|November 23, 2011|
Volume 13, Issue 24
|Midwifery Today E-News|
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In This Week’s Issue
Quote of the Week
The first cry of a newborn baby in Chicago or Zamboanga, in Amsterdam or Rangoon, has the same pitch and key, each saying, “I am! I have come through! I belong!”
— Carl Sandburg
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The Art of Midwifery
After the birth, your client may complain of an intense burning feeling of the vulva area. Frozen pads are often applied. In Chinese medicine, the rule is “never put cold on a new mother or baby.” It may seem counterintuitive, but the best remedy is to put very hot cloth compresses on the area. The woman will get instant relief.
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 email@example.com.
Send submissions, inquiries, and responses to newsletter items to: firstname.lastname@example.org.
Letter from Erika Obert
[Editor’s note: This week’s entry features a letter written by Erika Obert, and refers to one of Midwifery Today’s Birth Essentials movie found here: midwiferytoday.com/tricks/]
I feel compelled to share with you something that happened at a recent birth. After reading one of your Facebook questions some months ago, I watched several of your Tricks of the Trade videos on shoulder dystocia. One in particular stuck in my mind, “Shoulder Dystocia III,” in which you said the following: “And with a shoulder dystocia, remember, you never, never, never, never, give up. Have in your mind each of those things you’re going to do. There may be 10 or 15 right in a row. And don’t give up, start again.” I thought, “That’s really profound,” and tucked it away in the back of my brain.
Last Wednesday, I attended the birth of a first-time mom. Average sized baby on palpation, average sized mom, no pelvic constrictions. She labored on and off for a few days prior to progressive labor and seemed to have an inordinate amount of back pain for an anterior baby. She progressed well, got to nine with a lip and a slight pushing urge, but never experienced that undeniable urge to push. She was in the pool and nearly went under after she fell asleep in between contractions, so I suggested she move to the bed and push side-lying. We did this for about half an hour, 15 minutes on each side, and she began to bring the baby down. She then decided to squat next to the bed where she brought the baby’s head out. He presented LOA (Left Occiput Anterior).
Then nothing—baby was turning dark purple and mom showed no progress. She had a contraction and pushed to no avail. I had her assume the hands and knees (Gaskin) position and she had another contraction. Then I tried gentle traction, loosened a tight nuchal cord and still saw no progress. Two minutes later I asked her to lay flat on her back to employ the McRobert’s maneuver. She had another contraction and no progress. Three minutes passed and baby was an awful color. I have never seen such a dark purple head in my life. At this point it occurred to me to completely panic and call 911. Instead, I heard your wonderfully calm voice in my head saying “never, never, never, never give up.”
I was able to reach in and sweep the anterior shoulder to the right towards the baby’s chest while applying suprapubic pressure. This allowed me to free the anterior arm, and baby shot right out. The time from head to delivery was four minutes total…four eternally long, heart-stopping and unforgettable minutes. It took some time to call him into his body and overcome primary apnea, but he did not need to be resuscitated. His 1-minute Apgar was 5 and his 5-minute Apgar was 9.
Mom was awesome, following every direction and never failing to push when asked. I caused a first degree tear at the 6 o’clock position by pushing the baby downward, but it is healing well without sutures. Baby had some significant facial bruising that resolved in two days. He was only 7 lb 7oz—so much for the big baby/shoulder dystocia argument.
I want to tell you that your work made a difference for a mom, a baby and a midwife. “Thank you” just seems inadequate, but nonetheless, thank you. I am grateful for you and your selfless sharing of information.
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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News and Research
Midwives based in remote mountainous areas of Afghanistan have recently spoken out about the improving conditions of childbirth there, as well as the difficulties they have faced in educating impoverished families about the role of proper nutrition during pregnancy. Afghanistan has the highest maternal mortality rate in the world, and in 2007, “there wasn’t a single skilled midwife in a province of 800,000 people.” With the help of a growing team of midwives, hundreds of individuals have been trained in basic health care and more than 90,000 mothers and fathers now benefit from health classes.
— Pickworth, Sarah. “Newly trained midwives are saving lives in Afghanistan.” The Guardian. October 14, 2011. http://www.guardian.co.uk/global-development/poverty-matters/2011/oct/14/midwives-saving-lives-afghanistan
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The midwife’s watch is part of her birthkit—in Western culture, at least. She uses it for measuring a pulse and for recording the milestones of her job, including times of intervention and times of arrival. But the skilled midwife will sense the time to act, to help the birthing woman, without her watch. And yet, she has to keep records.
We live in a culture of time that is a product of the modern world. The culture of time in rural Africa, in the Arabian desert, in pre-modern communities around the world where there are no digital watches, only the sun and the moon, is of course very different.
“To everything there is a season, and a time to every purpose under heaven: a time to be born, and a time to die,” said Ecclesiastes (3:1–2) in one of the best-known phrases of the Bible. The idea that birth is a predestined, flowing process, with its own sequence of events, its own rhythm which follows a linear progression, seems very obvious to us. Today we can speed it up with drugs or prevent it (by removing the baby before the natural process begins). There is still a debate on how long a woman can safely go past her “due” date, when placental insufficiency is feared. Ideally, the “how long” should be assessed in biological time—the flow of the birth process—not in chronological time. However, if we don’t interfere, birth will happen in its own time, as in antiquity.
