|September 12, 2007|
Volume 9, Issue 19
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"I begin to love this creature, and to anticipate her birth as a fresh twist to a knot, which I do not wish to untie."
— Mary Wollstonecraft
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The Art of Midwifery
Several things have helped me deal with my fears as a midwife. First, I read a lot of birth stories. I go to several Web sites and re-read Ina May Gaskin's books. All of this reminds me that birth is normal and the body works. Difficulties that arise during labor and delivery make statistics, but are not common. Most of what midwives run into are just variants of normal. I also like to read the 139th Psalm, for it reassures me that our bodies and are babies are designed for this purpose.
— Dana Jespersen
Midwifery Today Issue 67
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 firstname.lastname@example.org.
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Professionalizing the Prenatal Clinic
The prenatal clinic is the dress rehearsal for the birth. When a pregnant couple comes in for a prenatal visit, they are getting a sense of how things will be done at their birth. If the midwife appears tired, hurried, bored or disinterested, the client will surely wonder if the midwife will turn up that way on the day of the birth. I spoke to a woman recently who told me she was changing from her doctor to a midwife because her doctor had never said "Hello" or introduced herself properly to the baby's dad. This doctor always seemed to be in a hurry, too, and the pregnant woman could tell she wouldn't get personalized service on the day of her child's birth.
Preparing in advance for the prenatal clinic visit lets your clients know that you value their time and want the visit to be as profitable for them as possible. Before the couple arrives, review the chart and calculate the number of weeks the pregnancy has progressed. Think through what you will expect to find when you do the physical exam. Will the mother have felt some movement yet? Will the fundus be above or below her umbilicus? How big is the baby now? Is it important to know the presenting part yet? Read your notes from the last visit to see if you need to follow up on anything. For example, if the woman had headaches at the last visit, inquire about them. Create a plan of action to investigate and fix the problem if the headaches persist. If they are better, ask what has helped. Your clients will appreciate your follow-up, and problems will not escalate without being addressed.
Give your undivided attention to the visit. Let your answering machine pick up phone messages silently. Keep office interactions with staff brief. If interruptions are unavoidable, say: "I'm with a client right now. Can I talk to you about that later?" Take the time to explain every unusual finding and its significance in the overall picture of the pregnancy, but avoid the temptation to tell long-winded stories to illustrate your points. Let the clients have lots of time to talk and express their concerns and questions.
Engender a secure feeling of privacy during the clinic visit. People waiting for the next appointment should not be able to overhear your conversations with clients. Use a "Confidential" rubber stamp on your notes, charts and paperwork. Don't discuss any of your other clients' births or affairs. If your clients know each other (networking is a big part of midwifery), simply say: "Bob and Cathy had a beautiful little girl. You should phone them and get the details." Professional practice includes a mature, refined way of speaking that keeps things brief, to the point and in good taste.
Ask a friend to critique your clinic environment occasionally. Sometimes we can't see the potential for using our own space in the most professional manner possible. Your cozy little office might need a new paint job. Maybe the photos need to be organized. Maybe the information pamphlets are in a mess, or the smell of coffee from the restaurant next door is too strong. An outsider is better able to assess things than the person who is working all day long in that environment.
Keep asking yourself, "What would take my clinic to the next level of excellence?
— Gloria Lemay
The Birthkit back issues
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Research to Remember
During a demonstration nurse-midwife program in a rural California hospital, prenatal care increased and prematurity and neonatal mortality decreased. Once the three year program ended, prenatal care decreased, while prematurity and neonatal mortality again increased. No similar trends were noted in the county during that same period. The authors concluded that the services of nurse-midwives were responsible for the positive results and that the profession should be used more extensively.
— J Midwifery Women's Health 50(2): e10-8, Mar–Apr 2005
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A retrospective study of prenatal care utilization by women in a large, university-based midwifery clinic found that women of color were less likely to receive timely and regular prenatal care than white, non-Hispanic women. The frequency of this was noted to be increasing. Authors recommended that consideration be given to recruitment and retention efforts for non-white midwives, regular education for cultural competence of midwives and provision of culturally and linguistically appropriate care for women of color.
— Midwifery 23(1): 28–37, March 2007
Web Site Update
Read this editorial by Jan Tritten in the brand new issue of Midwifery Today, Autumn 2007:
Who Are the Statistics?
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Question of the Week
Q: I am 20 weeks pregnant with my third child. I delivered vaginally full-term with a midwife for my first. For my second, I delivered at 32 weeks by c-section due to breech presentation and virtually no amniotic fluids. The obstetrician said the uterine incision would be vertical because the lower uterus is too narrow for a lower transverse incision at 32 weeks. Because I have had a vertical incision done, does that mean I have to have a repeat c-section? What are the chances of a uterine rupture? Are there doctors or midwives who would allow me to attempt to deliver vaginally? Thanks.
SEND YOUR RESPONSE to email@example.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: I am a hospital midwife in the UK and I occasionally see women admitted with symphysis pubis dysfunction pain so severe that it can only be controlled with opiates. When I was having my first baby in the US with an independent midwife, I remember discussions around the use of GLA (evening primrose oil) to ease this condition. Does anyone have any information on this, particularly on clinical trials that have been done to test its effectiveness?
