|February 2, 2011|
Volume 13, Issue 3
|Midwifery Today E-News|
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At our conference in Bad Wildbad, Germany this October! Plan now to attend. Other teachers include Robbie Davis-Floyd, Debra Pascali-Bonaro, Stephen Gaskin and Gail Hart. Part of our conference in Bad Wildbad, Germany, 19–23 October 2011.
Learn more about the Germany conference.
In This Week’s Issue:
Quote of the Week
The language of birth is like sheet music…Universal!
— Patricia Edmonds
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The Art of Midwifery
Recognizing healthy pregnancy, healthy labor and healthy babies is similar to recognizing healthy ecosystems. We watch the details. We take measurements. We watch the interactions among individuals. We interfere as little as possible. We watch and worry; we wish things were different; we wonder how we might be at fault. Still, we preserve what is there—we don’t take the forest apart looking for remaining toads to save because the ecosystems still supports other life and other processes…In birth, a single failed test or measurement is not reason to give up faith that the natural processes of labor might still yield a healthy birth. The ecosystem of birth should not be destroyed at the first sign of trouble.
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.
Send submissions, inquiries, and responses to newsletter items to: email@example.com.
The Times Are Changing: Motherbaby-Midwife Rights
When I look around the world at birth practices what I see now are rising cesarean rates. Abused and traumatized moms are in every country. I talked with a mom on Facebook seeking a homebirth in Turkey because the cesarean rate is 80–90% in the hospitals; she was coerced into a cesarean for her first birth and was looking for a traveling midwife. My midwife friend in Iran reports the same situation there. The good thing in Iran is that they also have three waterbirth centers in the country. In Egypt the scenario is the same—a high cesarean rate. Isn’t it interesting how many of these countries do not want to be like the United States and yet copy our horrendous birth practices?
These are not just statistics. These are real women and babies. We must look behind the numbers and see the hurt humans. What is wrong with our world? Look at birth. The way we treat people is reflected in the way we treat motherbaby. We can change. We must change. It may not look like there is any hope for the world’s mothers and babies because the birth boat is swamped. And yet I have hope. I have hope because people like many of Midwifery Today’s country contacts are changing the world. Read Joni’s story from Mexico, below.
I have hope because so, so many of us are working within our communities, our cities and the world to change birth practices and make birth as wonderful as possible for every motherbaby on the planet. Without good births I don’t think there is much hope for the world, but as Bob Dylan sings, “The times they are a-changin’.” I believe God sees midwives’ and mothers’ hearts and will help us change birth. The design for birth is beautiful and must be honored. It can give foundational strength to the new family.
Midwifery Today, with her readers, writers, teachers and speakers, is an important part of the change. We all touch others, who then touch others. I hope you will subscribe to Midwifery Today magazine and be a well-informed part of that change. Please come meet us at a conference; it is an opportune time to learn, share, plan and have your brain and heart filled.
We got some very good news from the EU recently: A victory for Ágnes, the Hungarian midwife-physician, and for Anna, the mother who took her case to the European Human Rights Court in Strasbourg, France. Strasbourg was the location of our last conference, whose theme was “Birth Is a Human Rights Issue.” You can read about these victories on Midwifery Today’s homepage: http://www.midwiferytoday.com. Ágnes and Anna’s cases will inform and influence all of midwifery and homebirth practices in Europe and have far reaching effects that I see reverberating around the world. First, in Europe and then in other countries that do not even have a human rights court, such as the United States. To think—we go all around the world touting human rights and do not even have a court where people can bring their complaints? Kind of criminal isn’t it? Maybe we can change that, too!
— 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.
Jan on Twitter: twitter.com/jantritten
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Rise in Iraqi Birth Defects Possibly Linked to US Weaponry
Research recently published in the International Journal of Environmental Research and Public Health reports that malformations in Fallujah newborns reached a record level in the first half of 2010, to nearly 11 times the normal rate.
