: I have had two women in the last seven years who had urinary
retention which was the result of a retroverted uterus that was cutting
off the outlet of the urethra. Both did hands and knees about two-three
times per day for about 20 minutes and voila-no problem.(We were just
waiting for that uterus to lift itself up and over and stop kinking the
- Mary Hogan-Donaldson, CNM
A: I have found that, if the uterus is retroverted, as the enlarging
uterus pushes upward the cervix often ends up under the symphysis. This
put lots of pressure on the bladder, and may prevent it from emptying
completely. I have instructed my patients to do knee-chest pelvic rock
exercises at least twice a day from about seven to 10 weeks gestation,
or until the uterus has lifted up out of the pelvis. It has worked well.
- Marilyn Osborne, CNM
A: Is there any chance that her bladder may be getting trapped
under the uterus? This is rare but can happen and makes mom have the feeling
that she needs to urinate but is unable to. To correct it, the doctor/midwife
needs to push mom's bladder out of the way and allow the uterus to come
- Holly U.
A: Urinary retention in pregnant women is very common, especially
around the 12th week. The position of the uterus (anteverted/retroverted)
can affect how well the bladder can fill/empty as it is around this time
that the uterus enlarges just enough to encumber the bladder enough to
affect flow. It is much less common after 12 weeks as generally the uterus
has enlarged enough to be palpable just above the pelvic brim, so therefore
does not encumber the bladder any more. Sometimes encouraging women to
assume a forward-leaning position when trying to void may help. However
catheterisation is generally the anticipated management (unfortunately).
Urinary tract infections are also common in gravid women due to hormone
changes causing relaxation of the tubercules/ureters so kinking is common
as is urinary stasis. Women who experience UTI when not pregnant seem
to experience UTI when pregnant too. Increasing fluid intake of diuretic
known fluids/herbs may help maintain good bladder maintenance as will regular exercise.
Coming E-News Themes
1. INTACT MEMBRANES: What are the fetal benefits to labor with intact
membranes? Do you have any documentation to share with E-News readers?
2. PROM: A 1996 study at the University of Toronto randomly assigned
5,041 women with premature rupture of membranes (PROM) to either have
their labors induced or to wait for up to four days for labor to start
spontaneously. In both groups, about 3 percent of babies developed infection,
and about 10 percent were delivered by cesarean section. The study concluded
that physicians should present this research to patients, who should choose
the option they prefer. Comments?
Send your responses to:
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QUESTION OF THE QUARTER for Midwifery Today magazine
Midwifery Today Issue No. 57 (Theme: Cesarean Prevention/VBAC)
How do you prevent cesareans?
Deadline: Dec. 15, 2000
Send your response to:
More on birth rituals:
You wouldn't believe the birth rituals that have taken place in some
countries of the world. Do you know they actually cut women open to get
the baby out--in some countries for 25% or more of births? They even give
a lot of drugs to the mothers in some places. Can you imagine? In some
countries they don't wait for labor to start--they "induce."
In some places they even cut the mother's birth canal which sometimes
rips into her anus. In some countries they even separate the mother from
the baby after birth. They put the newborn down the hall in a plastic
box all by itself. Can you even imagine such a ritual? In some places
mothers don't even breastfeed their babies. Can you imagine?
- Jan Tritten
Mother of Midwifery Today
How odd that they would wash the baby's hands so thoroughly at birth
[Issue 2:44]. We know from recent research that newborns placed on their
mother's belly, dried and covered or in a warm room, will spontaneously
crawl to her breast and latch on within an hour of birth. Along the way,
the infant will suck its hands, still bearing the taste and smell of the
amniotic fluid. This helps the baby find the breast, which emits a similar
odour/taste. A baby from whose hands the amniotic fluid has been thoroughly
removed will need good luck to find its way to its mother's breast without
Editor's note: Continue to send birth customs from your country
and culture and we will include them as a mini-column in E-News.
Dear aspiring/practicing midwives and aspiring/practicing preceptors,
I have a vision of North American midwives having a national registry
for apprenticeships, where those seeking out and those offering apprenticeships
could begin to find each other. It would offer information and support
to each group on the process of apprenticeship. Training and support services
would be offered to preceptors. It would be an advocate of the apprenticeship
training route for midwifery.
I don't even know if anyone has estimates of the current number of preceptors
and apprentices, and if those numbers are growing or dwindling. How would
we find such information? My sense is that there is a need to promote
preceptorship. With midwifery schools forming, many assume that midwifery
education is taken care of. Apprenticeship needs some kind of institution
to give it equal standing and voice with the other institutions we have
created: MEAC and NARM. Apprenticeship is the heart of homebirth midwifery!
We must nurture apprenticeship as much as create certification and schools
or we'll have lots of aspiring midwives and half-trained midwives but
not so many practicing midwives. Please contact me if you wish to help
get something going along these lines.
Blessings on all midwives (not just CPMs and CNMs),
PO Box 3146, Boulder, CO 80307 USA
I am an expectant mother who is going to September Hill Birthing Center,
an extension of Schuyler Hospital in Montour Falls, NY. The hospital's
new CEO, Don Lewis, has decided to close down the ONLY birthing center
in the region. I am asking for help to keep September Hill open.
Please write to: Schuyler Hospital, CEO Don Lewis, 220 Steuben Street,
Montour Falls, NY 14865.
- Wendy Sutterby
I have always thought that we do things backward by seeing women once
a month until they are farther along in pregnancy, etc. It makes more
sense to me to see women frequently during the first and second trimester
of the pregnancy. This allows us to establish a communicative and loving
relationship early on as well as guide the woman in terms of good nutrition,
one of the corner posts of good care.
I am interested in your response to the recently published study in The
Lancet that appears to make the vaginal breech a lost art and viable choice
of the woman who delivers outside the developing countries.
- Susan M. Haas CNM
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