|March 2, 2011|
Volume 13, Issue 5
|Midwifery Today E-News|
“Creativity and Birth”
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…at the full-day class with Carol Gautschi, Ina May Gaskin and Mary Cooper. You’ll learn the factors that may lead to breech presentation, the mechanism of normal breech birth, the mechanism of a stuck breech and techniques for handling both. Also discover strategies for the safe birth of twins, including positioning and time of delivery. VBAC pregnancy, labor, birth and healing will also be discussed. Part of our conference in Eugene, Oregon, March 30 – April 3, 2011. http://www.midwiferytoday.com/conferences/Eugene2011/
Attend “Comfort Techniques for Midwives and Doulas,” a full-day pre-conference class with Debra Pascali-Bonaro. You’ll learn about techniques such as the gate control theory of pain, hot and cold compresses, music, massage/touch, acupressure, aromatherapy and the birthing ball. You’ll see demonstrations of a variety of positions and techniques for both first and second stage, and there will be time for hands-on practice. Part of our conference in Bad Wildbad, Germany, this October.
Learn more about the Germany conference.
In This Week’s Issue:
Quote of the Week
Authority without wisdom is like a heavy ax without an edge: fitter to bruise than polish.
— Anne Bradstreet
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The Art of Midwifery
Passion for the subject, and passion for sharing what we know—most educators agree that these qualities keep our teaching fresh and vital. In my growth as a teacher, I have acquired yet another sense of the importance of passion, and it is this: It is paramount to acknowledge my students’ passion as a key to their success.
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“Traditional Midwife,” Not “TBA”
The World Health Organization (WHO) a number of years ago designated the term “traditional birth attendant” as the preferred term for traditional midwives. In doing so, WHO stripped midwives in many areas of the world, most rural and poor, of their title—”midwife.” We at Midwifery Today have always railed against the title “TBA.” There are differing opinions about this, and other terms, given to midwives. Several listservs I’m on have had some great discussion about this subject. What follows are excerpts from a conversation between midwives on a subject that should be of interest to us all.
Jan: The title of “TBA” still really bothers me. Could we continue this discussion? Here is a link from the Midwifery Today site regarding traditional midwives: http://www.midwiferytoday.com/iam/. Included are goals and beliefs, a definition of “midwife” and a piece on autonomy in the profession. I think it is really important. Many people worked on it. I know we may need to make a differentiation when we are talking but let’s call them midwives. Please let us not strip the title of our foremothers, many who still do the births in their communities.
Carol Gautschi: I was considered a local “healer” in my “village” (community) as a community-created, lay midwife for 25 years. Many families, mostly women, came to me for various reasons—when their grandmother was dying, when their children got hurt or sick, for spiritual counsel, if their husband got kicked in the head by a horse, if their daughter had a seizure, even when their animals were sick or cut.
They referred to me as a midwife, wise woman and healer. Legally I was referred to as a “birth attendant.” Sadly, now that I am a licensed midwife (for nine and a half years), they do not come as often as they once did. They know I am bound by the laws of the land and that I cannot as easily help them with their difficulties. I was always careful not to diagnose but would share how, if this were my child, etc., I would treat them. That kept me under the radar. (What are you to do when people are in need and you may have an answer for them?) I would not always show them how to treat themselves or help them, but gave encouragement and referrals.
Titles, for me, were not important. If someone referred to me respectfully, it made my heart glad and I was grateful. The idea of esteeming the women in the global community with a loving acknowledgement and title of their midwifery wisdom would be a gift worthy of the effort made to regard them. What it would say to the global community and to their own hearts could transcend a lot. The best traditional/village midwives I’ve met through the years are often humble and recognize their skills as a gift. Sometimes I think us acknowledging them is more for us; yet, I know they would be blessed and women would be strengthened if we did esteem them. Village midwives hold the value of the word “midwife” more accurately than those of us who are politically restrained because they have greater freedom to do so!
Sister Morningstar: Whatever else they may be, whatever additional adjectives we wish to put in front of the word, they are midwives. And if we are looking at the Western model and definition of midwife as someone who attends to a woman in the birth journey, then they are much more. The village midwives I have had the privilege of working beside, in multiple countries, handle the questions and needs of the whole family’s physical, mental, emotional and spiritual well-being, and all within a context of what will work and make sense to those they serve. Village midwives have a deep and living understanding of the dwelling, work, beliefs, past, diet, resources, fears and dreams of the people they serve. I’ve watched them bandage wounds of body, mind and soul. The village midwife is a healer and attending pregnant women and babies is probably one of the easier things s/he does. Well, it was one of the easier things s/he did. Politics, cultural tides, rejection, even self-doubt have made it the most unnatural of all the natural things s/he does in a day. Do we still need the midwife? Does she deserve our support as well as respect? If a family still needs a grandmother, if a family still needs the wisdom, experience, skill and commitment of a wise elder, then the entire global village still needs her midwife. The chief of our tribe says of those in power....”We don’t need new leaders. We don’t have time to grow new leaders. We need the leaders we have to get it.” We are all getting it. Everyone matters, every voice matters. That’s the pow wow way. We can honor the wisdom of the elders, respond to the vision of the youth and keep rooting out the tribal evil, adding to the tribal wisdom and getting the work done. And birth is the beginning and most important of all the work. Even the cries of joy or sorrow from the fresh born need to be heard and counted. Good will come of all this dialogue. Peace will come of it. It shows we are getting it.