Of the 547 babies born at Fallujah general hospital in May 2010, 15% had chronic deformities. Eleven percent of babies born during the same time came at less than 30 weeks and 14% of fetuses spontaneously aborted. Researchers believe the total number of abnormalities is likely higher than reported.
The deformities, researchers say, are caused by a chronic environmental contaminant, and though studies are inconclusive, metals, including depleted uranium from US weaponry used in 2004, and other battlefield residues, are believed to be a primary cause.
— Chulov, Martin. “Research links rise in Fallujah birth defects and cancers to US assault.” 30 Dec 2010.
Country Contact Reports
Editor’s Note: Midwifery Today maintains a list of country contacts who serve as liaisons in their communities and as international resources. For this international edition of E-News, we are featuring reports from country contacts around the world. These reports highlight the important work being done to promote midwifery and to connect both parents and care providers to needed resources.
Reporting from Mexico: In my position as country contact I straddle two worlds. Not only because I divide my time between two countries (I spent 18 weeks in Mexico during this first year of becoming a US resident) but because I witness what continues to be the “norm” in the nationwide statistics (scheduled cesareans, mother/baby separation, and far too much ignorance about breastfeeding) while receiving hundreds of e-mail requests each year from women who are seeking alternative: information and education, respectful care and breastfeeding support.
My colleagues at Nacer en Plenitud in Guadalajara continue to offer waterbirth and enthusiastic VBAC/VBAMC care in our four-room birth center tucked away in a corner of a traditional hospital, while 90% of the families that birth under the same roof with different providers experience cesareans. (Yes, a 90% cesarean rate!)
We’ve continued with our free monthly informational gatherings for the past ten years. Is there any other way to counteract the misinformation families are fed about the convenience and safety of scheduled cesareans or about bottle feeding being “just as good” than to educate, inform and inspire? This venue provides the opportunity to meet with beaming parents eager to share their birth experiences, coupled with the opportunity to listen and talk to every member of our birth group (surely they can relate to someone), to view an emotive DVD of Plenitud births set to music and to receive free handouts and Internet resources.
As a contact person I write to like-minded birth spirits and describe how our efforts are reaching women. I emphasize how critical having a Web site can be if they want to be found. In return, I receive updates from at least a dozen Mexican professionals announcing their informational meetings, presentations and activities and their satisfactions and frustrations working with birthing families or birthing organizations.
Then I open my e-mail and there they are: the women living in Puerta Vallarta, Colima, Cancun, Saltillo…The women with whom I can joyfully share contact information for a terrific professional within a two-hour drive. The mail from women who haven’t yet discovered the provider just minutes from their homes! What gladness when I can direct a woman to my coterie of colleagues throughout the republic who can provide exactly what they are looking for. What began as my small group of “go to” people in Guadalajara, Mexico City, Monterrey and San Miguel de Allende has grown over the years to include fantastic alternatives in Chiapas, Oaxaca, Queretero, Tulum and Culiacan. This year saw the addition of alternatives in Tijuana, Morelia, San Luis Potosi, Puebla and Baja California.
Each new name on the list of caring providers has been hard won. Each reflects travel to conferences, time talking and asking questions, many late nights online, hours spent reading birth forums in two languages and a Rottweiler-like insistence on following up by writing to the women who contact me to find who attended their births and if they were satisfied with the outcome. It means making presentations in other cities (this year that meant two in Mexico City) and meeting more professionals to discover who else loves and cherishes new families and respects them. And then there are the women living in Hermosillo, Chihuahua, Ciudad Lazaro Cardenas, Durango, Tampico and Acapulco…the cities where I don’t have any birthing resources yet. And I know the work of the Mexican contact person is truly ongoing.
— Joni Nichols
Update from Papua New Guinea
Papua New Guinea (PNG) now has a midwifery association in place with its executives in Port Moresby. The association was formed in 2009 with help from the World Health Organization office in PNG. PNG has 21 provinces and the provinces still need to have their own branches of the midwifery association.
