March 12, 2014
Volume 16, Issue 6
Midwifery Today E-News
“Delayed Cord Clamping”
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Read about the Umbilical Cord in Midwifery Today, Issue 108
Articles in the Winter 2013 issue of Midwifery Today magazine include “Optimal Cord Clamping” by Mary Esther Malloy, “Cord Cutting in the Framework of Neonatal Beliefs and Rituals” by Michel Odent, “The Navel String” by Patricia Edmonds and “Amniotomy and Cord Prolapse” by Judy Slome Cohain. To orderMT online store

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Enhance your midwifery skills and knowledge

Attend the full-day Midwifery Issues and Skills class with Diane Goslin, Mary Cooper and Carol Gautschi. Suitable for both beginning and advanced midwives, sessions include VBAC, Prenatal Care for Well-being, Care for Mothers with Miscarriage, and Twin Birth.

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UK conferenceJoin us in the UK this spring

Plan now to attend our conference in Bury St. Edmunds, UK, May 26–30, 2014. You’ll be able to choose from a wide selection of classes, including Rebozo Techniques and Practice, Breech Skills, Spinning Babies, Comfort Measures and Prolonged Labor. Planned teachers include Robbie Davis-Floyd (pictured), Eneyda Spradlin-Ramos, Jane Evans and Elena Piantino.

Learn more about the Bury St. Edmunds, UK, conference.

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When we do the best we can, we never know what miracle is wrought in our life, or in the life of another.

Helen Keller

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The Art of Midwifery

For providers used to clamping cords immediately, you are asking them to do nothing when they are used to doing something. Standing by and doing less can be quite challenging for many. As a doula, I have found that meaningful conversations (prior to the start of labor, of course) and sharing resources can help care providers put aside familiar habits and offer a willingness to try something new. During labor, as the moment of birth nears, birth partners might want to clearly remind care providers to delay clamping. Again, you may be asking a medical professional to do something outside her training and rituals of practice. A reminder will help.

Mary Esther Malloy
Excerpted from “Optimal Cord Clamping,” Midwifery Today, Issue 108
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Editor’s Corner

The Global Demise of Traditional Midwives

I believe that knowledge of how to help women through birth is something that should be shared widely and as often as possible, by whatever means possible. I believe birthing knowledge belongs to people.

Medically trained people have guidelines to follow regarding safe practice. They are responsible and they are held accountable. They can, and often must, do clinical observations, vaginal examinations and various tests, as well as keep detailed records on their clients. There is no doubt that we need medically trained midwives and doctors and obstetricians. We need them for many, many births, especially when women and babies have health issues. But I don’t believe we need them for every birth.

I am interested in and saddened by the global demise and alienation of traditional midwives in many cultures. In many countries, the noble ideal of having all women birth in clinics is unrealistic in the face of corruption, inaccessibility, disaster, lack of transport, lack of money, lack of permission and, for many, a lack of necessity. In many places, women would be very alone and frightened if not for the help and skills that traditional midwives provide.

Listening to heart tones, checking baby’s positioning, checking on progress internally, comforting the mother, communicating with the mother about how she is feeling and what she needs—these are all touch and communication skills that require empathy and a willingness to share and learn. They are not medical skills. Anyone can do them and they can be easily shared with traditional midwives, doulas, support people, husbands and to the women themselves. Contrary to popular belief, possessing these skills does not make unqualified people too proud or unduly confident, it just empowers them with knowledge and greater understanding.

I feel we are overly attached to the idea that medically trained midwives are the only ones qualified and skilled to deliver babies. They indeed can help in difficult circumstances, but we must remember that most of the time it is the women who deliver their own babies, or they could if given that empowering opportunity.

My appreciation goes out to everyone working in the world in any way—from the most humble offering of help to the most qualified—to improve women’s lives and comfort in pregnancy, birth and mothering.

Jenny Blyth has been working for over 30 years with natural birth and homebirth. Her greatest focus is on preparation of the mother and her partner for birth, including self-awareness, body skills and bodywork for birth. She has been facilitating Birthwork workshops for more than 10 years, and since 2010 has teamed up with Fiona Hallinan. She believes self-responsibility, self-care and body skills are important foundations for a satisfying birth experience, and compassion, tenderness and touch are essential qualities for birthworkers. Jenny will be a teacher at the Midwifery Today conference this year in Byron Bay, Australia.

