March 27, 2013
Volume 15, Issue 7
Midwifery Today E-News
“Postmaturity”
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How common is postmaturity syndrome and how should it be managed?

Learn about this and more in The Postdates and Postmaturity Handbook, the newest addition to Midwifery Today’s Holistic Clinical Series. This handbook will help you understand the myths and prevent the risks associated with postdate pregnancies and postmaturity syndrome. This valuable resource belongs in every midwife’s library.
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Learn about birth, the Mexican way

Eugene conferenceSign up for the full-day class, Mexican Traditions and Techniques, with Angelina Martinez Miranda. She will discuss positioning, remedies, techniques and customs from Mexico. You’ll learn how to use a rebozo and discover simple techniques that promote healthy pregnancy and birth. Part of our conference in Eugene, Oregon, April 3–7, 2013. March 27 is the last day for pre-registration; please register at the conference after that date.

Learn more about the Eugene conference.

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What is a rebozo and what can you do with it?

Attend the full-day class, Rebozo Techniques and Practice, to learn how this traditional Mexican tool is useful all parts of the childbearing cycle. Thea van Tuyl, Mirjam de Keijzer and Eneyda Spradlin-Ramos will show you simple techniques that promote healthy pregnancy and birth. You will also have time for hands-on practice. Part of our conference in Belgium 30 October – 3 November.

Learn more about the Belgium conference.

In This Week’s Issue


Quote of the Week

According to traditional wisdom in rural France, a baby in the womb should be compared to fruit on the tree. Not all the fruit on the same tree is ripe at the same time…we must accept that some babies need a much longer time than others before they are ready to be born.

Michel Odent


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The Art of Midwifery

In a well-nourished woman who salts to taste and drinks to thirst, pregnancy usually proceeds to term and often goes one to two weeks past the 40-week mark. In fact, 42 weeks may be the normal gestation for humans. When a well-expanded blood volume has stimulated a well-grown and well-nourished placenta, neither baby nor placenta will suffer before birth occurs. Fetal growth continues; fetal movement and heart rate variability maintain themselves normally; the volume of amniotic fluid is adequate; blood volume remains appropriately expanded providing optimal placental profusion; and everything is fine.

Anne Frye, excerpted from “Postdates vs. Postmaturity: An Overview,” Birth Wisdom, Tricks of the Trade, Vol. III, 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.


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Jan’s Corner

Journey into Midwifery

[Editor’s note: Rahima Baldwin Dancy, co-producer of the DVD, Normalizing the Breech Delivery, provided the editorial for this issue of E-News.]

Are you drawn to the wonder of birth and long someday to attend women as either a doula or a midwife? For many of you, midwifery comes as a calling that seems to choose you, often calling you repeatedly and guiding your journey. Midwives-in-process will be able to explore their path in a workshop called “Journey into Midwifery” offered in Bali April 1–10. Midwife Robin Lim, CNN Hero Award winner in 2011 for her work in Bali over the past 25 years, offers workshops and opportunities for North American midwives to get their practical experience at the birth center she founded.

Robin writes about this workshop: “In Indonesia, a woman on the path to become a midwife (we say bidan here) is not called a “student midwife;” she is called a “promised midwife.” Let’s face it, you are engaged to your passion for gentle childbirth! The good news is midwifery already loves you as deeply as you love midwifery.” Robin, will be one of several midwives leading the workshop, including Katherine Bramhall, Erin Ryan, Lianne Schwartz and myself. We will balance presentations, exploration, discussion and the learning of basic midwifery skills. The workshop will be held at a retreat center in Bali with wonderful food and ample time for contemplation and re-creation. To learn more about the program or to register, go to www.journeyintomidwifery.com.

