February 14, 2007
Volume 9, Issue 4
Midwifery Today E-News
“Ethics”
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Join DONA International Doula Educator Debra Pascali-Bonaro for a three-day Doula Workshop at our May 2007 conference in Costa Rica. You'll learn the history, research and doula skills that enhance labor and birth while decreasing many medical interventions. Attend all three days and you'll have taken one step in the certification process for DONA International. Go here for more information and a complete program.


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In This Week’s Issue:


Quote of the Week

"I would prefer to die of a hemorrhage giving birth at home with a midwife, if that were my fate, than to go to the hospital to give birth again."

— Said to Judy Slome Cohain, CNM, MSN, by a 20-year-old woman carrying her second child, during a prenatal check.


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The Art of Midwifery

Increasingly, midwives are recognising the importance of using a philosophical and an ethical approach in discussing and evaluating their client's care. However, the issue of the most appropriate methodology for such an approach has yet to be raised. It is vital that this issue should now be confronted so that the field of midwifery ethics can be made of real practical relevance. It is not sufficient, as in the past, for midwives to uncritically adopt the well-developed methodology normally used in the field of biomedical ethics. A "case-based" approach is more relevant to midwifery practice, and it is more accessible by midwives.

A case-based approach to ethical thinking and discussion can help midwives put issues in perspective. It is also intended that the use of the case-based approach will raise the awareness of ethical issues amongst midwives in terms that are readily understood by them. This approach has the special advantage of not stultifying classification of concepts. Nor does it use any complex technical nomenclature (factors which can prove to be an obstacle for midwives and others when first approaching ethical issues on a more traditional basis). Perhaps even more important, the practice of "critical incident analysis," utilised in the case-based approach, provides a vital means for developing skills in identifying and examining ethical issues in relation to practice.

— Louise I. Silverton, excerpted from "Ethics Examined," Midwifery Today Issue 30

To read more about the case-based approach and find examples of cases to discuss, you can purchase this issue: http://www.midwiferytoday.com/products/MT30.htm


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

Passionate Midwifery Education

Eugene Conference and Beginning Midwifery

A great way to test whether midwifery is a life path for you is to attend a Midwifery Today Conference. The conference in Eugene, Oregon, March 14–18, 2007, is especially designed for aspiring midwives* to learn a lot about midwifery in a short amount of time. This year for the first time we are offering two full days of Beginning Midwifery. On the first day you will study the Art of Midwifery, Normal Birth and Prenatal Care, Being With Woman and Apprenticeship.

On the second day you will be introduced to student-centered Midwifery Education, Paths and Program, Emotional Issues in Labor, Trusting Birth and much more. The teachers for these classes are dedicated to mentoring midwives. They are very accessible, as are the other speakers we invite. Do not hesitate to approach them.

The rest of the conference is designed with both beginners and experienced midwives in mind. You will learn about the issues surrounding birth, as well as a motherbaby-centered ways to practice. We will cover everything from Communication to International Issues. Time to dance, sing, share stories and give gifts are built into the conference program. Each of the roundtables gives you extra time to discuss fascinating subjects in small groups.

Your head and heart will be full when you go home to ponder all you have learned. You will have ideas, options and paths to ponder, but you will also have a sense of possible directions to take as you consider midwifery, childbirth education or being a doula or an activist. Your path may be circular or straight, but meanwhile you can serve motherbaby while on the path, with a destination clearly in mind.

*I use the word midwife to refer to all birth practitioners. Whether you are a mother, doula, educator or understanding doctor or nurse you are doing midwifery when you care for motherbaby.

love, Jan
Jan Tritten, Mother of Midwifery Today

To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.


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Top Five Reasons to Choose a Midwife

You and your baby deserve to have a midwife for your prenatal care, labor support and postpartum care. The Midwives Model of Care is a fundamentally different approach that includes safe, health-promoting and effective "natural" maternity care that avoids harmful and unnecessary drugs and interventions. Midwives believe in allowing women to make informed decisions regarding their pregnancies. Midwives are trained to view childbirth as a natural process and not as a medical problem. With a midwife:
  1. Women have shorter labors. According to the World Health Organization women who give birth with a midwife often have shorter labors.
  2. Women:
    • Have fewer Cesarean sections,
    • Receive less anesthesia,
    • Have a much lower rate of episiotomy
    As a result, low-risk patients who choose nurse midwives for their obstetrical care experience fewer complications. This is safer for both mother and baby.
  3. Birth is less expensive. Because midwives use fewer interventions, women incur less expense, compared to similar women who choose physicians for their care.
  4. Women are more successful breastfeeding past the first six weeks. One major focus of midwives is to provide the mother with individualized education, counseling and postpartum support.
  5. Mothers are satisfied with their maternity care and their birth experiences. Only 1.7% of the mothers who experienced midwife-attended homebirths said they would choose a different type of caregiver for a future pregnancy.

Resources:

— Liza Janda, AAHCC, RYT
www.yogajanda.com


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Research to Remember

An epidemiological study was undertaken in Canada to determine whether an association exists between amniotic fluid embolism, a rare delivery complication, and medically induced labor. Induction was shown to double the risk. About 13% of women who developed an amniotic fluid embolism died. The researchers noted that although the risk of this event is low, women and their physicians should be aware of the risk in making decisions regarding labor induction.

