October 24, 2007
Volume 9, Issue 22
Midwifery Today E-News
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In This Week’s Issue:

Quote of the Week

"The flowering of midwifery education is in the opening, the grace, the surrender, the beauty and the union with what is great and good and the strength that comes with this."

Elizabeth Davis, BA, CPM

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The Art of Midwifery

I believe in midwifery and in women. I believe that when each community abounds with truth and respect, women will be opened up to the prospect of changing the way that they bring their children into the world and the way that they are treated during this rich and empowering time of their lives. I believe that by teaching apprentices this way of caring for women, we can have a very powerful impact on our world. This is why I love apprentices.

Cynthia Luxford
Excerpted from "Why Apprentices"
Midwifery Today Issue 78

Midwifery Today Issue 78

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.

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Do You Really Want an Apprenticeship?

Over the past 15 years I have shared my calling to midwifery with over 30 different women, as apprentices. Some have attended one birth with me only to realize that midwifery was not their heart's call. Others have attended dozens of births and are still serving expectant families in numerous ways. I have learned from each apprenticeship: how to teach better, how to interact better, how to communicate more clearly. Even the apprenticeships that ended in very negative ways taught me how to teach the next apprentice better.

I have found several areas not related to academia that I believe are crucial to the relationship between midwife and apprentice. Every midwife should seek academic wisdom, in order to serve her clients to the best of her abilities. Twenty years ago the options in directed studies were few and restrictive. Now many options are available to help the apprentice round out her book knowledge.

Those who are seeking an apprenticeship need to remember that apprenticeships of the past were usually financed by parents. The apprentice worked very hard, usually for several years, to learn the vocation of the mentor. The mentor was not obligated to take on an apprentice and usually the position was in demand.

Apprentices need to make themselves worthy of the position, developing skills, studying, gathering equipment and being ready to learn to serve the midwife's clients and the midwife. In addition, they should expect to be willing to communicate their desires, needs, limitations, skills and, especially, birth philosophies. If apprenticeships increase the midwife's workload they will likely be few and far between. Midwives usually are already heavily burdened by the needs of the expectant mothers they serve, as well as their own families; taking on an apprentice is a gift and should be recognized as such by that apprentice.

For midwives who are considering apprenticing as a way to pass on what they were given, I recommend a few things that may help prevent some of the mistakes I made:

  1. Clearly share your expectations, in writing, to prevent later misunderstandings.
  2. Clarify time requirements and limitations.
  3. State up front any fees that you will charge the apprentice, or whether she is to be paid.
  4. Inform her of equipment that she will be required to purchase.
  5. Share other study or academic requirements.

I share this information with a heart that desires that midwifery not only grow but thrive once again in our country, for us and for the sake of our granddaughters. I wish for all midwives-to-be to find a midwife willing to share what she has been given. I wish for all midwives to find apprentices who will assist their practice and clients.

Renata Hillman
Excerpted from "Apprenticeship: Do You Really Want One?"
Midwifery Today Issue 78

Midwifery Today Issue 78

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Research to Remember

Two studies, involving a total of 130 women, looked at whether the use of creams to prevent stretch marks during pregnancy was effective. Both found that they were.

Application of Trofolastin cream (Centella asiatica extract, alpha tocopherol and collagen-elastin hydrolysates) appeared to help prevent the development of stretch marks in pregnancy in some women. Verum ointment (tocopherol, panthenol, hyaluronic acid, elastin and menthol) was found to possibly be helpful, but because the trial used no placebo, it may actually have shown the benefit of massage alone.

Cochrane Database of Systematic Reviews 2: CD000066, 1996

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The North American Registry of Midwives (NARM), in its 2006 Annual Report, showed an increase of more than 25% in midwives taking the written exam. Since 2002, the number had hovered around 135. In 2006, 174 people sat for the written exam.

www.narm.org/reports.htm, accessed October 11, 2007

Web Site Update

Learn about the Hope & Healing Conference—Collaborating to Bring Midwifery and Mental Health Care to Women Who Are Survivors of Sexual Abuse, to be held in Ann Arbor, Michigan, in May 2008, on this overview page: http://www.midwiferytoday.com/conferences/HopeHealing2008/

Read these articles recently posted to our Web site:

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Question of the Week

Q: Some women experience technological birth as rape. Have you encountered this in your practice and what do you do to prevent it or deal with it when it comes up?

— Anonymous

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Question of the Week Responses

Q: I had a primipara in pre-labour. The baby's heartbeat showed spikes. In 16 hours of slow labour it became dips. We then moved to Hospital where the obstetrician ruptured the membranes, finding stained amniotic fluid. Dilation decreased from 7 cm to 5 cm. The mom was given a c-section.

