May 26, 2010
Volume 12, Issue 11
Midwifery Today E-News
“International Midwifery”
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Midwifery Today Conferences

Learn about breech birth with Ina May Gaskin, Michel Odent and Cornelia Enning

In the morning, Ina May and Michel will help you develop a variety of breech skills, including palpation and assessing fetal weight. You'll also learn about frank, footling and complete breech, as well complications that can occur. In the afternoon, Cornelia will discuss the special circumstances of breech waterbirth. Did you know that breech birth in water improves fetal oxygenation by increasing uterine blood supply during immersion? Attend this class to find out more!

This full-day Breech Workshop is part of our conference in Strasbourg, France, Sept. 29 – Oct. 3. Learn more about the Strasbourg conference.

In This Week’s Issue:

Quote of the Week

“The greatest joy is to become a mother; the second greatest is to be a midwife.”

Norwegian Proverb

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The Art of Midwifery

Love the Baby Out

Encourage lovemaking during pregnancy. The Japanese say, "Use the container so it's easy to open."

Aki Otani, Japan
Excerpted from Birth Wisdom, Tricks of the Trade, Vol. III
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Jan’s Corner

International Midwifery

International Midwifery is one of my favorite subjects. Since the first issue of Midwifery Today nearly 25 years ago, we have been dedicated to including stories of birth and midwifery from around the world. I think each country, each midwife, each one who cares deeply about birth is part of this big puzzle—of making birth optimal for every motherbaby in the world.

In the Western world we have a different set of problems: chiefly, abuses in the birth room. But in some places, motherbaby does not even get enough to eat. I do believe this is solvable. We need the love, care and political will to do better. I also believe that, if we all work together in love and without petty jealousy, we can move mountains. If we are busy fighting, we are sacrificing motherbaby because they need our unity. Our diversity is our strength. Respect needs to be our motto.

I have great hope for this because, as I make friends on Facebook, I have learned that there are literally thousands of us around the world fighting to make birth better. Midwifery Today is doing our part, too. Our magazine, conferences, books, Web site and now even videos are dedicated to this worthy goal of a loving, respectful midwife for every woman. I know deep in my heart and soul this would make a huge difference in our world. This has been my calling for 33 years and I am so pleased to know that now there are thousands more with this calling. We will reach critical mass of 20% knowing about good birth and influencing the rest of the world if we don't give up.

Conferences play a large part in our quest to teach and inspire. I used to fret a bit about how the conference would work. Would everyone get what she or he came for? It is important to me that people get rejuvenated and ready to serve motherbaby. Many people come to conference burned out and really need a shot of love and enthusiasm. We need you all to stay full of enthusiasm for your calling. Any of the birth callings—whether as a doula, midwife, educator or activist—are tough professions. Of course, the mothers have a huge calling, too. We leave them after their births with their beautiful baby in their arms. They are mothers. They hold the future, literally, in their arms. Midwives can stop, but I want them to keep going. We need them. But we need them enthusiastic and educated with the newest information—and I don't mean the mainstream lies. I have found if we just get great teachers together with great classes and some fun activities we can stand back, get hugs (thanks Lexi) and let a conference happen. Well, it takes a bit more behind-the-scenes organization to make a conference run smoothly, but Midwifery Today has a great conference staff. A big thank-you to my faithful sister, Lo, (Lora Jean—I named her when she was born and I was 8). Lo has been with us to nearly all of the conferences.

Conference planning is one of the activities I love to do. Midwifery Today has held more than 50 conferences in 12 different countries—China, Japan, United States, Mexico, Costa Rica, Jamaica, the Bahamas, England, France, Germany, Denmark and Norway. We are planning conferences in Russia, South Africa, Australia and Spain. I hope you will join us for one of these. You will learn ideas, insights and techniques from all around the world. Even in Philadelphia this past April we had midwives from 14 different countries. Thank you, God, for your love and guidance and the truly international influence Midwifery Today has been able to give.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Infection-related Stillbirths

An article recently published in the medical journal Lancet, says more research into the relationship between infections and stillbirths, especially in low- and middle-income countries, where researchers estimate at least half of all stillbirths are due to infection, is needed to reduce worldwide stillbirth rates.

The article points to infections prevalent in the developing world, such as malaria and syphilis, as contributing to a high rate of stillbirths in these areas. In developed nations, infections account for 10–25% of stillbirths, the article points out.

The article points to ways of prevention, stating that, "Syphilis, where prevalent, causes most infectious stillbirths, and is the infection most amenable to screening and treatment," and that "intermittent malarial prophylaxis and insecticide-treated bednets should decrease stillbirths."

— Goldenberg, Robert L., et al. 2010. Infection-related stillbirths. Lancet 375(9724): 1482–90.

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Childbirth in Rural Ethiopia

At the age of 15, before having given birth herself, Danyanish began to learn about childbirth from a female slave of her husband's family. She started by helping the woman and eventually took over as the birth attendant for all the members of her family. Danyanish never went to school or had any formal training. She learned everything from experience and from the stories of the women around her. When I tried to ask Danyanish why she was drawn to this type of work the question had no meaning to her. She could only say that this is what God intended her to do.