My own calling into midwifery came unexpectedly in 1972 while I was sitting on a bus in India. As in the Bob Dylan song, my immediate reaction was, “God, you must be putting me on,” since I had no experience and was terrified of giving birth. But I also said “Yes” to this impulse, and my willingness led me to discovering Myles’ Midwifery and attending childbirth classes with Sheila Kitzinger while in England and meeting Frederick LeBoyer in Paris before his work on gentle birth was published. Over the next five years I gave birth to two children at home in Los Angeles and Mexico, and became a direct entry midwife in Colorado in 1977 when an experienced, foreign-born midwife couldn’t make the birth of a friend in labor. Now my journey in midwifery is taking me to Bali to share with others about “the long and winding road.” I hope you’ll be able to join us!

Rahima Baldwin Dancy

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: https://twitter.com/jantritten
Midwifery Today on Facebook: facebook.com/midwiferytoday
Jan on Facebook: facebook.com/JanTrittensBirthPage
International Alliance of Midwives on Facebook: facebook.com/IAMbirth
Birth Is a Human Rights Issue: facebook.com/birthisahumanrightsissue
Midwifery Education: Caring and Sharing: facebook.com/MidwiferyEducation


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Featured Article

The Tree and the Fruit

L’arbre et le Fruit (“The Tree and the Fruit”) is the title of a 600-page academic book by the French historian Jacques Gelis (1984). It examines the history of childbirth in western continental Europe from the Middle Ages to the 19th century. If you have on your shelf the English version of the book, titled History of Childbirth: Fertility, Pregnancy and Birth in Early Modern Europe, you will miss the analogy transmitted by the original title and the importance of the pages on the history of beliefs about the duration of pregnancy (Gelis 1991).

According to traditional wisdom in rural France, a baby in the womb should be compared to fruit on the tree. Not all the fruit on the same tree is ripe at the same time. A fruit that has been picked before it is ripe will never be fit to eat and will quickly go bad. It is the same with a baby. In other words, we must accept that some babies need a much longer time than others before they are ready to be born. If you have some apple trees in your garden, you will listen to your common sense and choose an individualized and selective approach: you will not pick all the apples on the same day.

What about human babies? Today, all over the world, a routine approach to postmaturity is typically adopted. This aspect of the industrialization of childbirth is rarely, if ever, the subject of discussion. Modern pregnant women are given a very precise due date. Pregnancies are punctuated by routine medical visits, according to an established program. In the age of medicalized prenatal care, the duration of pregnancy is calculated in weeks rather than months, using the beginning of the last period as the main criterion. Long in advance, women are warned that if their babies are not born on a certain date, their labors will be induced. The first result of such attitudes is that in many hospitals more than one-quarter of labors are artificially induced. The other result is that more and more women doubt that they will go into labor without the help of doctors.

An induced labor is more difficult than a labor that has started spontaneously. It usually leads to the need for epidural anesthesia and an oxytocin drip, which more often than not precedes a cascade of interventions, culminating in a vacuum, forceps delivery or an emergency cesarean. The labor induction epidemic helps to explain the rising cesarean rates all over the world.

At the root of this epidemic are statistics. When looking at a very large number of births, it is clear that outcomes are optimal when the baby is born between 38 and 40 weeks. The statistics are not as good when focusing on babies born at 41 weeks or after. Such data lead to simplistic conclusions: “If we routinely induce labor whenever the pregnancy has lasted more than a certain number of weeks (41 in many hospitals), we’ll eliminate the risks of fetal distress and even deaths related to postmaturity.” The risk of death related to postmaturity is not a legend, but it is usually overestimated. It should be balanced with all the risks associated with induction. Is it wise to induce one-quarter of labors, in order to save one baby in thousands? Are more individualized and selective strategies possible? The answer is, “Yes.”

Michel Odent
Excerpted from “The Tree and the Fruit,” Midwifery Today, Issue 72
View table of contents / Order the back issue


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…are what you’ll find in Placenta: The Gift of Life by Cornelia Enning. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You’ll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. Placenta: The Gift of Life is a book from Motherbaby Press, an imprint of Midwifery Today. Get the book.


