March 13, 2013
Volume 15, Issue 6
Midwifery Today E-News
“Cesarean”
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In This Week’s Issue


Quote of the Week

You don’t have to teach people how to be human. You have to teach them how to stop being inhuman.

Eldridge Cleaver


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The Art of Midwifery

The primary ingredient for a successful transport is communication. I believe open and honest communication best exists within a relationship that is established and ongoing between midwife, client and physician. In my case, the direct entry midwives in my area sought me out for a cup of tea. This informal meeting turned into a question and answer session on “What would you do if…?”

Anne E. Stohrer, MD, excerpted from “Transport Etiquette,” Birth Wisdom, Tricks of the Trade, Vol. III, a Midwifery Today book
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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.


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Jan’s Corner

Re: February 13 edition of E-News, Jan’s Corner

I was so passionate in writing about birth freedom and mothers being abused—an issue close to my heart—that I got carried away and didn’t use words and images as carefully as I should have. It was unwise on my part to make this comparison. My sincere apologies to all I have offended. I ask you to please forgive me. The article has been taken down and we at Midwifery Today have again been reminded to be more careful with the content we publish.

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

Necessary Cesarean

“I don’t think a 25% cesarean rate is too high.” The words jolted me to attention. The speaker is a woman I respect: my cousin, a family historian, who has farmed with her husband in the Midwest for decades. I forced myself to overcome my prejudices and listen to her seriously. “Not if it saves women from what my niece is going through,” she continued.

The niece delivered her son vaginally six years ago. He was a big baby and during the difficult birth, the oxygen supply to his brain fell too low. He is disabled with cerebral palsy and can neither walk nor talk. He attends special education classes and has learned to communicate with a specially fitted computer.

Traumatic as surgical delivery may be, the effect on family life is minor compared with the life-long responsibility of caring for a disabled child. We as midwives sometimes ignore this potential tragedy with such generalities as, “the baby is made to fit through the mother’s pelvis” (usually it does!), implying that cesarean section is an unnecessary intervention, forced upon vulnerable women in labor by controlling medical practitioners. Unfortunately, this is often true. But not always.

In Midwifery Today Issue 65 (Spring 2003), Deb Abramson writes about her cesarean for fetal distress in “More Than Just a Scar.” She describes herself as unprepared for the possibility of a necessary cesarean and unsupported in the aftermath.

“I have felt left out since my cesarean section, abandoned in a way by the natural birth proponents whose camp I so enthusiastically joined when I first found out I was pregnant. I didn’t deliver my baby in the way they celebrate, nor was I abused by the medical community in the way they condemn. There is cheerleading in the one case, finger pointing in the other. Either way, you have their full and vocal support. But I had missed both boats and gotten stranded…”

What I would like to say to Deb is that she made a parenting decision when she chose to cooperate with her surgical delivery. (I say “chose to cooperate” because, although coercive attitudes occur, to perform surgery on any person without their written consent is legally assault; that is, unless a court order has been obtained.) This early decision will be one among many that she will make for the welfare of her child, putting the child’s safety and comfort above her own. Because that’s what mothers do. This is why it is so important that mothers be able to trust their obstetrical care providers to tell the truth. When they say, “The baby is at risk,” they must really mean it. It can’t be just, “this has gone on too long and I have other things to do.”

Marion Toepke McLean
Excerpted from “Necessary Cesarean,” Midwifery Today, Issue 67
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Website Update

The table of contents for the brand new issue of Midwifery Today, Spring 2013, is available now. The theme is “Hemorrhage.” Take a look at all the articles and departments here!


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Birth Q&A

Q: In that cesareans do save lives, tell us how your cesarean, though maybe not the kind of birth you may have planned, ended up being an empowering and positive birth experience. What helped to make it this way?

— Midwifery Today

A: Without my caesarean, I would never have planned a VBAC and then would never have become a doula, and then a HypnoBirthing practitioner, and then a complementary therapist, and then on to becoming a NO HANDS Massage Advanced Practitioner and offering pregnancy massage. Thankfully I found my way to accepting my cesarean and seeing the positives.

— Karen Law

A: I had a wonderful cesarean birth experience with my second baby, just four weeks ago. I had a negative cesarean experience with my first birth.

I had planned for a homebirth VBAC with my husband, midwife and doula. After laboring at home for three days and my water breaking, we went to the hospital to augment with Pitocin. I still expected a vaginal delivery at the hospital. After 12 more hours of labor, it became necessary to have a cesarean birth. Our daughter’s heart rate began to dip dangerously low as contractions got stronger.