Jan: I really appreciate the ability to continue this important conversation because these midwives are our colleagues and how we treat our colleagues is important. “Colleague” suggests an equal and that is how we must treat one another. When we did the conference in Costa Rica, traditional midwives from all over Central America came. Their knowledge of midwifery was something to behold. The forest around them is their pharmacy. Their techniques are ones that could improve all our practices. Their outcomes are amazing.
One midwife brought the books where she’d recorded every birth she had ever done, nearly two thousand. Never lost a mother and rarely a baby. The traditional midwives brought their fear with them, too. Fear of the authorities in their countries. Fear of going to jail. But not their fear of birth—they had none. These midwives are needed members of their communities, often the only option, and yet they are harassed. When the conference was ending there was not a dry eye in the house. The traditional midwives were all crying because it was the very first time in their lives that they were honored. We were crying for the same reason and because they had so blessed us with their presence. When we reach out in equality to our sister/brother midwives we will learn and be blessed beyond titles.
The title of “TBA” is denigrating. It says, “You are less.” That is why I want to change it. Ideally we would call midwives from each area of the world what they call themselves, but there would be too many different words. How about “midwife”? Often, traditional midwives are blamed for others’ mistakes, perpetuating the idea that they are unskilled. Mostly, they are quite skilled and know what they’re doing. Often they are too far from help. Often help is no help at all. Traditional midwives know a lot but have been disregarded and are being wiped out. It’s a real loss because we have a lot to learn and share with one another.
I could share many, many stories, but the truth is that not one of us is better than anyone else. We all have a role to play in making birth better for mothers and babies and we are blessed to have amazing colleagues around the world. The WHO states that we need 300,000 more midwives. Let’s start by properly recognizing the ones we already have.
— 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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Link between Mouth-rinse and Preterm Birth
A new study reports that the use of non alcohol antibacterial mouth-rinse is linked to a decreased incidence of preterm birth. The study followed pregnant women at 6 to 20 weeks gestation that had periodontal disease and were not receiving additional dental care. Of mothers who used the mouthwash twice a day, 6.1% delivered prematurely, compared with 21.9% of the control group, who did not use the mouthwash.
After adjusting the findings for smoking status and age, the rate of premature birth in those who used the mouthwash was around two-thirds less than those who did not. The study’s authors, who were surprised with the results, noted that hormone surges in pregnancy can cause the gums to swell and that too much inflammation may trigger premature labor. The results of the study emphasize the importance of preventative dental care during pregnancy.
— Society for Maternal-Fetal Medicine. 2011. "Study finds that use of alcohol free antibacterial mouth-rinse is associated with decreased incidence of preterm birth." Accessed February 21, 2010. http://www.smfmnewsroom.org/wp-content/uploads/2011/02/SMFM-51-Use-of-Mouth-rinse-decreases-PTB.pdf
Why Music Matters in Childbirth
Music gives us pleasure. Music inspires creativity. Music also distracts us from pain. And it has the power to help us heal our bodies. So why is music largely absent from a typical childbirth? This is one of the questions I have been trying to answer as a lay musicologist and childbirth educator.
Typically, pregnant women are invited to practice yoga or learn meditative breathing to prepare for childbirth. Consider this: Roughly two million Americans practice yoga and meditation each year while over 100 million have purchased a digital music player such as the iPod. The majority of Americans listen to music every day. Not only does music have near-universal appeal, but it is one of the best and most accessible pain management tools around.
A growing body of scientific research links music with positive outcomes in pregnancy, childbirth and postpartum adjustment. Some of what I’ll share in this article has been studied carefully; other findings are qualitative and based on my experiences with childbirth clients. What you should know is that the history of music therapy dates back to 550 BC when Pythagoras suggested the confluence of music and medicine to Greek doctors. His premise was that music’s harmony and resonance could help the human body achieve a similar level of accord.
The field of music therapy emerged much later—in the 1940s—to help veterans cope with post-traumatic stress disorder. Music helped distract veterans from painful memories and opened new avenues for creativity and joy. While little apparent overlap may exist between a glowing pregnant women and a weary veteran, both share a propensity for anxiety. Recent studies demonstrate how music can act as a salve for pregnant women, especially women in higher risk categories or first-time mothers, who generally experience more stress leading up to and during childbirth.
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Question of the Week Responses
Q: What role does creative expression play in the births you attend?
— E-News editorial staff
A: The childbearing year is an opportunity for a woman to take part in her ultimate creation—the growth and birth of her child. With any creative endeavor there are steps to the process. Conception is when the concept is sparked and a new work of art is conceived. This is the planning stage, a time of organizing and gathering supplies. During incubation the creation grows and develops, the vessel for creation goes further into the dream world (unconsciousness). This allows the process to develop illumination. The project is ready to be brought forth. An “a-ha” is the moment of creation. In the process of birth verification, the project now has a life of its own but continues to need nurturing. The creator comes back into conscious self. The creative process follows these steps for any of the expressive arts. I firmly believe that if women during the childbearing year thought of themselves as artists and focused on going inward, to the depths of their unconscious selves, that the process would be as smooth as possible for them. Taking part in the arts, whether it be singing, drawing, writing, dancing, sewing, knitting, etc., brings women to the inward place.