Any help on this would be gratefully received!
— Elizabeth Pentz, RM
A: I am a chiropractor practicing in Canada. I have used the Webster technique in reducing uterine constraint to help optimize babies' positions. I have had many patients with severe symphysis pain who are unable to walk. Doing some very gentle adjusting of the symphysis and round ligament work prior to delivery has shown amazing results. Try looking for a chiropractor who is trained in the Webster technique and you will find some amazing results with mums.
— Dr. Joelle Johnson, D.C.
A: I have information about SPD on my Web site, www.plus-size-pregnancy.org, about living with the difficulties of symphysis pubis dysfunction (SPD). It also has hints to help a woman with SPD in labor so she does not increase the risk for damage to the pubic symphysis.
Offhand, I do not know of any trials about the use of EPO for SPD pain. Some of the Scandinavian journals have a lot of research on SPD so you might check there. Anecdotally, I used EPO in my second and third pregnancies, both of which were strongly affected by SPD, and did not experience any relief with the EPO.
What helped my SPD the most was to be seen by chiropractors with special training in pregnancy (i.e., the Webster technique or the Bagnell technique). When they aligned my pelvis and helped release the ligaments that support the uterus, I experienced a huge degree of relief from the SPD. A direct adjustment to the pubic symphysis itself was the MOST effective help of all. The pubic symphysis itself needs to be evaluated and treated, if needed. Not all chiropractors do this.
In the UK, if no chiropractor is in your area with this training, you might seek out an osteopath who has been trained in the classic way, with experience in manipulation. Several osteopaths in the UK have had great success in helping women with significant SPD pain. My Web site has some links to stories of UK women who were helped by this.
Thank you for wanting to find out more about how to help women with SPD!
— Pamela Vireday
Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Medela, a provider of breast pumps and breastfeeding accessories, seeks nominees for their second annual Lactation Consultant Hall of Excellence program, which honors the hard-work, dedication and best practices of lactation consultants across the US.
Eligible nominees must be practicing International Board Certified Lactation Consultants (IBCLC) in the US and be nominated by a peer and client for their role as an exceptional professional. The nomination process requires the completion of an online nomination entry form, a letter of nomination and a letter of support from a past or present client.
The Lactation Consultant Hall of Excellence inductees receive a $5,000 grant to fund research, continue education, purchase equipment for use in their practice or donate to the charity of their choice. Inductees are chosen by an independent judging panel comprised of healthcare industry representatives. The panel is solely responsible for judging entries and selecting the program inductees.
Program guidelines and the online nominee submission forms are available online at www.medela.com. Entries must be submitted via the online nomination form by October 12, 2007.
Think about It
As you may be aware, midwifery is under attack in Iowa. Midwives in our state face criminal investigation and prosecution for practicing medicine without a license—a felony charge that carries a sentence of up to five years in prison.
Many of you are familiar with Melanie Moore, a Certified Professional Midwife and mother of six, who was recently charged. Her case is but one example of this disturbing trend, and unless something is done, we face the very real risk of losing this vital community of holistic health care providers.
Midwives like Melanie have upheld the rights of Iowa women to have safe home births for many years, under the constant threat of unnecessary prosecution. With midwives practicing legally in 24 states, and legislation pending in 10 others, it is clear that Iowa's approach to midwifery is outmoded and ineffective.
Now is the time for supporters of childbirth options to come together to preserve the rights of Iowans to give birth where and with whom they choose.
Please join Friends of Iowa Midwives at a Preparing for Legislation workshop to learn how you can help ensure that Iowa's families have access to safe home birth with legal midwives.
Registration fee: $15 (low-income $5)
Presenter: Ida Darragh is one of the nation's foremost authorities on midwifery law. She is a Certified Professional Midwife and testing director for the North American Registry of Midwives.
To Register: Call Moira at (319) 484-4086 or e-mail email@example.com. Please include your name, phone number and mailing address.
— Monica Brasile
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I'm not sure if I misunderstood the comment made regarding vaccines (E-news 9:17). The comment seemed to state that vaccines are only for preventing viruses. However, two of the illnesses mentioned (pertussis and Haemophilus Influenza B) are bacterial. The CDC has some nice articles on these diseases. Some of the currently mandated vaccines are for bacterial infections. Just thought I would clarify this.
— Kristen Riley
I agree with everything that Gwen wrote in her response to the concerned grandmother of a seven-day-old baby, as far as getting help to correct the problem. However, I am concerned that she recommended Milk Thistle tea, as I have been told and read that a lactating mother should NEVER take Milk Thistle. Many herbs are effective galactogogues: Fenugreek, blessed thistle, alfalfa, goat's rue and many others work well.
I love reading your online publication! Thanks for all the great information. I have passed on some of the tips for birth to an obstetrician here in town. I look forward to learning something new every time I receive Midwifery Today, which I incorporate into my birth preparation classes and doula work.
— Christine Pillado, BA, IBCLC, RLC
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