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Conference Chatter

One of the greatest things about conference (besides our amazing teachers and the wonderful classes that we carefully craft for you) is you, the registrants. We have met the most remarkable people at our conferences and I have personally made so many incredible and long-lasting relationships. Besides learning top-notch midwifery skills, at our conferences you have the opportunity to make many new and marvelous friends from around the world who share your goal: to make each birth the best possible for both mother and baby!

At the Eugene conference in 2013, we made friends from Vietnam—two midwives and a doctor. In Belgium, we met a Korean physician who had set up a natural birthing center in his country. When I taught at a conference in Puerto Rico a couple of years ago, I met Diego Alarcon. He is a physician from Quito, Ecuador who runs a beautiful birthing center. I was able to go to two births at his center and participate in prenatal visits. Diego’s loving birth practices are inspiring and he has agreed to come and share his knowledge with us at the next Eugene conference. A doctor from India is planning to join us in the UK!

Be sure to come to our next conference with an open mind and address book—you are sure to make some surprising connections!

— Jan Tritten

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Featured Article

A Natural Approach to the Third Stage of Labour: A Look at Early Cord Clamping, Cord Blood Harvesting and other Medical Interference

The medical approach to pregnancy and birth is so ingrained in our culture that we have forgotten the way of birth of our ancestors, a way that has ensured our survival as a species for millennia. In the rush to supposedly protect mothers and babies from misfortune and death, modern Western obstetrics has neglected to pay its dues to Mother Nature, whose complex and elegant systems of birth are interfered with on every level by this new approach, even as we admit our inability to understand or control these elemental forces.

Medical interference in pregnancy, labour and birth is well documented and the negative sequelae well researched. However, medical management of the third stage of labour—the time between the baby’s birth and the emergence of the placenta—is, to my mind, more insidious. At the time when Mother Nature prescribes awe and ecstasy, we prescribe injections, examinations, and clamping and pulling on the cord. Instead of body heat and skin-to-skin contact, we offer separation and wrapping. Where time should stand still for those eternal moments of first contact as mother and baby fall deeply in love, we have haste to deliver the placenta and clean up for the next case.

This management of the third stage has been taken even further in the last 10 years with the popularity of “active management of the third stage,” which has its own risks for mother and baby. While much of the activity is designed to reduce the risk of maternal bleeding or postpartum haemorrhage (PPH), which is most certainly a serious event, it seems that, as with the active management of labour, the medical approach to labour and birth actually leads to many of the problems that this active management is designed to address.

Active management also creates specific problems for mother and baby. In particular, use of active management leads to a newborn baby’s being deprived of up to half of his or her expected blood volume. This extra blood, which is intended to perfuse the newly functioning lungs and other vital organs, is discarded along with the placenta when active management is used, with possible sequelae such as breathing difficulties and anaemia, especially in vulnerable babies.

Drugs used in active management have documented risks for the mother, including death. We do not know the long-term effects of these drugs—given at a critical stage of brain development—for the baby.

As a mammalian species (so defined by mammary glands that produce milk for our young), we share almost all features of labour and birth with our fellow mammals. We have in common the complex orchestration of labour hormones, produced deep within our mammalian, or middle, brain, to aid us and ultimately ensure the survival of our offspring.

We are helped in birth by three major mammalian hormone systems, all of which play important roles in the third stage as well. The hormone oxytocin causes the uterine contractions that signal labour, as well as help us to enact our instinctive mothering behaviours. Endorphins, the body’s natural opiates, produce an altered state of consciousness and aid us in transmuting pain; and the fight or flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine, also known as catecholamines or CAs), which give us the burst of energy we need to push our babies out in second stage.