Before the operation, my birth team and I talked to the doctor, nurse and anesthesiologist. We explained the issues with the first cesarean birth, including how the experience interfered with getting breastfeeding started.

We asked for three things: That my doula be present, along with my husband, to continue to support me while he watched the nurses care for our daughter; that the anesthesiologist use the least amount of drugs so I wouldn’t feel pain, but I could be as alert as possible to start breastfeeding; and that we start breastfeeding before any non-essential procedures were done. Amazingly, everyone was on board!

The OR nurse swaddled Jennifer and handed her to my husband as soon as she was done with the basics. He brought her to me while I was still on the table. My doula had my husband place Jennifer’s cheek to mine, so we were able to start bonding within minutes of birth.

In the recovery room, Jennifer was placed on my chest. She nursed immediately, and we had two hours of quiet time before the nurse came back in to do the rest of the usual stuff.

Even though I didn’t get my homebirth VBAC experience, I feel so blessed to have had a beautiful, peaceful and joyful cesarean birth experience.

— Almitra Buzan

A: I planned a vaginal birth of surrogate twins. My OB was on board, the parents were on board, the first baby was on board, but the second baby was not. Neither was the nurse nor the anesthesiologist. But my OB listened to me, allowed time to pass without hurrying my body, stood up for my choices when the nurse and the anesthesiologist were pushing, and when I finally said, “I think it’s time to talk about a cesarean,” he bowed his head for a moment and I could see he had wanted me to birth both of those babies vaginally as much as I had. I truly felt like he was my partner in the birth experience. I felt that he listened, that he respected and that we collaborated on what my body was telling us. And when it was time to make the call for the cesarean, I felt it was the right call and that I was part of the decision.

— Adrienne Black

A: I’m a midwife and practiced in Ontario before going on maternity leave. With each and every client that needed a cesarean I was always so grieved for them (necessary or not), but they seemed to be okay afterwards and I never understood. I came to find myself two weeks overdue, with little fluid showing on ultrasound. After 30 minutes, my little one could no longer handle the induction and I had an emergency cesarean. I grieved before going into surgery, but there are many positive things to my tale: the OB on-call that day, the anesthetist who filled in last minute who was a whiz at spinals, my midwife who was with me the entire time and received my baby once he was born, etc., etc., etc. And I now know why all my previous clients had somehow come to terms with their cesareans: because they had gotten the prize! And now I have my prize and can hope for a chance to one day experience birth in a more natural way. However, I wouldn’t exchange the cesarean for anything, because of Marcus.

— Jenna Smith

A: My first son was born by emergency c-section—he was moving so very, very slowly the evening before he was born, a full month before he was “due.” That birth taught me to trust my instincts. However, as I started looking for VBAC options, I could not shake the fears of something going wrong and so I once again chose a hospital birth with my OB who was kind and caring. When I said, “I’d like to try a VBAC,” my OB said, “Okay,” and that was the end of our conversation regarding a VBAC. Both of us just assumed that it would happen, and it did. I did my research, prepared myself and had a beautiful, empowering VBAC. This then led to my being a doula for a friend who wanted a VBAC and then to becoming an LCCE, to now being a midwife who runs a birth center in India.

— Vijaya Krishnan


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Magazine Matters

The “Hemorrhage” Issue

We just sent the next issue of Midwifery Today off to the printer. The theme this time is “Hemorrhage,” and by the time this edition of E-News reaches your inbox, the magazine will be on its way to subscribers near and far.

The more I work with Midwifery Today, the more I realize what a valuable resource the magazine is for all birthworkers. Whether you are, or aspire to be, a midwife, doula, childbirth educator, obstetrician, nurse or even if you are just fascinated with birth, Midwifery Today will not disappoint. With over 20 articles in every issue, there is a vast amount of knowledge to be gained. This issue features an article from Robin Lim, CNN Hero of the Year. She shares a typical day in Bali, and her story teaches appropriate and safe ways to deal with and help prevent hemorrhage, a very common danger in Indonesia mostly because of poor nutrition.

Do you have something to share? Then please, send us an article to give to the birth world. This is your magazine. It is not filled with ads as most magazines are; it is filled with the words of our subscribers and mentors. We hope you enjoy the next issue of the magazine and consider writing for us some day.

— Nancy Halseide, managing editor for Midwifery Today


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Stories

After 38.5 hours of exhausting on-again-off-again labor, I was getting discouraged about my HBAC. The midwife suggested a beer and 2.5 hours after that beer, I was holding my daughter. Thank God for beer and midwives!

— Meagan DePerro


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