|September 10, 2014|
Volume 16, Issue 19
|Midwifery Today E-News|
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In This Week’s Issue
Attend the full-day Shoulder Dystocia and “Malpresentations” class with Tine Greve and Gail Hart
In Part 1 of this two-part class you will hear about the mechanical and physical causes of shoulder dystocia; the associated risk factors; symptoms and signs to predict it; and tools to remedy it. Tine and Gail will also analyze tools and methods used to overcome panic reactions and demonstrate effective treatments. Part 2 will give you an in-depth look at malpresentations and mal-rotations; their likelihood and causes; palpation methods to identify them and the techniques for assessing and dealing with them.
Join us in Eugene in 2015!
Plan now to attend our conference in Eugene, Oregon, next March. You’ll be able to learn from teachers such as Gail Hart (pictured), Elizabeth Davis, Robbie Davis-Floyd, Fernando Molina, Sister MorningStar and Michel Odent. Choose from a wide variety of classes including full-day classes on Midwifery Skills, Breech Birth and Essential Oils.
Quote of the Week
Birth is not only about making babies. Birth is about making mothers—strong, competent, capable mothers who trust themselves and know their inner strength.
— Barbara Katz Rothman
Do you like what you’re reading? You’ll get even more content when you subscribe to our quarterly print magazine, Midwifery Today. Subscribe here.
The Art of Midwifery
[H]ow the body goes about getting a baby out of the body is an extremely amazing feat. This seems downright impossible if you look at the size of a newborn baby and the size of the pelvis, especially the vaginal opening. What does make it possible is the way both the baby’s head and the mom’s pelvis are able to shift their sizes. The fetus’s cranial bones overlap to make it smaller, and the pelvic inlet and outlet are made larger by the movement of the pelvic bones as the baby passes through.
— Lynn Schulte-Leech
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Helping VBAC Moms
I recently posted these questions to my Facebook page, “Do you do VBACs? Do you do anything extra to help these moms? How do you help them handle their fears?” I especially like the encouraging answers I received from Patricia Edmonds and Sherri Holley:
From Patricia Edmonds: I cherish caring for VBAC mammas. They are so invested in working for their births—well, all my mammas are, but there is something so special about seeing a VBAC mother’s courage and walking with her on her journey. Whether it ends with a vaginal birth or with a repeat cesarean, she claims this new experience, makes solid choices and continues her journey to healing. I spend lots of quality time with VBAC mothers in their own homes where they will labor and birth. I sit with them for as long as it takes to answer every question and to guide the family through all the “what if’s.” I try to prepare her to love and accept this baby’s birth no matter how that comes to be.
From Sherri Holley: After just having done VBAC #601, I have to say that I am very comfortable with attending them. I only needed to transport six of these VBAC births, with none of them being emergency transports and only two requiring a repeat cesarean. I certainly understand the fears associated with VBACs, but my clients are very well-educated by their own research and that, coupled with the things we go over together, helps to make the births successful. I always say, “You have to prove to me that you can’t give birth vaginally, because I know you can!” I am not foolish, and I choose my VBAC clients carefully. However, I only take a few kudos for my VBAC success, because it truly is what my clients do that always impresses me and helps to make the births successful. I have never seen a rupture with a VBAC birth, but I am not cocky about it either and realize it can happen.
I was a part of an active midwifery practice many years ago before I started Midwifery Today. At that time, there wasn’t the cesarean epidemic that we currently see in this country. I started MT in 1986 and began to wind down my homebirth practice. My partner and I only had one VBAC request and since we were uncomfortable about the possibility of a uterine rupture, we didn’t take on this birth. This woman’s VBAC ended up going smoothly under another birth practitioner’s care, and I have to say that I have learned so much about the safety of VBAC birth since 1986! Bravo to all you midwives who help these moms heal through normal birth!
— 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.
Greetings everyone! We’re slowly coming closer to our first conference in Australia this November, and we are incredibly excited to bring you such an enriching and unique program, all in the scenic beauty of Byron Bay.
We’ve also just put up the program for our Eugene, Oregon, conference, which will take place March 18–22, 2015. The theme for this conference is “Birthing with Love Changes the World.” We are thrilled to bring you a fresh and exciting program, including a new Midwifery Today speaker, Diego Alarcon. Diego is an obstetrician working in Quito, Ecuador. He owns and runs a small hospital with a beautiful waterbirth center which occupies the whole upper floor of the building and is decorated with his paintings. He primarily takes photographs at births, but he puts on his highly skilled obstetrician hat whenever a humane cesarean is needed. The loving focus he gives his work was the inspiration for the theme of this conference.
