January 2, 2013
Volume 15, Issue 1
Midwifery Today E-News
“Shoulder Dystocia”
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Want to know more about shoulder dystocia? You need the Shoulder Dystocia Package!

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When you order this package you’ll receive The Shoulder Dystocia Handbook, the Shoulder Dystocia and Malpresentations Audio CD and Midwifery Today, Issue 103, which has the theme of Shoulder Dystocia. This is a great way to learn more about this important topic and would make a welcome gift for an aspiring or student midwife.
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Attend the full-day Spinning Babies Workshop with Gail Tully!

Gail will discuss how you can spot a long labor before labor begins and turn it around to a shorter labor. You’ll learn about the 3 Principles of Spinning Babies: Balance, Gravity, and Movement in pregnancy and in labor. You’ll compare anterior and posterior fetal position and practice labor progress techniques appropriate to the level of descent. Part of our conference in Eugene, Oregon, April 2013. Plan now to attend!

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In This Week’s Issue

Quote of the Week

Qualities inherent in safe, loving childbearing experiences must be recognized as the global rights of all women.

Leilah McCracken

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The Art of Midwifery

From Central American midwives, Ina May Gaskin learned that with shoulder dystocia, it is best to turn the mother over onto hands and knees. The success of this maneuver (and our love for the messenger) is revealed by the fact that this technique was named after Ina May and is now commonly called the Gaskin Maneuver. It is often the turning over onto hands and knees that frees the baby.

Gail Tully
Excerpted from “FlipFLOP: Four Steps to Remember,” Midwifery Today, Issue 103
View table of contents / Order the back issue

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Jan’s Corner

And Then They Came for Me

I am concerned about midwives who are being persecuted. It also troubles me greatly that so many midwives and midwifery organizations are unsupportive of our sisters facing these horrendous charges. I am saddened by our lack of support for midwives who are going through so much, all because they are trying to support women. Midwifery care is so very good for women. How then can we fall so short in our care for each other? This is where we should be shining stars of love because it could so easily happen to us. Where is our empathy? Where is our authentic midwifery? Authentic midwifery demands more of us than our tiny circle. It demands that we enlarge our circle of care for all aspects of birth, including our sister midwives.

The doctors don’t eat their own, but we will destroy midwifery because of what we do to each other. It is time to stop and take an accounting and make sure we are giving love, care and support to those who are going through extremely difficult circumstances. The time is now for each of us to look at ourselves, think about what we are doing and who we need to offer love and support to and then do it. It may be a kind phone call of support—ask what you can do to help her. Reach out. Think, “What if this was happening to my mother or my daughter?” and act accordingly.

First they came for the Communists,
and I didn’t speak up,
because I wasn’t a Communist.
Then they came for the Jews,
and I didn’t speak up,
because I wasn’t a Jew.
Then they came for the Catholics,
and I didn’t speak up,
because I was a Protestant.
Then they came for me,
and by that time there was no one
left to speak up for me.
— Martin Niemöller

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

Preventing Shoulder Dystocia

Shoulder dystocia will become exceptionally rare the day the art of midwifery is understood in terms of creating appropriate conditions for the “fetus ejection reflex.” This term was coined by Niles Newton in the 1960s when she was studying the environmental factors that can disturb the birth process in mice (Newton, N, D Foshee and M Newton 1966). Twenty years later, with her support, I suggested we save this concept from oblivion (Newton 1987; Odent 1987); I was convinced it could be a key to triggering a radically new understanding of the process of human parturition (Odent 2001).

The basic difference between humans and mice is that we have developed a huge and powerful neocortex which covers more archaic structures. When our neocortex is at rest, we have more physiological similarities with mice.

An authentic fetus ejection reflex is possible among humans. It takes place when a baby is born after a short series of irresistible and powerful contractions, which leave no room for voluntary movements. In such circumstances, it is obvious that the neocortex is at rest and no longer in control of archaic brain structures in charge of vital functions such as giving birth. Civilized women can behave in a way which would usually be unacceptable, for example, they may shout, swear or be rude. They seem to cut themselves off from our world and may even forget what they have been taught or what their plans were. During a fetus ejection reflex, women can find themselves in the most unexpected, bizarre, often mammalian, quadrupedal postures. They seem to be “on another planet.” At the very time of the birth and during the minutes following birth (at the beginning of the interaction with the newborn baby), these mothers seem to be in an ecstatic state.

Interpreting the fetus ejection reflex leads us to understand the reduction of the activity of the new big brain as the solution Nature found to overcome the specifically human handicap during the period surrounding birth. This implies that the involuntary birth process is highly dependent on environmental factors since it needs to be protected against all kinds of neocortical stimulations.