Sarah Buckley
Excerpted from “A Natural Approach to the Third Stage of Labour: A Look at Early Cord Clamping, Cord Blood Harvesting and other Medical Interference,” in The Third Stage of Labor, a Midwifery Today e-book
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Purchase and download Waterbirth, a collection of 16 informative articles from Midwifery Today magazine. The topics you’ll be able to read include “A Lovely Way to Enter the World” by Judy Edmunds, “Aquadurals and Douladurals Replace the Epidural” by Judith Elaine Halek, “Waterbirth Makes the Midwife’s Job Easier” by Samantha McCormick, “A Landmark in the History of Birthing Pools” by Michel Odent and “Waterbirth and GBS” by Judy Slome Cohain.

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Midwifery Today Magazine Issue 107

Learn about the pelvic exam

Maternal Exam for the Student Midwife, Part II, The Pelvic Exam, is a two-disc DVD set packed with information about various aspects of pelvic examination. You will see how to do internal, bimanual, rectal and speculum exams. Also covered are visualization of the external genitalia, palpation of the internal reproductive organs, and the procedure for collecting cultures from the cervix and surrounding tissues. To order

Maternal Exam for the Student Midwife, Part I, is also available.

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Enjoy the wisdom and knowledge of our Germany conference teachers

You can now purchase a portable USB drive with MP3s of selected classes from the 2012 Germany conference. You will receive most classes from the two-day Midwifery Skills sessions, as well as several others. Teachers include Elizabeth Davis, Gail Hart, Carol Gautschi, Lisa Goldstein and Gail Tully. To order

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Website Update

Read this article excerpt from Midwifery Today magazine, recently posted to our website:

  • Premature Ligation of the Umbilical Cord by Patricia Edmonds

    Excerpt: The placenta and cord are, in effect, organs of the newborn. The cord develops from the same tissue that makes up the fetal side of the placenta and this tissue is contiguous with the baby’s skin. Cord clamping is the first medical intervention experienced by most humans as part of the third stage of labor. Delay in clamping and cutting of the umbilical cord improves neonatal cardiopulmonary adaptation, increases blood pressure, improves oxygen transport and red blood cell flow, reduces the number of days on ventilation and oxygen with sick and premature infants and reduces the incidence of anemia.

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Birth Q&A

Q: For midwives, nurses, doctors: What do you do when you help birth a baby with a super short cord (one that is too short to bring baby to mom’s chest)? Do you wait to cut it? Share with us your protocol in these situations.

— Midwifery Today

A: My second daughter’s cord was short enough to only allow her to be just above my pubic bone. I was in the water, so she couldn’t come out of the water unless I stood up. I instinctively stood and held her very low on my belly so the cord wouldn’t pull. I stayed that way until I was ready to have the cord cut, about 30 minutes after birth, just before the placenta delivered.

— Jessica Weed

A: It is usually mama’s choice. I can cut it or leave it, as she wishes. She has, after all, employed me to serve her, not the other way around. However, it depends on other circumstances as well. If baby isn’t breathing well, that would be my first concern, and cutting the cord cuts off the oxygen, which I won’t do until I’m sure baby is doing well. However, if postpartum hemorrhage is in progress, I’d want the mother’s nipples stimulated, however that happens! Nursing the baby is the usual go-to in that event, but dad can suck or twiddle, or we can cut cord—it is up to them how they want to accomplish nipple stimulation.

— Marlene Waechter

A: I’ll put the baby on mom’s abdomen or legs and let her interact. In a few minutes uterus will contract and come down with placenta and cord all together and the cord will elongate inch by inch. In 10 minutes, baby will be almost on mom’s chest.

— Ana Cristina Duarte

A: We had a mother recently give birth on all fours with only inches of cord. We held the baby between the mum’s legs to allow for a decent placental transfer before cutting the cord and lifting it up to its mum. Van Rheenen and Brabin (2006) suggest that holding the baby below the perineum decreased the time that is needed for this transfer to take place. We cut the cord within 60 seconds and then the mother enjoyed skin-to-skin.

— Annie Barnes

A: I have had babies jack-knife out, due to a very short cord. We left the baby there, covered him and dad bonded with the baby until we had a separation gush and knew the placenta was on its way. I tend to keep the placenta/cord intact for as long as possible.

— Sharon Evans

A: If I have a short cord or long cord, I do not cut. In a situation where I cannot put baby to breast, I have dad get down and start talking and greeting baby. Remember, he is part of the birth, too, and is the perfect substitution for mom in this case.

— Celesta Rannisi

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