— Janice Marsh-Prelesnik
A: It’s a funny sort of question, really, as birth is the ultimate “creative expression.” I do find mothers who use song or sound, visualization or dance “bring on” their babies well. We are in Vermont, and there are mountains out the window in a range. Many moms work through a set of contractions up and down over the peaks with rough sounds and sometimes motions like climbing and descent. This is never a directed activity and really fascinating to observe.
— Stevie Balch
A: Express those inner animal noises…involve the younger ones attending, and dance, dance, dance that baby out!
— Mackenzie Christy
A: I often suggest low (rather than high-pitched) sounds as this seems to resonate better with helping the energy to direct downwards. To help with this, I, and perhaps the partner and other birth attendants, chant in a low tone, something like an “oh” sound. This can help the woman find a lower tone. Even if she can’t do it herself, she finds it’s helpful to have that low tone resonating around her. Leboyer has written some great stuff about this, and about chanting during births.
— Nicky Grace
A: I had a mom at a naval base that planned for an unmedicated birth. She sang in her church choir. It was wonderful how she sang songs through early labor, but then the pitch started going high as she moved into more active labor. Working with her breath and moving her into lower tones, I sang and breathed through the entire labor with her. One of the labor and delivery nurses came quietly into the room and said that she wished she could record those sounds, that it was like Gregorian chanting. It was so beautiful, just lovely.
— Diana Mincin
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.
Think about It
As a clinician, I have never ceased to be amazed by the total focus and concentration that occurs when people have become fully engaged in an artistic project. There is absorption and a complete connection with the self that I seldom see in any other context. I never fail to be impressed by the strong evidence of pride and ownership as each individual gathers up his or her piece and heads for home. At that moment the hope and the confidence in a new future are almost tangible.
— Sue McDonald
Dear Midwifery Today,
Over the past four months, since my first child was born, I have gone through a rollercoaster of issues surrounding my daughter’s inability to breastfeed. Throughout this time I had diagnosed her with a posterior tongue tie and had it fixed. After finally getting her to latch, I was hit with severe supply problems. It has been my goal since dealing with these problems to spread the word about posterior tongue tie to as many people as possible, especially the care providers who help women initiate breastfeeding after birth. By having knowledge of this supposedly rare, but definitely underdiagnosed and very misunderstood problem, those who help women at birth can be the first line of defense against this crippling and seemingly invisible barrier to breastfeeding.
The more my story has spread, the more women have spoken up about their breastfeeding issues and identified their babies as having tongue ties, never having known. These are women who may have had their breastfeeding relationship destroyed from the get go because of a tongue tie, as well those who could breastfeed but went through months of pain and agony caused by a bad latch. My personal blog describes how my story has already spread to thousands of people and details my problems with breastfeeding.
I would love it if this issue could get coverage in Midwifery Today so midwives and others who are involved in birth have in-depth information about how to diagnose and treat this problem. There’s information out there, but it’s just not reaching enough people. I want nothing more than to help make sure other mothers and babies do not go have to go through the same thing I did over such a simple problem.
— Cassandra Roy
I just received my latest Midwifery Today E-News bulletin and thoroughly enjoyed reading the international birthing stories.
I have lived in Yemen for almost nine years now and have given birth to three babies here. Traditionally, women give birth in their homes, with the women of their family and extended family in attendance, along with a midwife. I do not know the exact figures, but I do know that the mother/infant mortality rate is fairly high. Now most hospitals have birthing facilities, which I feel is a mixed blessing. The good part is that the care is there for those who need it, though even the best of hospitals here don’t match what we are used to in the West. The bad part is that women here are increasingly coming to rely on hospital births and are turning away from homebirths even when there are no expected problems.
I gave birth to the first two babies I had here (I have eight in all) in a mother-baby hospital in Sana'a, the capital city. (I cannot have homebirths due to a serious bleeding problem.) I found the female doctors to be knowledgeable and efficient but they were not prepared to “think outside the box,” and expected me to act in a certain way. I am always very quiet and inwardly focused in my birthing processes and because of this they didn’t believe I was really in labor and kept wanting to give me ultrasounds!
There seems to be more dependence on technology like ultrasounds. They recommend you have one every month you are pregnant, just to be sure everything is okay. I refused and explained to them why, though they thought I was a little crazy. I had my last baby in Mukalla at a general hospital, with a doctor and a midwife in attendance. They discouraged me from walking around and then would not allow me to sit up to have the baby! In general though, they try to be supportive within the framework that they are familiar with.
I am an herbalist, practicing both American and Arab medicine and one of my great aspirations is to become a midwife. The government here has actually started some midwifery schools, one in Adan and I believe one in Sana'a as well, but none in my area. Most midwives here are women who are known for being able to deliver babies—no training, just experience.
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