|September 24, 2014|
Volume 16, Issue 20
|Midwifery Today E-News|
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Midwifery Today’s Prolonged Labor Handbook discusses the benefits of positioning, trusting birth, and the political ramifications of time assessment and responsibility. You’ll also learn ways to prevent prolonged labor, including herbal remedies and psychological assessment. Part of the Holistic Clinical Series,the Prolonged Labor Handbook belongs in your birthbag! To order
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In This Week’s Issue
Learn about midwifery skills from around the world
Come to our conference in Byron Bay, Australia, this November. You’ll be able to choose from classes such as Prolonged Pregnancy with Gail Hart, Undisturbing Birth with Sarah Buckley, and Placenta as Medicine with Jodi Selander. Plan now to attend.
Learn how “Birthing with Love Changes the World”
Come to our conference in Eugene, Oregon, next March and learn from teachers such as Yeshi Neumann (pictured), Carol Gautschi, Marion Toepke McLean, Gail Tully and Suzanne Thomson. Classes you can choose from include Essential Midwifery, Hemorrhage and Estimating Blood Loss, A Day with Michel Odent, and Mexican Traditions and Techniques.
Quote of the Week
Patience, persistence and perspiration make an unbeatable combination for success.
— Napoleon Hill, an American author widely considered to be one of the great writers on success
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The Art of Midwifery
The first thing I do for a woman with obstructed labour is to ask her to go for a short walk. If there is a stairway in the house, I ask her to walk to the top and down again. I explain to her that the changes in posture, particularly in the movement of the lumbar spine, frequently enable baby to alter the position of its head. The head then enters the pelvis, causing descent and moulding to start. Moulding is a valuable clue in these cases; the head propped on the brim does not mould, but as soon as progress commences, the moulding sagittal suture becomes easy to feel. This simple trick works so often that it is crazy not to try it.
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 firstname.lastname@example.org.
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Altering the Natural Process of Birth
[Editor’s note: This issue’s guest editor is Carla Hartley.]
Altering the natural process of birth is a risky experiment and actually adds more risk factors. Midwives need to stop interfering with this normal biological process, which often happens because of their lack of education about the physiology of birth. Under-education or miseducation may be the source of fear, or it may be that fear is predicated on the need to be the hero or the saver of women from birth, so being peripheral rather than essential becomes the fear.
Most of the time, women do not need anyone to save them or their babies from birth. They most often just need to be left alone so they can finish what they started. As Barbara Harper says, “Let’s stop working on how to get the baby out and concentrate on how to let the baby out.” If intervention is needed, then make sure the mother and baby get the help they need, but do not interfere first “just in case.” Trust that the mother and baby know what they are doing; assist and support unless a medical event presents itself, and if it does, be sure you know what to do without exacerbating the problem. Get help from a medical professional for any medical problem and stop playing doctor at home.
I find it ironic and sad, really, that most of the natural birth hecklers out there are also the most medically dependent—the ones who tell mothers what to do, who expect all mothers to tear and to bleed, who think that drugs and oxygen are necessary, who don’t think induction is risky, who interfere with the physiology of birth and third stage without a thought for what they are changing about the entire future of the baby and mother. Birth is not safe in the experience of these hecklers, but that is not the way birth is designed or the way it would be without the unnecessary interferences. I trust birth and the mother and baby who own it!
Carla Hartley created the first distance academic program for midwives in 1981. She is the author of Helping Hands: The Apprentice Workbook, which was first published in 1988. In 2005, Carla founded the Trust Birth Initiative and Birthtruth on Labor Day individual advocacy events. Carla is the mother of four and Baba to eight, with one on the way.
Prolonged Labor in the Hospital Setting
The single most important clinical decision to make to avoid the pitfalls of managing prolonged labor in the hospital setting is to not admit women until they are truly in labor—preferably in active labor. Prenatally, we tell women who come to our clinic to stay home as long as possible (except in high-risk cases where there is greater concern for monitoring mom and baby).
We instruct them to stay home generally until contractions are five minutes apart, lasting a minute long, for at least an hour. We also suggest they pay attention to the intensity of the contractions and stay home until they can’t talk through them and need to focus all their attention on their labor. Obviously we individualize these instructions depending on how far away they live, if they have someone to be with for early labor support, if they have reliable transportation, and so forth.
Some women insist on coming in sooner. They call back multiple times and are worried about staying home, or their family members are scared and want to bring them in despite what we encourage them to do. In that case, we usually end up “walking” them—sending them to ambulate for an hour or two at a time down hospital hallways, rechecking them for cervical change.
Read Jan Tritten’s editorial from the Autumn 2014 issue of Midwifery Today magazine, which just arrived from the printer!
Q: What is the longest labor you have had and how did it turn out?
— Midwifery Today
A: Two clients had four days of hard labor. (I don’t remember how long the prodromal labor was.) There was slow but steady progress in both and both resulted in the homebirths of happy, healthy babies to tired but ecstatic moms! The one who was a single mom, never married or had any more babies. The other couple went on to have four more kids.
— Marlene Waechter
A: I think how this question gets answered depends on how you calculate the length of labor. I typically calculate the length of labor from the start of active labor. I’ve seen moms labor in stages, i.e., with hours of regular strong contractions that disappear for 12 hours and then pick back up later—I don’t count those hours of resting in the middle. So if you’re counting from that viewpoint, the longest I’ve attended as a midwife was 46 hours. If you’re counting from say PROM until birth, I’ve seen six days. From the first strong contraction to birth, I’ve seen grand multips go with sporadic contractions for weeks.
— Anita Woods
A: The longest was 46 hours and it was my own. The birth was prolonged by OP position, ignorance, lack of support and fear, and it ended with a caesarean. Now with my own clients, I ask them to ignore contractions and rest in between rather than do hours of walking to try and “get labor going.” I ask them to leave the iPhone contraction app alone and to instead eat, drink, smooch and snooze. Babies often get exhausted, as mum does.
— Alison Reid
A: Forty grueling hours—I never left her side. I don’t think I peed the entire time. It started with PROM and then eight hours of triage and monitoring. She started at 0 cm and achieved a vaginal birth in the end. The baby was floppy, though, and needed major resuscitation, but she is gorgeous and healthy now.
— Teresa Fox-Magri
A: Eight-six hours. There was a really short cord. Baby was born fine at home.
— Samantha Rossi
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