PNG is still experiencing high maternal mortality. The PNG government’s focus is on providing health services at the community level. Assistance given to address the high maternal mortality rate includes having one unified midwifery program for all universities at the bachelor’s level to train a midwife for every community post in the country. All universities are supported to train midwives.
For 2011 and onwards, PNG needs a new breed of midwives who can best serve our PNG mothers and babies with knowledge that is PNG homegrown and owned, without too much interference from outsiders. We need help but not suppression. We want to work with other midwives who can help and be there for us when we need to think through the strategies we have developed. We want to try what we have developed in PNG and we need to be given the chance to do just that. Every family must have a mother, every parent must have a child, every community must have productive members.
— Lillian Siwi
Midwifery in India
I am a British midwife trained in El Paso, Texas. After training I worked as a midwife in the Philippines and then lived in Hong Kong, I have been living in India for almost four years now and am one of the founders and the director of Justlink Health Services India Pvt. Ltd.
Although there is a new trend for natural birth in India, there is no support for it in the hospitals as they are not set up with any facilities to accommodate water birth or alternative methods. There is also often a shortage in water. It is my dream to train midwives to be confident in supporting women to birth in their choice of venue, either at home, at birthing centers or in hospitals.
There is a continual increase in cesarean births and I have also seen an increase in interventive births. There is a huge demand on the medical doctors in hospitals as there is no midwife-based care for low-risk women. This means that doctors are overworked and births often end up being augmented; many are assisted with either vacuum or forceps or end up being operative. I would like to work alongside the government so that women from all socio-economic groups can avail of good support through doulas and midwives to achieve the births of their choice. The government hospitals are extremely busy, lonely and traumatic places for women to birth alone. I would like to train doulas and implement a system that provides work for women and support for the birthing women.
There is one established birth centre in Goa and I hope that many more can be set up in different cities and areas of India. Most importantly, I want to work alongside the local communities to achieve these goals so that Indian midwives and doulas grow in their confidence in natural birth and can support birthing women and their families in the settings of their choice.
The most experienced MD and midwife in Hungary, Dr. Ágnes Geréb, was arrested in October. Before Christmas she was released and put under house arrest. She and a few other midwives who work with her have several legal actions pending against them. Demonstrations and a huge number of articles in the press maybe helped to raise awareness about the current level of care in hospital obstetrics being unacceptable.
Meanwhile, the European Court made a decisive ruling on the request of a Hungarian mother who felt that the state did not support her human rights, including the right for homebirth. The Royal College of Midwives criticized Hungary and suggested an EU level guideline on midwifery, a very good idea that we support. A local politician, a representative named Ilona Ékes involved actively in motherbaby-friendly activism, helped to organize a conference on IMBCI in December 2010. Only a few OBs took part.
Right-populist local government created pressure to start a new consultation process, involving a lot fewer civil activists and almost excluding (!) independent midwives, when designing regulations for out-of-hospital births. Legislation will come out in April 2011, restricting a high number of mothers from choosing this option, but at least permitting midwifery. We haven’t seen the final version, but most probably it will exclude VBAC, twins, breech, babies heavier than 4 kg and moms younger than 18 and older than 35. Out-of-hospital birth won’t be covered by national health insurance! Midwives will need two years practice to work independently. It’s a question of whether previously illegal homebirth practices will be acknowledged or not.
— Nóra Schimcsig, mom, activist, doula, HBCE
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Saudi Arabia Birthing Culture
Birth in Saudi Arabia has as many similarities as it has differences to birth in the United States. One similarity is that the medical model has arrived in the big cities and is here to stay. With it has come a significant increase in cesarean sections, 80% over a 10 year span (Saudi Cesarean Epidemic: http://saudibirthstory.blogspot.com/2010/11/saudi-cesarean-sections.html). In Saudi culture “natural” birth simply means “vaginal,” rather than “non-medicated.”