Discover belly mapping!

The Belly Mapping Workbook shows how a woman can discover her baby’s position in late pregnancy. This technique can be a fun bonding activity and is often used for proactive childbirth preparation using optimal fetal positioning. The workbook includes 100 drawings and photos that take you through details of head-down and breech babies. At just $14.95, it makes a fine gift for a pregnant friend! To order

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Get breastfeeding information in e-book format!

Suitable for both parents and practitioners, the Breastfeeding e-book is filled with insights into various aspects of this important topic. This collection of 15 articles from Midwifery Today magazine includes “The Role of the Shy Hormone in Breastfeeding” by Michel Odent, “Milk Supply: You Have Enough” by Lina Duncan, “Supporting Mothers in Long-term Breastfeeding” by Janell E. Robisch and “The Four Pillars of Safe Breast Milk Sharing” by Shell Walker and Maria Armstrong.

Get your copy on Amazon or on Smashwords in a variety of formats.

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Make sure you get the whole story.

Midwifery Today Magazine Midwifery Today E-News is only a sample of what you’ll find in Midwifery Today magazine. Subscribe and you’ll receive a 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Subscribe.

Do you work with laboring women?

Then you need the sixth edition of Anne Frye’s Healing Passage, A Midwife’s Guide to the Care and Repair of the Tissues Involved in Birth. Even if you have an earlier version, you’ll want this one, which is more than twice as long as the fifth and packed with vital information about the art and science of perineal care and repair. The anatomy section has been completely overhauled, the suturing lessons have been expanded and the information about tear repair has been updated. You’ll also find a completely new pelvic floor model with pattern and instructions in the appendices. To Order

Healing Passage


Website Update

Read this editorial by Jan Tritten from the newest issue of Midwifery Today, Spring 2013:

  • First, Do No Harm
    Excerpt: The most important thing I can say about hemorrhage is, “Don’t cause one.” If the body is well fed and mom is low on stress and feels loved, motherbaby and their process of labor and birth work well. Our first and most important job is to facilitate what is already a beautiful process.

Get the whole story!
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Birth Q&A

Q: For you ladies who carry babies longer than average, how many weeks were you pregnant? Was there pressure to induce, or were you able to remain pregnant, healthy and happy?

— Midwifery Today

A: My 42-weeker was covered in vernix and my placenta didn’t show any signs of being “old.” I gestate longer than “average,” and I also labor longer than average and dilate slowly—just my normal! My backup OB knows my history of dilating slowly and carrying long so he said he wouldn’t be concerned at all to let me do my own thing and make my own decisions, but he isn’t the norm. I just saw him recently since I don’t have a midwife yet and when I said I wasn’t planning on doing an ultrasound and wasn’t going to do the glucose screening, he didn’t even bat an eye. He just said it was all completely up to me.

— Kristen Bergman Kloepping

A: My first baby was born at 41 weeks and 4 days. My midwife had already scheduled an induction for that day “just in case.” I understood I still had a choice, so I simply refused to go to the hospital. Later that day, about noon, my contractions which had been going slowly for a few days, began to take rhythm. I was so relieved! I definitely was stressed under the pressure of being “overdue.” The natural fears of preparing to have my first baby were overtaken by fear of man’s time schedule for me. My husband and I secretly chuckled at the annoyed nurses after we arrived. They furrowed their brows at our not showing that morning for induction. My reply was, “Well, I’m in labor now.” I have had three more babies since then and one was born at 41 weeks and 3 days. For that birth I was meeting with midwives who left the timetable to the birds. It was a much more peaceful transition, and still my baby was so healthy and perfect.

— Ginger Perron

A: For my babies I went 44, 43 and 42 weeks—all solid dates. No one ever pressured me, and none of my babies had postmaturity markers of any kind. Some people just gestate longer. We need to remember that due dates are based on averages and that human beings encompass a whole lot of natural, normal and healthy variations.

