October 24, 2012
Volume 14, Issue 22
Midwifery Today E-News
“First Stage Labor”
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In This Week’s Issue

Quote of the Week

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure.

Marianne Williamson

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The Art of Midwifery

The first thing I do for a woman with obstructed labour is to ask her to go for a short walk. If there is a stairway in the house, I ask her to walk to the top and down again. I explain to her that the changes in posture, particularly in the movement of the lumbar spine, frequently enable baby to alter the position of its head. The head then enters the pelvis, causing descent and moulding to start. Moulding is a valuable clue in these cases; the head propped on the brim does not mould, but as soon as progress commences, the moulding saggital suture becomes easy to feel. This simple trick works so often that is crazy not to try it.

John Stevenson, MD, excerpted from “Managing First Stage Problems,” Wisdom of the Midwives, Tricks of the Trade, Vol. II, a Midwifery Today book
View table of contents / Order the book

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.

Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

Jan’s Corner

Cytotec and Cell Memory

I was talking recently with a dear friend and experienced midwife, and she told me something she had noticed about Cytotec—something I hadn’t previously known, though my fight against it has been strong. My friend and several other midwives have noticed that if a woman has been given Cytotec during birth, her next birth can be greatly affected with increased laboring time, as well as other issues.

Later that same morning, I was talking with Eneyda Spradlin-Ramos (another midwife and friend). Eneyda is also a massage therapist and she told me cells have memory. She explained it so well that I asked her to write it for us. Here is her explanation:

The Golgi tendon organs and muscle spindle cells are both sensory neurons called “proprioceptors.” These sensory neurons are located in nerves and tracts, but their cell bodies are found just outside of the spinal cord. They move messages from sensory organs in the tendons and muscles to the spinal cord. Some of these neuron fibers are called “proprioceptive fibers.” These fibers monitor the way that a muscle contracts and stretches, as well as measure the tension that is in a tendon and transmit that information to the spinal cord in order for the information to be processed. This feedback allows the body to know positions and postures of the limbs even when they cannot be seen.

This is one of the reasons that learning appropriate technique is always stressed with many activities that involve the body’s muscles, such as playing an instrument. You want your muscle memory to reflect the correct way to do things, not the incorrect way. Your muscle memory can actually play against you if you’ve constantly been practicing something the wrong way. Likewise, the muscles of the uterus can send the wrong message to the brain and, therefore, not be able to kick into labor during the subsequent pregnancy if Cytotec has been used.

— Eneyda Spradlin-Ramos

My hope is that all midwifery is protected and that motherbaby is protected, too. I think we midwives are that best option for motherbaby care, but if we get off course, we jeopardize our beloved midwifery and each other. We cannot do birth as medicine does. Cytotec is so pervasive—unbelievably so—but we are held to a higher standard. Please do not use Cytotec. The lives and subsequent births are in your hands and care.

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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Featured Article

The Amniotomy Question: Examining the Pros and Cons of Rupturing Membranes

Abstract: The culture of birth establishes practices and embraces rituals. Currently there is a movement toward midwifery and away from hospital births as women and professions question the value of some practices and interventions common in hospital births. Amniotomy is a well-established practice that is accepted as an intervention to help women in their birth process, with the hope that it will shorten labor. There is little research regarding the psychological implication of amniotomy on the infant. This paper explores the pros and cons of amniotomy, its role as a ritual for birth attendants and the possible psychological effects on the infant.

Artificial rupturing of the amniotic membranes (AROM), or amni-otomy, is a common and even routine practice in the North American culture of birth. Amniotomy is accepted as a useful means to get labor going again if it has become stuck (1). Throughout gestation, the amniotic fluid is an integral component of the baby’s environment. The baby learns to move in this fluid, breathes it into his lungs and swallows it in preparation for sustaining life outside of the womb. At the time of birth, amniotic fluid functions as a cushion for the baby during contractions and passage down the birth canal (2). The decision to rupture the membranes or to wait for spontaneous rupture is an important part of the birth plan. But with amniotomy having become such a common practice, and so accepted within the realm of natural childbirth, this decision is often overlooked.

When the doctor or midwife makes the decision to rupture the amniotic membranes, it is done by inserting an amnio hook into the birth canal to snag and break the membrane. In deciding to break the amniotic membrane, the hope is that the baby’s head will push against the cervix, helping to open the cervix and shorten labor. Some studies (3–6) have found that amniotomy to shorten labor is not helpful because it shortens it by only one or two hours. One study (7) found that amniotomy increased the pain of labor and interfered with the onset of maternal affection immediately after birth because many women felt that their body’s process had been disturbed (8). In some women however, especially multiparas, amniotomy during the second stage of labor is reported to alleviate pain (9).