In addition to Diego’s classes, we will have a roster of other phenomenal speakers and a diverse array of class offerings. You can find out more on our website. Our online registration form will be up and running soon; in the meantime, you can register via mail, fax, or over the phone. Be sure to take advantage of our early bird prices and discounts for subscribers and students.
We appreciate your support, and we look forward to seeing you at a conference in the future!
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Pelvises I Have Known and Loved
What if there was no pelvis? What if it was as insignificant to how a child is born as how big the nose is on the mother’s face? After 20 years of watching birth, this is what I have come to. Pelvises open at three stretch points—the symphisis pubis and the two sacroiliac joints. These points are full of relaxin hormones—the pelvis literally begins falling apart at about 34 weeks of pregnancy. In addition to this mobile, loose, stretchy pelvis, nature has given human beings the added bonus of having a moldable, pliable, shrinkable baby head. Like a steamer tray for a cooking pot has folding plates that adjust it to any size pot, so do these four overlapping plates that form the infant’s skull adjust to fit the mother’s body.
Every woman who is alive today is the result of millions of years of natural selection. Today’s women are the end result of evolution. We are the ones with the bones that made it all the way here. With the exception of those born in the last 30 years, we almost all go back through our maternal lineage generation after generation having smooth, normal vaginal births. Prior to 30 years ago, major problems in large groups were always attributable to maternal malnutrition (starvation) or sepsis in hospitals.
Twenty years ago, physicians were known to tell women that the reason they had a cesarean was that the child’s head was just too big for the size of the pelvis. The trouble began when these same women would stay at home for their next child’s birth and give birth to a bigger baby through that same pelvis. This became very embarrassing, and it curtailed this reason being put forward for doing cesareans. What replaced this reason was the post-cesarean statement: “Well, it’s a good thing we did the cesarean because the cord was twice around the baby’s neck.” This is what I’ve heard a lot of in the past 10 years. Doctors must come up with a very good reason for every operation because the family will have such a dreadful time with the new baby and mother when they get home that, without a convincing reason, the fathers would be on the warpath. Just imagine if the doctor said honestly, “Well, Joe, this was one of those times when we jumped the gun—there was actually not a thing wrong with either your baby or your wife. I’m sorry she’ll have a six-week recovery to go through for nothing.” We do know that at least 15 percent of cesareans are unnecessary but the parents are never told. There is a conspiracy among hospital staff to keep this information from families for obvious reasons.
In a similar vein, I find it interesting that in 1999, doctors now advocate discontinuing the use of the electronic fetal monitor. This is something natural birth advocates have campaigned hard for and have not been able to accomplish in the past 20 years. The natural-types were concerned about possible harm to the baby from the Doppler ultrasound radiation as well as discomfort for the mother from the two tight belts around her belly. In l999, the doctors joined the campaign to rid maternity wards of these expensive pieces of technology. Why, you ask. Because it has just dawned on the doctors that the very strip of paper recording fetal heart tones that they thought proved how careful and conscientious they were, and which they thought was their protection, has actually been their worst enemy in a court of law. A good lawyer can take any piece of “evidence” and find an expert to interpret it to his own ends. After a baby dies or is damaged, the hindsight people come in and go over these strips, and the doctors are left with huge legal settlements to make. What the literature indicates now is that when a nurse with a stethoscope listens to the “real” heartbeat through a fetoscope (not the bounced back and recorded beat shown on a monitor read-out) the cesarean rate goes down by 50 percent with no adverse effects on fetal mortality rates.
Q: What do all aspiring midwives and doulas need to know about the pelvis?
— Midwifery Today
A: [The pelvic bones] are like the jaws of a snake—they detach.
— Aline Dowd
A: It’s flexible!
— Rosie Pearl
A: They should know about the shape of a normal gynaecoid pelvis, the different types of pelvises. They should also learn pelvic assessment in order to identify abnormality, shape and position of the fetal head in relation to the pelvis to be sure it can allow the fetal head. Finally, they should know the functions of the pelvis.
— Amaka Elochukwu
A: Being upright lets gravity help the pelvis to open and aids the descent of the baby during labour.
— Stephanie Closset
A: Moms need to listen to their bodies and move their pelvis in whatever direction or speed they need to—this helps the baby come down. Being stuck in one position and unable to move can be devastating for this process.
— Lulia Kas
A: It’s impossible to judge a pelvis’ size and ability to birth just by looking at it!
— Micheline Walkey
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