Unlike the United States, a single room for labor, delivery, and recovery is unheard of. Mothers are wheeled back to operating theaters, even for natural births, and fathers (or other support persons) are often times not permitted to enter. Fathers are considered little more than seed-planters in the childbearing process. They are not expected to attend and some doctors act as if the request for such a thing is absurd! A rare few are open to it. Early bonding with mom is not facilitated as babies are quickly whisked away to hospital nurseries. Early bonding with dad isn’t even a consideration as it is customary for the new mother and baby to spend her first 40 postpartum days in the home of her mother, away from her husband.
Unfortunately, childbirth education is also virtually unknown and women enter their labor and birth with little option other than to hand their bodies over to the obstetrician like a car to a mechanic. Since my recent arrival in Saudi Arabia I have been able to locate and link up with other doulas. At present, we are a scattered few and all from foreign lands. The Western expatriate community is keen on our birthing values but the locals are in the dark. There is also a language barrier that must be overcome if we hope to reach Saudi nationals. As doulas and advocates for natural birth we are working hard to unite and dream of a changed birthing culture where childbirth education, involved fathers, doula services and natural birth are the norm.
Hopes and Goals from Belize
I am licensed here and have attended some great workshops, sponsored by the Nurses Council of Belize. One of the best, for me, was titled “Evidenced Based Care.” I learned that Belize has implemented a country-wide policy promoting breastfeeding. On one hand, I was elated to learn this since breastfeeding is cost effective and has many benefits for mother and child. On the other hand, I was disappointed to find that other “Evidence Based Care,” as it relates to childbirth, has not yet been widely implemented. Instead, it seems to me that the medical model of care from the United States has been making inroads into Belize.
There has been little or no comprehensive childbirth education in Belize. If consumers, maternity patients, are not educated, they cannot be expected to ask for and receive any obstetrical care that is different from the current standard of care. If obstetrical caregivers are not educated concerning alternate birthing techniques then new techniques and procedures are not likely to be adopted. I have attempted on a limited local basis to provide some childbirth education and training in natural birthing techniques to local patients and to medical staff, but I have had limited success. I think I would require a great deal more help and involvement from the government of Belize and, more importantly, from hospital administration and staff in order to have any hope of migrating current standards of obstetrical practice toward the goal of “Evidence Based Care.” Still, I stand ready to provide such education and training, if asked to do so.
This last year I organized a refresher training program for remote traditional midwives and I also help bring in medical supplies through clubs, organizations and contacts back in America. I am constantly printing off educational material on reducing episiotomy rates, use of optional birth positions, postpartum care and childbirth classes. (These classes take place here in Corozal, my home town, but no where else as yet.) I deliver these materials to physicians, nurses and midwives in an attempt to educate them and to provide support for proposed changes.
One achievement has been a national health policy change that now allows a family member to be present during labor and delivery. While I had been advocating this for three years (among other things) a baby died because no one was there to run for a nurse/midwife’s assistance in a hospital here in Belize. An investigation led to the policy change.
Let there be no misunderstanding concerning my regard for Belize physicians and midwives. When medical problems arise, it is wonderful to have their skills available. It simply is my belief that much of the time, medical intervention in the birthing process is not required. Indeed, statistics indicate that unnecessary medical intervention is not only costly, but it often results in poorer birth outcomes. If Belizean women can only gain an understanding of the normal birthing process and how to assist it, I am sure that, barring complications, they have the strength and capacity to birth naturally.
Belize is a young country. It has come a long way in just a few years. I expect obstetrical care will evolve in the coming years and look forward to observing changes and improvements. As in most countries, we have a shortage of nurses. I volunteer to help, as needed. Yet, my offers of help are often declined. That is one of my frustrations here in Belize. There is a lot to do. I am also trying to motivate retired midwives to come and live in Belize and help me. You must have an independent income to do this.
For more information about our country contacts, please visit Midwifery Today’s International Alliance of Midwives at: http://www.midwiferytoday.com/iam/ Click on a flag on the right side to find out more about that country and our country contacts.
Web Site Update
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Question of the Week
Q: What role does creative expression play in the births you attend?
— E-News editorial staff
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.
Question of the Week Responses
Q: Have you done midwifery internationally? If so, in what country or countries have you worked? What did you learn?