  1. Goer, H. 1999. The Thinking Woman’s Guide to a Better Birth. New York: The Berkeley Publishing Group.
  2. Simkin, P. 2001. The Birth Partner, 2nd ed. Boston: The Harvard Common Press.
  3. Davis-Floyd, R, and CF Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-cultural Perspectives. 3rd ed. Berkeley and San Francisco: University of California Press.
  4. Enkin, M, et al. 2000. A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. New York: Oxford Press.
  5. May, KA, and LP Mahlmeister, eds. 1994. Maternal & Neonatal Nursing, 3rd ed. Pennsylvania: JB Lippincott Company.
  6. Wagner, M. 2006. Born in the USA. Berkley, CA: University of California Press.
  7. Robson, KM, and R Kumar. 1980. Delayed Onset of Maternal Affection. Br J Psychiatry 136: 347–53.
  8. Mayes, M. 1996. Mayes Midwifery, 12th ed. Oxford: Baillière Tindall.
  9. Brenda. 2001. Artificial rupture of membranes: breaking the waters. Message posted to UK Midwifery Archives at http://www.radmid.demon.co.uk/arm.htm. Accessed 2 Jun 2010.

Verna Oberg
Excerpted from “The Amniotomy Question: Examining the Pros and Cons of Rupturing Membranes,” Midwifery Today, Issue 95
View table of contents / Order the back issue

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Website Update

Read this article excerpt from the Autumn 2012 issue of Midwifery Today magazine now available on our website:

  • LifeWraps: Low-tech First Aid for Obstetric Hemorrhage by Caroline Rodgers
    Excerpt: [Midwife Suellen] Miller, based in the United States (with frequent trips abroad), founded and heads up the Safe Motherhood Program at the Bixby Center for Global Reproductive Health, located at the University of California, San Francisco. Her promising innovation is expanding the use of a type of “non-inflatable anti-shock garment” (NASG) from use in tertiary care facilities to the community level, where it is used specifically to stabilize and transport hemorrhaging women, often over long distances, to health care facilities. The suit has been found to be effective for up to 48 hours and can mean the difference between life and death for women who might otherwise bleed to death in as little as two hours.

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Birth Q&A

Q: Looking back, what helped you most get through first stage labor?

— Midwifery Today

A: Surrender. Letting the contractions come, do their work and go without fighting them. Being separate from the labour and letting it run its course through my body.

— Serafine Nichols

A: Being at home with no pressure to perform! It was just my husband and I—we kept our midwife in the loop via phone. We readied the house, ate and watched a funny movie together. Only my sister and midwives knew I was in labour, and it was a great feeling to be able to hide in our cave while my body readied itself to birth our baby girl. She was born into the water at the birth centre 24 hours after I felt the first twinges of labour.

— Sophie Merchant

A: Privacy in my own bathroom, a nice big tub full of water and a really, really good book I had saved just for labor!

— Gail Hart

A: What can help women most is actually making sure she is actually in her first stage of labor! Lots of contractions do not necessarily mean you’re in labor! If it isn’t changing your cervix in a reasonable amount of time, you need to go home or the midwife needs to leave. Wishful thinking with herbal use or stripping membranes will only cause trouble.

— Carol Gautschi

A: Sitting on a toilet will help speed up labor. I keep my mommas on as long as possible. It works like a charm!

— Heidi Basford Kerkhof

Conference Chatter

Upcoming Conference Plans


Russia 2010 Conference Group in Moscow Bakery

It is settled—we are sending off our contract to Harrisburg, Pennsylvania, this week and will be going there for the 2014 USA conference. This is a venue we enjoyed very much. We haven’t settled on a theme for the conference yet, so if you have any ideas you might like to share with us, e-mail me at jan@midwiferytoday.com. We are facing so many issues in birth practice these days. I would like our theme to reflect that, but also to give hope because there is a lot to be hopeful for.

For our European 2013 conference we are going to Belgium. It is in a beautiful venue on the seacoast with fantastic meals at a reasonable cost, with room and meals included in the price. The dates are October 30 – November 3, 2013, so please save the date. Moscow is another possibility for 2013.

Eneyda Spradlin-Ramos (midwife friend) and I are going to check venues in England and Cyprus this month, so we will see where the future takes us! There are other places on the conference radar—I will keep you informed as we explore locations, themes and speakers.

— Jan Tritten


I went to the midwife for my weekly check at 37 weeks and my baby crowned—no labor!

— Donna, an E-News subscriber

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