April 9, 2014
Volume 16, Issue 8
Midwifery Today E-News
“International Edition”
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Five Countries, Six Births, Seven Babies showcases homebirths in Guatemala, Costa Rica, France, the USA and Bermuda. Filmed between 1994 and 2010, this DVD’s powerful images of mothers and babies can inspire a woman to learn to embrace birth as a joyful experience. It definitely belongs on any birth professional’s media shelf. To order

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In This Week’s Issue


Start your journey into midwifery

Harrisburg conferenceAttend the full-day Beginning Midwifery class at our conference in Harrisburg, Pennsylvania, April 2014. Carol Gautschi, Sister MorningStar, Heidi Yanello and Eneyda Spradlin-Ramos will share their wisdom and love of midwifery in a way that will nurture your interest and make you feel welcomed to the world of birth. Topics covered include Prenatal Care for Well-being, Normal Labor Care, Anatomy of a Home Birth Bag and Emotional Issues in Pregnancy, Labor and Birth. This class will also help you decide if midwifery is the profession for you. Walk-in registrations only after April 10.

Learn more about the Harrisburg conference.



UK conferenceSign up for the full-day Shoulder Dystocia and “Malpresentations” class

Gail Hart and Jane Evans will discuss the mechanical and physical causes of shoulder dystocia, as well as symptoms and signs you can use to predict it. You will learn about more than 14 maneuvers for shoulder dystocia and discover techniques for assessing and dealing with different types of presentation.

Learn more about the Bury St. Edmunds, UK, May 2014 conference.



Quote of the Week

Change your thoughts and you change your world.

Norman Vincent Peale
A minister and author and a progenitor of positive thinking


Midwifery Today E-News is just the beginning.

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The Art of Midwifery

The benefits of kangaroo care are numerous: The baby has a more stable heart rate (no bradycardia), more regular breathing (a 75% decrease in apneic episodes), improved oxygen saturation levels, no cold stress, longer periods of sleep, more rapid weight gain, more rapid brain development, reduction of “purposeless” activity, decreased crying, longer periods of alertness, more successful breastfeeding episodes, and earlier hospital discharge.

Holly Richardson, excerpted from “Kangaroo Care: Why does it Work?,” 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.


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

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Editor’s Corner

Waterbirth: ACOG on the Wrong Side, Again

ACOG always seems to come out on the wrong side. A committee decided that waterbirth needs further study. The following is from their report: “The safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit. Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent.”

One of the members of the committee writes: “But there’s less good evidence that it’s safe for the baby and even safe for the mom, in terms of infection risk, to give birth in the tub.” Hundreds of thousands of waterbirths provide a different side to the story. In the UK waterbirth is common even in hospitals. There was a conference on the safety of waterbirth nearly 25 years ago in London, England. The evidence presented convinced me of the safety of giving birth in water (which I was questioning at the time).

I asked on my Facebook page what experience people have had with waterbirth. Almost all were positive stories. Here is what a couple of midwife friends had to say about it:

Carol Gautschi said, “I do at least 90–95% of births in water—always the mom’s choice. I have seen water resolve many problems from correcting questionable fetal heart tones to breech prolapsed cord. Waterbirth also clears meconium out of a nose and mouth, facilitates repositioning of baby in utero, minimizes tears if you don’t interfere with pushing, provides safe and appropriate pain relief, gives mom extra privacy by providing a gentle and sacred space while allowing others to observe the miracle. Waterbirth provides a smooth and loving transition for the baby.”

Patricia Edmonds said, “I have been a midwife for almost 40 years. My first waterbirth was back in 1986. I have never seen any kind of complication or infection or any adverse problems associated with waterbirth!”

Joni Nichols said, “I’ve attended 262 waterbirths—all resoundingly positive!”

My dear doctor friend Diego Alarcon, who lives and works in Ecuador, has probably done thousands of waterbirths himself. Feel free to watch some of his beautiful videos here. There are many doctors around the world who, like Diego, definitely would not agree with ACOG!