I can describe a situation I am familiar with, which is compatible with the expression of an authentic ejection reflex. It is when there is nobody around the laboring woman apart from one experienced and silent midwife (or doula), perceived as a protective mother figure, sitting in a corner and knitting. The physiological perspective can easily interpret all the components of this simple, but almost unknown, scenario. The midwife remains silent; language is the main stimulant of the neocortex. The midwife is perceived as a protective mother figure; the physiological concept of adrenaline/oxytocin antagonism implies that one of the basic needs of a laboring woman is to feel secure. The midwife is not standing in front of the laboring woman, but behind her; feeling observed is a neocortical stimulation. There is only one midwife; the feeling of being observed is more likely to be present when there are two birth attendants. (Many proverbs, in a great diversity of societies, suggest the dangers related to the presence of two midwives.) The midwife is knitting; it has been demonstrated that repetitive tasks, such as knitting, tend to reduce the levels of adrenaline. Furthermore, an emerging scientific discipline based on the study of the “mirror neuron system” is a reminder that the adrenaline the birth attendant might release is contagious; the main preoccupation of an authentic midwife should therefore be to maintain her own level of adrenaline as low as possible. Modern sophisticated scientific methods can help us to rediscover what is simple and should be commonsense.

Michel Odent
Excerpted from “Preventing Shoulder Dystocia,” Midwifery Today, Issue 103
View table of contents / Order the back issue

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Midwifery Today Magazine Issue 103

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Belly Mapping Workbook cover

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Learn and review basic midwifery skills

If you’re studying to become a midwife, you need General Skills for the Student Midwife. This 2-DVD set is packed with demonstrations by experienced midwives and nurses and gives you the opportunity see hands-on skills being performed. Topics covered include Sterile Technique, Basic Treatment of Shock, Maternal Temperature Assessment, Maternal Skin Assessment, Newborn Temperature Assessment and much more!
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General Skills for the Student Midwife

Website Update

Read this editorial by Jan Tritten from the newest issue of Midwifery Today, Winter 2012:

  • Babies Have Rights, Too
    Excerpt: The “Birth Is a Human Right” initiative needs to be expanded to include babies. Everyone who has been to a hospital birth (and some homebirths) has probably seen violations of baby’s rights. A baby’s imprinting in the first 1–6 hours after birth is the foundational experience of life and has lifelong health ramifications, both emotional and physical. Does the baby receive the bacteriological inoculation from her mom or from a germ-filthy hospital? Did the baby get her stem cells from the placenta at three minutes of age or was her cord amputated before this was able to occur?

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Birth Q&A

Q: Tell us about a shoulder dystocia experience you encountered.

— Midwifery Today

A: I had an OB who didn’t know she could help by having me change positions. Instead she attempted to pry the baby out of me. My midwife jumped in and helped by pushing my leg up to get me into a better position.

— Andrea Davis

A: My son was a homebirthed dystocia. From the birth of his top half until his shoulder was dislodged and his body was free, was 11 minutes. I am 5 ft 1 in tall and 130 lb. My baby was 11 lb 2 oz and nearly 23 in long. When he was finally born, I was standing up with my arms around my husband’s neck.

— Ashley Bodner

A: Had a 10 lb 14 oz waterbirth with three-and-a-half-minute shoulder dystocia. As soon as I flipped onto hands and knees (this was easier to do in the water), she delivered!

— Shannon Crites

A: Thank God for the Gaskin maneuver!

— Tammi Moran

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Conference Chatter

A Birth Revolution

In order to outline and try to solve the problem of the persecution of midwives, we are having a one-day seminar as a prelude to the Eugene conference, “The Persecution of Midwives as a Human Rights Issue.” It will be led by Hermine Hayes-Klein, who put on the “Human Rights in Birth” conference in The Hague in 2012. We will have courses within this day that are of importance to all of us who care about birth.

One of the classes for the one-day seminar is “Persecuted Professionals and Concerned Consumers.” Representatives of the global Human Rights in Childbirth movement will talk about the role and responsibility of birthing women in the defense of birth professionals. Do consumers understand that the persecution of midwives is a violation of their own basic rights? If not, we will discuss how awareness can be raised. Another of the classes we are including is, “The Effect of Persecution on the Midwifery Community.”

The other part of this day will be led by our friend, midwife and filmmaker Diana Paul. She will be showing How to Start a Revolution by Ruaridh Arrow, which is an inspiring documentary about one man’s ability to change dictatorships into democracies. From this film we learn 198 detailed methods of nonviolent actions that result in transformation. A key is informing and assembling a mass of people who want change. That’s us!

We will be discussing and starting our birth revolution, as well as showing this film. It is time to organize and we can do this if we all put our harmonious energy and love into this movement. Again, that is why we must care for and support each other. Watch for full details about this study day which will be posted soon!

Toward Better Birth!

— Jan Tritten

ed page graphic

You want to be a midwife, but where do you start?

Are you an aspiring midwife who’s looking for the right school? Or maybe you’re trying to decide if midwifery is the path for you. Visit our Better Birth Education Opportunities page to discover ways to start or continue your education.


I was laboring well in a big birth pool with my husband supporting my back and my 4-year-old daughter pouring water over my belly during contractions. At one point, my midwife left the room to return a phone call. My daughter quickly swam from my right side to my bottom side and shouted with her arms outstretched, “Don’t worry! I’ll catch the baby while you’re gone!” We were actually a few hours from the birth, but she was ready to help!

— Rachel Brown

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