Lancet 368:1444–48.


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Web Site Update

Check out the updated information on our Norway conference page. You'll find the complete program and registration form for this conference in September 2007. Read about the fabulous speakers and classes lined up.


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Advertising Opportunities

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Question of the Week (Repeat)

Q: Women being discharged from hospital receive almost universal postpartum instructions to avoid tub baths. I suspect that long ago some obstetrician thought this sounded reasonable and it was repeated from generation to generation till it became etched in stone ("common" sense??).

I rather think this is hogwash but have no evidence one way or the other. Apart from the studies cited about women in labor with ruptured membranes NOT having increased infections caused by tub baths in labor, does anyone know of any evidence supporting or discrediting the theory that bath water gets up into the vagina (postpartum or otherwise)?

— Susan Robinson
Ukiah, California


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


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Question of the Week Responses

Q: This year I gave birth to my first baby. After forceps failed, an hour-and-a-half emergency cesarean was performed. The first incision made was a low transverse. Upon discovering I had [what is known as] Bandl's ring [a ridge that forms around the upper and lower segment's of the uterus, a sign of threatened uterine rupture], a classical incision was made. My baby's head was through this ring and after about an hour-plus of tugging, the decision was made to pull her out breech. I am sure a single layer of sutures was used on my uterine incisions because the time spent sewing me up seemed extremely brief. Subsequently my baby spent three weeks in the NICU and I returned to the hospital for ten days of IV antibiotics for a persistent postpartum infection. Despite the extreme amount of stress and worry this has all caused, I want to have one more baby. I appreciate any knowledge midwives have to share because I want to make a fully informed decision about my next pregnancy.

— Katie

A: Be sure to get the facts. Find an obstetrician you like or whose opinion you trust. Review the operative report with the physician or surgeon who performed your surgery. Then take the operative report (which is yours to have) to the other doctor. Review it with him or her and get information. You need to find out about the incision on your uterus, not on your skin. Check out the Vermont/New Hampshire VBAC protocol (available online)—which is a resource regarding risk and benefits of VBAC. Best to you in your decision.

— Kristen Werner, CNM
Vermont_midwife@msn.com

A: Try to have an out-of-hospital birth, breastfeed and avoid medical management for getting pregnant and for birth and beyond.

— Jessica A. Bruno

A: I would suggest for your next birth you lock yourself in the bathroom with the lights off and have a wise, calm midwife outside the door. You will probably birth fine in a couple of hours.

— Cristina Alonso

A: Without knowing the details of your pregnancy and labour, and your emotional and physical anatomy, I can only put forward some very general points:

First, you greatly increase your chance of having a VBAC by giving birth at home with an experienced midwife. If that is not your choice, VBACs are possible in the hospital, but you need to work hard to find a physician who has the right attitude. Don't settle for second best—you will be settling for another c-section.

Now, the evidence? Only anecdotal, but I'm sure ICAN (http://www.ican-online.org/) has more numbers.

I worked with a doctor here in Quebec who had great faith in the uterus. He was very supportive of a woman who arrived here from central Africa who had had a c-section with a vertical incision. She laboured and delivered vaginally with no problems. Closer to (my) home, my mother had a c-section fifty years ago. She bears a huge scar from navel to pubic bone, and her uterus was also cut vertically. She had two vaginal births after that, again, with no problem.

Remember that trauma at birth will haunt you as you move forward. I hope you can find support and that your very reasonable request will be granted.

— Rivka


Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Think about It

NPO (nothing by mouth) [during labor] is yet one more example of modern medicine's century-long endeavor to convince women that their bodies are not their own and that their powerful fecundity must be manhandled if creation is to occur. Starving you to the point of pain, your hospital obstetric caregivers will cheerfully show you their concern by performing further interventions to save you from their myth-based ignorance, interventions that could have been avoided with a little research and a will to care.

— Jock Doubleday, excerpted from Spontaneous Creation: 101 Reasons Not to Have Your Baby in a Hospital, Vol. 1: A Book about Natural Childbirth and the Birth of Wisdom and Power in Childbearing Women, www.SpontaneousCreation.org


Help spread the word about birth to older woman so they can teach their daughters and granddaughters.

One of the Midwifery Today staff members has started a group on Eons.com, a social networking site for people 50 and older. The name of the group is "Better Birth for our Daughters and Granddaughters" and you can find it here.

If you're over 50 and would like to share your knowledge of natural birth and midwifery, please join Eons and join this group.

Just go to the link above, then click on the "Join or Sign-in" link to join Eons.


Feedback

I was taught a wonderful technique by another midwife—if a woman is making slow progress in active labor and walking and position change, etc., has not worked, I use a technique that I call Tibetian Birth.

I immediately turn up the heat in the room, wrap the woman all over in prewarmed blankets and have her drink warm to hot caffeinated tea.

The heat starts to become intolerable—and she dilates—out comes baby.

Sherrie St. Clair, CNM


Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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Calling in the Voices of Midwifery: The California Association of Midwives will be holding our 2007 conference June 1–3 in Occidental, California. See our list of classes and register at www.californiamidwives.org


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This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

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