— 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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Conference Chatter

For this year’s conferences, we are going to be at opposite ends of this big earth of ours while making every effort possible to bring change to outdated birth practices. We head to Harrisburg, Pennsylvania, in a couple of weeks for our domestic conference. This is a lovely spot in Amish country. There is still time to register and you will learn from, and share with, some amazing speakers. Walk-ins are always welcome. (Check in advance for openings in any specific class.)

We will also host a conference in the UK near the market town of Bury St. Edmunds at Culford School. This is a great place to share the week together. Our venue’s website describes it this way: “Culford Hall sits on approximately 480 acres of historic Suffolk parkland with a mixture of pastures, woodland and formal grounds surrounding it.” This event also has many inspiring classes and teachers. One of the very special aspects of this conference is that we get to stay right at the school with meals included in the very reasonable accommodation cost.

This November 4–9, 2014, we head to the beach town of Byron Bay, Australia. The conference is planned during a full moon so join us at a beautiful location for an awesome set of teachers and classes.

— Jan Tritten

Keep up to date with conference news on Facebook:


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ICEA Online Doula Certification Program Rolls Out! The ICEA certification program for doulas has expanded to include the option of training within the comfort of your own home. This is a great opportunity for want-to-be-doulas who may not have the ability to attend a training face-to-face. ICEA ~ International Childbirth Education Association For more information, please visit http://www.icea.org


Featured Article

Motherbaby Placenta: State of Emergency

It is the season in which we celebrate birth, yet I cannot sing one Christmas carol. If I try, I risk that the dam I have built to hold back the tears unshed will break, and I will cry a deluge.

“So why, Ibu Robin (grandma, lola, midwife, alleged ‘hero’), don’t you have the courage to cry?”

To be honest, I am afraid that if I let slip one tear, I will drown. You see, I have been in and out and into the Philippine disaster zones. I have seen the bodies, of those who had still decades of beauty left to live, lying by the roadside due to the biggest storm ever in our human history to make landfall. Typhoon Haiyan, known to Filipinos as Yolanda, was the grimmest of reapers. In the aftermath she has left 14.9 million people affected; 4.1 million people displaced; 5632 confirmed dead; 1759 reported missing; 26,000 reported injured and uncounted millions homeless. Those “counted” dead must have registered death certificates. Every pregnant woman I meet whose husband and children were killed has not registered them. The grandparents who lost their six grandchildren and daughter buried them in a small space they cleared by their devastated home because they did not wish to place their loved ones in a mass grave. Only four of the seven lost are accounted for, but the grandparents will not report their dead for fear of being punished for burying them on sacred family ground.

As I am told these and many stories, my eyes remain dry as stone. I am afraid that if I begin to cry, my team will fall apart. I fear that Teresa, Lucibelle, Tina, Jun, Riko and I will no longer be able to find the pregnant and lactating mothers, their children and the remains of their families’ food. How, if we break down, will we buy a thousand tarps to provide a little shelter from the rain? When a young homeless father is asked, “What do you need?” He says, “Only a bolo knife. I have the rubbish of my house and with that one tool I can make something from this corrugated tin scrap and broken bamboo to shelter my children. Their mother has died; they need to stay dry.” We can deliver the long bolo knives, the buckets to catch rain, the hygiene kits and some food, but we must not begin to cry. And the songs sing, “Soon it will be Christmas day.”

What does this have to do with placenta? Placenta is the mother root. In times of strife it is even more essential that we respect her and that we keep her intact with our babies, so they can receive their full supply of oxygen, iron stores and stem cells. It is the birthright of every child to have time to transition and achieve optimal health supported by the delay of umbilical cord severance. For babies born into disaster, it is a matter of life and death. I believe that the simple gift of patience on the part of the birthkeeper can save lives. Immediate clamping and cutting of the umbilical cord robs our newborns of up to 150 ml of blood—one-third of their God-given blood supply. They desperately need this promise of health and intelligence, especially when born in a kind of purgatory on Earth. Remember, when these babies go home from the makeshift hospitals or maternity tents where they were born, there is no home. Their mothers will breastfeed them, which is absolutely the only way they can survive, but the mothers are dehydrated, hungry and living in the open.