I agreed with his decision as I was worried from much earlier. Baby was 40 weeks gestation and weighed 2680 g (5.9 lb). He appeared quite angry at first, on the verge of fetal distress, but slowly calmed down to normal breathing.

My question is: Could the spikes becoming dips, could they be due to just worry? My worry, worrying the mum and then the baby?

— Françoise Bardes

A: I think, in general, a rapid fetal heart rate should be taken as a sign of a possible problem. A "spiking" or rapid heart rate (tachycardia) may indicate that the baby is sick or is having trouble getting enough blood flow or the correct oxygenation through the placental circulation. Our heart rates react quickly to such forms of physiological stress. (You probably have noticed that your heart speeds up when you run up the stairs.) Babies in the womb are even more sensitive and their heart rates will rise under even gentle stress such as normal fetal movements. If the accelerations are the result of stress, the baby's oxygen reserves will start to become depleted and the heart rate "spikes" will eventually become dips (decelerations). If the stress still continues, the heart rate decelerations will begin to spike again. This "late tachycardia" can be a sign of a very severe problem.

In this case though, the baby was born before severe fetal distress developed. The meconium in the water may have been another sign that the baby was developing problems, or the meconium may have been passed before labor began.

I don't think that your worry could have affected the baby's heart rate. I think some evidence shows that severe maternal anxiety can trigger a more rapid-than-usual fetal heart rate as a response to maternal adrenaline. (Of course, in that case, the woman herself will have a rapid heart rate and will show signs of anxiety). I can't think of any way that ordinary worry could cause the fetal heart rate to have "spikes" and then "dips."

I wonder if there were some mild problems in this pregnancy, though. Before this woman reached 40 weeks, I might have become concerned about the small size of the baby, and I might have wondered if the placenta wasn't functioning correctly. In some ethnic groups, a 5.9 pound baby is normal, but in others a baby of this size might be considered growth-restricted. If so, a baby who is growth-restricted might be at higher risk of developing fetal distress in labor. I like to see babies grow appropriately during pregnancy and I'm always a bit concerned if my exam shows the baby is smaller than expected.

Anyway, this baby was born safely by cesarean section. You observed the signs that he needed help in labor and you brought him to hospital. Good job!

— Gail Hart
Oregon, USA

A: I do not think that your worrying influenced the health of this baby. I think that your decision to transport was timely and your concern was correct. Tachycardia can be an early sign of fetal distress while the baby can still compensate, while the dips are signs that the baby is losing the ability to compensate for the stress that labor is causing.

The fact that the baby was on the small side for gestational age may have been a sign that the placenta was not functioning as well as it could have, and labor may have been more than that baby could tolerate. I have seen tachycardia from very excited or worried mothers, but that resolves as everyone settles into labor. I would also add that fetal heart tone variability is very important, as well, in demonstrating fetal health.

— Katherine Zieman, ND, LM
Private family practice and homebirth
Faculty Member, National College of Naturopathic Medicine
Portland, Oregon

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

Are you a midwife seeking an Apprentice? The Association of Midwifery Educators offers a service designed to connect students in midwifery education programs with potential mentors or preceptors. Go to http://www.associationofmidwiferyeducators.org/apprentice.php and complete their form, which will be sent to member educators to see whether they have a student who is a good match.

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Dear Friends,

As you know, the state of Iowa was charging me with practicing medicine without a license, a felony. My court date was set for August 20 but on August 17 the state made an offer, which I accepted.

Here is a break down:

The good: No jail! If I follow the rules of my probation for one year all charges against me will be expunged. The charge was considered a "serious misdemeanor."

The bad: One year probation, $315 in fines, $100 court costs and $300 probation fee (so far). Not bad fees, but they are compounded by my inability to earn a living. An added surprise was 25 hours community service (not a part of the original deal). I will look at it as an opportunity to expand my horizons and work toward empowering women through birth.

The ugly: I was forced to sign a plea of guilty to practicing medicine without a license. I feel nauseous to even write this. You know and I know that midwifery is NOT the practice of medicine and I will yell it from the rooftops forever!

Please forgive me for signing those papers. If you had seen my family when they made the offer - the looks on their faces - you would surely understand. A friend who has been through it herself counseled "THEY have all the power; you are a mere speck. A flea on the back of the elephant. You can fight them and destroy your life because it will take herculean stamina and financial resources AND you will undoubtedly lose."

I hope women will continue to choose homebirths, lay midwives will attend them and apprentices will wait in line to assist at these incredible events! Please decriminalize midwifery in Iowa! Or at least recognize the Certified Professional Midwife.

What does my future hold? Time will tell. I continue attending births as a certified doula. I dream of combining my love of dance and women to teach some pregnancy belly dance classes.

Thank you so very much for all your support. I and my family have been humbled. You are all awesome.

Please never give up!

Melanie Moore

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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