— Jan Tritten
A: I had the good fortune to attend a family in China who were there as missionaries back in 1996, and in Guatemala in 1999 I attended another missionary family. So fun and so much to learn each time. These experiences are some of the highlights of my midwife career!
— Janessa Craig
A: I’m Italian and I’ve worked in Finland, Indonesia and Ireland. They have all been completely different experiences to me. In Finland I learned how midwives should behave gently and respectfully to each other. In Indonesia I learned how even the most lost and desperate tsunami survivor woman can have a healthy and powerful birth. In Ireland I learned that homebirth midwives are brave and that western women are forgetting their power. I’m trying to bring to Italy all I have learned. A few amazing women keep my midwife light alive!
— Lisa Forasacco
A: I worked as a midwife in both Iran and Afghanistan. I learned you can provide good quality services in very low-resource settings. There is no need to always have modern technology. The second lesson I learned was that if I wanted to have a voice at a policy level I should be involved in policy development, otherwise someone else who never knows my needs as a midwife will decide for me.
— Sabera Turkmani
A: I am from Peru and did my training as a midwife there. I worked in a hospital where doctors tried their best to promote natural childbirth. Their c-section rate was 15% and no epidurals at all. There’s lots of homebirths in the rural areas, some of them with lay midwives and even unattended births. Women there just don’t want to go to hospitals. I also worked at the only birthing center in Lima. That was great because it made me realize more and more that people from the city were deciding on having births either at the birthing center or at home. Great experiences! Now I’m trying to get my license as a CM in New York so I can start doing homebirths.
— Tania Zirulnik
Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
Regardless of the locations where midwives practice, for traditional midwifery attitudes and practices to endure within our rapid-paced technological society, midwives need to be viewed as leaders in our communities—visible, respected, dynamically active members of the communities in which we live and practice. We are not required to be civic leaders, but to live our beliefs through socio-cultural leadership, effectively teaching and modeling respectful attitudes and behavior.
Thank you for the information about using parsley tea to stamp out UTIs. [In E-News issue 13:1: http://www.midwiferytoday.com/enews/enews1301.asp#art] Please consider adding a note that this is not recommended for mothers who are breastfeeding because it inhibits milk production. Other herbs which can dry up milk include mints, sage and oregano.
— Norma Ritter, IBCLC, RLC
Dear E-News readers:
I want to involve you in important project I and Birthing The Future are doing: “The Time is Now.”
Phase 1: I’ve committed to find the “right” 25 people from around the world with as much diversity and richness of experience as possible, to meet together April 6–12 on the island of Tenerife (in the Canary Islands) and do some serious thinking and planning that will have positive impact on the state of birth, midwifery, breastfeeding, and preventing and healing birth-related trauma.
In Phase 2 I’ll bring together the next “right” group to turn these ideas—and the filmed footage from the first event—into a series of media and social networking campaigns that can spread around the world.
In Phase 3 we’ll launch with press conferences and regional conferences and give the campaigns away to any and all persons and groups trying to do good in the world—whether for women’s rights or the environment or peace—as well as all those in birthing issues.
I’ve selected 22 of the people and they’ve each given an enthusiastic YES. All but six people are committed to pay their transportation, and room and board. Six must have a full scholarship—$1,800–2000 for their plane ticket—(because they come from such distances) plus room and board. They come from Sri Lanka and Hong Kong, Bali, Africa, and Uruguay, and…the final scholarship is for me. I receive no salary from Birthing The Future, the nonprofit I founded in 2003 and direct, nor for this project.
So, dear ones, here’s the challenge: contribute whatever you can (be it $15 or $20 or more) Today. It’s fully tax-deductible, because Birthing The Future is a 501c3 nonprofit. Just click on the link here and Paypal will take your donation. Please share this message with others!
With love, blessings and appreciation,— Suzanne Arms
Visit http://birthingthefuture.org/ for more information, or e-mail me at firstname.lastname@example.org if you want the full description of The Time is Now and the people coming.
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