Robin Lim
Excerpted from “Motherbaby Placenta: State of Emergency,” Midwifery Today, Issue 109
View table of contents / Order the back issue


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Midwifery Today Country Contact Reports

Editor’s Note: Midwifery Today is interested in promoting international networking among childbirth practitioners. Our goal is to strengthen the international community by establishing a country contact in every country of the world. If you would like to become a country contact, please e-mail Jan Tritten.

For this international edition of E-News, we asked Midwifery Today’s country contacts the following question:

How is gentle childbirth/undisturbed birth faring in your country? Please give us a brief report.

Haiti

In Haiti, gentle childbirth is most likely to happen at home with granny matrones. In one sense this is good since the women who birth at home have the ability to be very mobile during labor and frequently birth in the squatting position. They receive encouraging words and have a constant companion in the matrones. On the other hand, these homebirths are frequently happening on dirt floors, without sterile instruments and without the skill and medications present to deal with common emergencies and preventable deaths. The matrones still may interpret eclampsia and the need for resuscitation as a result of a curse.

In Haitian hospitals, the problems women encounter have to do with poorly staffed and busy wards, lack of supplies/medications and lack of readily available anesthesia and cesareans. At a local rural government hospital, the cesarean rate is rising due to protocols that prohibit VBACs. The rising rate is also due to poorly educated obstetricians and midwives who do not understand how to appropriately use the medical equipment. Patients are frequently treated like lower class citizens with sharp words, no explanations for procedures and rough physical treatment.

The good news is that more and more birth centers are being started by non-governmental organizations staffed with nurses and midwives who have had training in compassionate and evidence-based care. Although they are few, more are coming. Birth centers are the most promising solution to access to skilled care in rural areas. They offer community involvement with the matrones, partnerships with local medical providers and education for women and their families for long-term health.

Nadene Brunk

Slovakia

Sadly, in Slovakia, very few women experience what could be called gentle/undisturbed birth. Virtually all births happen in hospitals with widespread use of interventions, even when they are not necessary (e.g., extensive use of episiotomy). It is not uncommon for women to encounter disrespectful behavior of health care providers, lack of privacy is standard, and mother’s state of mind is usually not considered an important factor during childbirth. We need more providers who will trust and respect birth enough to disturb it only when truly necessary.

Iva Jancigova

Ghana

In times past when homebirth was the norm, birth was gentle and undisturbed. Now most women are birthing in the hospitals in the care of tired midwives (they care for huge numbers of mothers). Birth is now the mass production of babies filled with all kinds of interventions with the “just in case” justification. Women enter labour wards in fear and tension wondering if they will also be counted among the mortality.

Women labour all alone with no support. It is sad. “Gentle birth” is not in the vocabulary of midwives here.

Abena Odum Okra


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Letters

Dear Ms. Tritten,

Doctors Without Borders/Médecins Sans Frontières (MSF) is an international medical humanitarian organization bringing medical care to people in crisis regardless of race, religion or political affiliation.

We would like to invite you and your readers to our upcoming LIVE Recruitment Webinar for Midwives and Nurse-midwives. Join our recruiters and a New York-based nurse-midwife and MSF aid worker for a special presentation and Q&A session. Learn about global career opportunities and how you can be part of the MSF mission.

LIVE Recruitment Webinar for Nurse-midwives and Certified Midwives
April 24, 2014 7:00 PM Eastern time
Join us by telephone and online.

Go here to register and reserve your spot.

Sincerely,
Ria Benitez-Combes, Field HR Volunteer
Doctors Without Borders / Médecins Sans Frontières


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