— Laureen Hudson

A: How many women are hiding things from caregivers out of fear of being bullied? When my daughter was overdue this past month, the talk wasn’t really, “Should we be induced?” or “What kinds of induction?” but rather, “Should we fire our midwife, rent a Jacuzzi room at the Holiday Inn and go unassisted?” We like the analogy comparing the “choice” of induction to a choice between vanilla or strawberry ice cream, but if you choose strawberry, you get a punch in the nose. So, do you submit to the caregiver’s bullying or do you proceed without care? Women are often being forced into a corner without safe options.

— Jenee Clark

A: The year was 1973. My baby was a healthy boy weighing in at 7 lb 15 1/2 oz, and he had nestled in my womb for over 43 weeks.

— Linda Crownover-Inch

A: I went to 42 weeks with my first baby and was forced into induction with Cytotec since the CNM said she couldn’t keep me as a client by law in New Jersey if I went past 42 weeks. I ended up with hyper stimulation and near constant contractions for seven hours. With my second birth in Florida, I was induced with herbs and acupuncture at 42 weeks because of the threat of being transferred from the midwife practice to a hospital with an induction by a physician. Babies #3 and #4 came at 41 weeks and 6 days on their own.

— Kirsten Shrawder

A: Every baby must be carefully monitored and watched over during pregnancy. After 42 weeks there is a slight uptick in stillbirth rates, but after it begins to jump. Most of those deaths are in babies who were not growing well in pregnancy—they are in essence victims to a long-standing problem which could probably have been recognized if attention was being paid to them. I am a proponent of kick counts and of assessment tests after 42 weeks.

My personal history: 43.4; 42.3; 46 (good dates, but may have a ten-day fudge); 40.4 (we had nothing ready!) and 42. Every woman in my extended family has ten-month babies.

— Gail Hart

A: I gave birth just shy of 43 weeks. No pressure. When I was pregnant with him, they had not invented postdate-fear protocols. I just quietly grew him as long as he wanted, and when he was homeborn at 9 lb 8 oz, no one ever spoke the words gestational diabetes! Oh, to have true midwifery back again!

Patricia Edmonds


Conference Chatter

Eugene Conference

Join us for “Weaving Together the Art, Science and Spirit of Midwifery” in Eugene, Oregon, April 2–7, 2013.

Pre-register by Wednesday, March 27 or just plan to come in and register at the door.

Be sure to sign-up for full-day pre-conference classes such as Essential Midwifery, where Patricia Edmonds, Carol Gautschi, Anne Frye, Gail Hart, Maryl Smith and Eneyda Spradlin-Ramos will discuss the art, the essence and the subtleties of midwifery care. Other full-day classes you can attend include Midwifery in the Age of Primal Health Research with Michel Odent, Mexican Traditions and Techniques with Angelina Martinez Miranda and the Spinning Babies Workshop with Gail Tully.

You can also choose to take one or both days of the Midwifery Skills class, where you will learn from Sister MorningStar, Marion Toepke McLean, Katy Bowman, Carol Gautschi, Anne Frye and Patricia Edmonds. Be sure to register for The Persecution of Midwives as a Human Rights Issue summit on Tuesday, April 2.

During the main days of the conference, you can choose from a selection of shorter classes, including: Shoulder Dystocia; Placenta Medicine; Group B Strep and Vaginal Health; Preeclampsia and Hypertension in Pregnancy; Cesarean Cut and Birth Abuse; and Prolonged Labor.

To see a complete list of classes, please go here.

— Donna Zelzer, marketing director


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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.



Stories

My waters broke while I was driving on the freeway, so I had a valet park my car at the hospital (poor valet—the seat was wet!) and I had to squelch my way to the delivery suite wearing a white linen skirt and flip flops. Thankfully it was my third baby, so it was more funny than traumatic. The baby came so fast my husband missed the whole thing!

— Sarah David


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