The natural season for the time to be born is nine moons after conception. In Jewish tradition, God holds the key to the womb and decides when it is time for the baby to make its way out. Birth begins, said Abaye, a Jew who lived in Babylonia, c. 300 C.E., when the travailing woman sits on the birth stool, i.e., when she feels she is ready to push the baby out.
Rabbi Huna, another Babylonian a generation older than Abaye, said that birth begins when the blood slowly flows down from the mother’s womb. Other rabbis stated that birth begins when her friends support her by her arms, i.e., when she can no longer walk around on her own. This rabbinic discussion took place in late antiquity in a discussion of the laws of the day of rest, the Shabbat. As a Jew is permitted to work for a birthing woman (e.g., to light fire to warm a room), the rabbis discussed at what time a woman begins birthing. They were also interested in how long a woman could remain [in the status of] a birthing woman—when work is allowed on her behalf on the Sabbath. One rabbi said three days, another said seven days and others said 30 days.
The Jewish culture of time with regard to birthing dictates not only the time for work, but also the time for separating the birthing woman from physical contact with her husband, time for prayer, time for blessings and time for purification. Time is measured not in seconds or minutes, but in days and months, derived from the movement of the earth around the sun as well as the appearance of the moon and the stars. Time is not an entity in itself. It is circular and rhythmic, as well as longitudinal and arrow-like.
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Question of the Week Responses
Q: Do you have a cultural practice that you have found helpful in birth?
— Jan Tritten
A: In some districts of West Bengal, India, the midwives sing a special song for a painless delivery. The words and tune of this song seem to help the expectant mother push and deliver very easily. This kind of traditional song prevailed in our region from an unknown time. This is the treasure of midwifery.
— Soma Mukhopadhyay
A: In the indigenous Mam region of western Guatemala, midwives enter the temascal (traditional Mayan sweat bath) with the postpartum mom every day for a week after the birth. It is said to aid in overall postpartum healing, especially in regards to the shrinking of the uterus. The placenta is placed on the fire inside the temascal and as it burns, it shrinks, aiding the uterus to shrink back to size.
— Sarah Kraft, citing Voices of Maya Midwives: Oral Histories of Practicing Traditional Midwives from the Mam Region of Guatemala, by Sarah Proechel
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.
Birth Wisdom from the Web
Midwives are very privileged, supporting women as they go through one of the biggest events of their lives, turning from a woman to a new mother.
— Manvir, a newly certified midwife from Wolverhampton, England
You do not make the course that a baby will go, you follow it.
— From Maida Owens’ article “Waiting for Birth: Lay Midwives in Louisiana”
It’s always fun to surprise women with customs from their culture that they don’t expect you to know about. They are pleased with the little things we do, such as when a midwife learns Somali words to use during their visits. Women from varied cultural backgrounds labor and birth differently from one another.
— Rita O’Reilly, midwife advocate, discussing the cultural aspects of giving birth
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to firstname.lastname@example.org.
An Awesome Conference in Bad Wildbad, Germany
Midwives and doulas, as well as a doctor, from over 37 different countries attended the conference in Bad Wildbad, Germany. The learning aspects of the conference were top notch and our teachers, as always, lovingly imparted their knowledge. Below are quotes from a few conference participants:
“I couldn’t have asked for more from the conference. It had inspiring speakers, a beautiful setting, endless learning, and above all, a loving, healing and supportive atmosphere that I was greatly in need of!”
“This conference is the best place to be for anyone who is [studying] or wants to study midwifery or who is considering midwifery as a career path. If you’ve started pursuing your career, or are already working as a midwife, this is really a place to be.”
“This was a great place to gather inspiration and empowerment to carry on your journey. I loved the welcoming and loving atmosphere, and all the speakers at my sessions were great. The conference gave me a lot of inspiration and hope, and it also opened my eyes about the art of midwifery.” ~ Comfort, a midwife from Nigeria and studying in Bulgaria
“I sincerely appreciate all your great efforts in organizing such an enriching, inspiring, empowering and educating conference. I enjoyed all the sessions and speakers and I am grateful to them for helping me remember who I am and what I must be doing in my pursuit of excellence in the field of midwifery.”
“I learned that if you want to change a system you need to start to change yourself. Change is possible! I’m very, very thankful.”
“The presenters did not speak above the participants—they spoke and shared with them. Each participant was encouraged to share [her] knowledge and story.”
“I haven’t cried or laughed so much in years. Thank you for the enchanted atmosphere!”
“The whole experience of being in a love soup of open-minded, passionate birth workers, set in a wonderful, perfect location.”
“I loved every minute of it.”
I hope you will consider joining us in Harrisburg, Pennsylvania in 2012, from April 11–15.
— Jan Tritten
Think about It
In the Andean tradition, as with most cultural traditions, birth represents a rite of passage that has great importance to women, where their autonomy—especially their knowledge and control over their bodies—should be reinforced and celebrated.
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