Traditionally, when labor starts, the birthing woman will go to the house of her mother. When she arrives at her mother's village, all the men leave the family hut and the women of the village gather to provide support and encouragement. By the time most women give birth themselves, they have already witnessed the births of siblings, cousins and other children of the village. Childbirth is not hidden from them as it is in many other cultures so most women go into labor without fear. The women of the village stay with the birthing woman throughout her labor, with one woman always near her head and one behind her to support her and hold her up. When the awaledje arrives she brings her only tools: a razor blade, some string and the leaves of the castor bean plant. The women sing and tell stories and stay with the birthing woman for as long as the labor lasts. Children come in and out of the hut but no male child over the age of seven is allowed in.

As in every culture, the people of Ethiopia have their own particular ideas and beliefs about childbirth. Here, birth ritual is steeped in the Christian religion. Most Ethiopians belong to the Coptic Church, which is believed to be the oldest Christian sect in the world. In their belief system, the Virgin Mary, or Miriam as they call her, oversees and protects the birth process. When a pregnant woman prays for the protection of her baby, she prays to Miriam. When she is in labor and prays for relief from the pain, she prays to Miriam. The castor bean leaf used in labor is also connected to Miriam. Miriam was believed to have used the leaves of the castor bean to cover herself when she journeyed to the place where she gave birth.

As the labor progresses and the pains become more difficult, women of the village pray and chant to Miriam to help the birthing woman cope. Sometimes, when a labor is very long and difficult the women of the village will put huge rocks on their shoulders and walk around the hut trying to take some of the burden of the mother's pain and to encourage her to keep going.

When the baby arrives the birth attendant will catch the baby in the castor bean leaves. She will measure four fingers width on the cord then tie string on both sides and use a razor blade to cut it. Another castor bean leaf is used to push on the genitals to protect the uterus from "coming out." When the time comes to birth the placenta the women dig a hole in the floor of the hut and the new mother squats and births the placenta in the hole where it will be buried. If the woman's perineum tears, the awaledge will wash the area with warm water then paint the perineum with clarified butter every day for one or two weeks.

The postpartum period lasts a long time for Ethiopian women. The new mother stays in the hut, mostly in bed, for 40 days. She is considered unclean and cannot enter a church during that 40-day period. She will not cook any food or perform any of her normal duties in the village. Her mother or another woman of the village will prepare a special dish for her, which is believed to have special healing properties for a postpartum woman. The dish is a type of porridge made from roasted, crushed barley and topped with spiced clarified butter. She will also drink diluted tella, a homemade beer.

After she gives birth the woman will not be left alone with her baby for 10 days. Ethiopians believe that during this time the new mother is more likely to become crazy or possessed and may harm herself or the baby. To prevent harm, either another woman or a child will always be with her. Soon after the birth a priest from the closest church will come and bless the baby and sprinkle holy water on any family member who has touched the woman. Since she is "unclean" during those 40 days the holy water is meant to protect anyone who has had contact with the mother.

Debra Craig
Excerpted from "Women's Secrets: Childbirth in Rural Ethiopia," Midwifery Today, Issue 75
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Entry Deadline is August 10, 2010, so get your creative gears spinning! Go here for more information and instructions.

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Placenta rituals, remedies and recipes…

Placenta: The Gift of Life

…are what you'll find in Placenta: The Gift of Life. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You'll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. Placenta: The Gift of Life is a book from Motherbaby Press, an imprint of Midwifery Today. Get the book.

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Question of the Week

Q: We're looking for interesting postpartum customs from other cultures. Do you know of any? Please share them with us.

Midwifery Today staff

SEND YOUR RESPONSE to 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: What do you look for in an apprentice and what role does the apprentice play in your practice?

Midwifery Today staff

A: I look for someone who has effective communication skills, a sense of humor, is willing to do the deep work and engages in self-inquiry. I'm drawn to one who is heartfelt, sensitive to energy and able to be fully present and accountable. I also look for someone who is self-motivated and looks for ways to contribute to my practice in return for mentoring. Realizing that there is a learning curve for all of us in acquiring these skills, the sincere willingness to grow personally and change is appealing to me.

Apprentices can help with organizing office papers, downloading MANA statistical data, updating/copying or composing client handouts (depending on their knowledge base). They can make phone calls regarding appointment times or announcing client potlucks. They can keep track of lending library items, going over the card file and checking for items to be returned.

— Constance Miles, LM, CPM, RN

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

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Dear Midwifery Today,

A "last resort" method of dealing with severe postpartum hemorrhage was creatively taught at the 2009 annual "Women Helping Women" retreat in West Virginia. Using mannequins and cantaloupes in a simulation training workshop, participants quickly and easily learned the use of the Bakri postpartum balloon—a 54-cm, 24-French silicone catheter with a large central lumen and a balloon that is inflated with 250–500 cc of sterile saline after being inserted into the uterus. This method of providing direct pressure to the uterine cavity has been shown to be successful in temporarily reducing uterine bleeding when other methods, including uterotonics, laceration repair and placental tissue removal have failed to resolve the hemorrhage. The balloon may be left in place up to 24 hours and has been used for difficult-to-control postpartum hemorrhage after vaginal or cesarean birth. Here in rural West Virginia, where back-up hospitals may be more than an hour away, the Bakri postpartum balloon appears to be a "hands-free" way to achieve the effect of bi-manual compression—potentially making transport in this situation easier and safer. I bought one, hoping not to use it.

Sarita Bennett
West Virginia

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