April 1, 2015
Volume 17, Issue 7
Midwifery Today E-News
“Midwifery Education”
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In This Week’s Issue

Germany conferenceCome to Germany This October!

Plan now to attend our conference in Bad Wildbad, Germany, October 2015. You’ll learn from teachers such as Robin Lim (pictured), Elizabeth Davis, Cornelia Enning, Gail Hart, Fernando Molina, Sister MorningStar and Michel Odent. Choose from a wide variety of classes, including Breech, Mexican Techniques, Shoulder Dystocia, Birth Positions and Organic Midwifery.

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Quote of the Week

Intelligence plus character—that is the goal of true education.

Martin Luther King, Jr.

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The Art of Midwifery

I treat the women I work with as friends, not just clients or patients, and nurture our relationships well beyond a strictly health care model. Our visits are open ended, usually an hour or more long, with free phone access in between. I want to know each woman as a unique person, learning what’s important to her within the context of her individual family/friends/spiritual support systems.

Judy Edmunds, excerpted from “My Top 10 Favorite Complementary Modalities,” Sharing Midwifery Knowledge, Tricks of the Trade, Vol. IV, a Midwifery Today book
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Editor’s Corner

Midwifery Education

I love the way I was taught midwifery in the 1970s. After the homebirth of my second daughter in 1976, I knew I wanted to help other mothers have homebirths. In other words, I wanted to be a midwife. I read all that I could get my hands on. There wasn’t Midwifery Today magazine during those days—it sure would have made learning so much easier! Marion Toepke McLean became my midwifery mentor, and she taught me so much! She met with me once a week and taught me the foundations of midwifery. At the same time, I was part of a birth co-op that allowed me to attend homebirths, learn hands-on prenatal care and help with postpartum care. It was very personal and loving, and we really got to know the families.

Later in my learning process, Marion obtained a curriculum from a nurse midwifery program and taught me from that, and she continued attending births with me. It was such a great hands-on approach. Everyone needs to have a mentor like Marion!

I think it is extremely important to be able to go to prenatal visits and births as you are learning the didactic part of midwifery. It is from the women and their babies that we learn the most because every birth is unique and provides a golden opportunity to learn in a very special way. This way of learning keeps the information from becoming fragmented. I was able to start serving families right away while learning a craft in which you are never done learning.

— 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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A Groundbreaking Resource

Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care is a landmark resource for maternity care, midwifery and childbearing families. Dr. Sarah J. Buckley is the author of this unprecedented, up-to-date synthesis of over 1100 studies. The report, along with an ongoing agenda to address its implications within the nation’s maternity care system, is a project of Childbirth Connection Programs at the National Partnership for Women & Families.

The report focuses on four hormone systems that are consequential for childbearing. Chapters consider how each functions when promoted (by policies, environments and capabilities), supported (by direct facilitating care), and protected (from disturbances), as well as the impacts of common maternity care interventions on each system. Another chapter compares the physiologic (spontaneous) onset of labor with birth that is scheduled by labor induction or cesarean section. Human and animal studies and physiologic understandings lend consistent and coherent support to the conclusion that innate hormonally driven processes from pregnancy through the early postpartum period optimize labor and birth, maternal and newborn transitions, breastfeeding and maternal-infant attachment. Abundant evidence also finds that common maternity care interventions can disrupt these valuable processes and limit their benefits. The report also identifies many gaps in knowledge, including possible unintended moderate and longer-term impacts of common interventions. The “Precautionary Principle” is prudent: foster the hormonally-driven processes whenever safely possible and use interventions only when clearly warranted.

Images in the report depict care in hospitals to convey that this type of care can and should be routinely provided in settings where most women give birth. What does this report offer to midwives whose practice is already largely aligned with its conclusions and recommendations? Quite a bit, in fact. This is the back story that helps birth advocates explain to clients, students, policymakers and others why midwifery practice is safe and effective. The report provides an opportunity to strengthen core competencies to encompass greater understanding of hormonal processes and is a core resource for midwifery education programs. Knowledge of hormonal processes is engaging and compelling to childbearing women and can help build their confidence. The report can be used to develop or strengthen position statements, guidelines and protocols. In the United States, it is a mandate for extending CPM licensure to all jurisdictions, for removing barriers to the growth and sustainability of birth centers, and for implementing the ACNM Physiologic Birth Toolkit. Finally, midwifery researchers will find in the report a delineation of gaps in knowledge and priority research questions.

The new report and many related materials are freely available at http://www.ChildbirthConnection.org/HormonalPhysiology (please click here). In addition to the report and key sections broken out as separate documents from the report (executive summary, abstract and top line recommendations and full recommendations), this web page includes a booklet for women, fact sheets for maternity care providers and an infographic for each of these groups. The infographics are available in digital form and as 11 x 17 inch printable posters or handouts. Please investigate, use and share these resources widely.

— Carol Sakala

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Featured Article

Midwifery Education?

What is the purpose of midwifery education? What is your purpose for midwifery education? Has shifting it from the apprenticeship model to the formalized education model improved birth outcomes? Does making midwifery education stream through a formalized route create a profession and a professional that improves birth experiences for women? What does the effect of fear have on the birth outcome? Is there a causative effect of fear for safety that diminishes the goal of a positive outcome, as well as diminishing a mother’s perception of happiness in her birth experience? What long-lasting effects does a professional creation of fear for safety have on a woman’s happiness beyond the birth experience? Has safety become the yard stick by which midwifery education is researched and measured and globalized? Have we succeeded in creating a false sense of security in birth with the presence of a professional?

In the late 1970s and early 1980s in Missouri, you could have your baby at home but you couldn’t have anyone help you who knew what they were doing. By law physicians, trained or not in birthing babies, could have helped you, but they wouldn’t. Truthfully, that difficult situation helped those of us who chose homebirth to be clear and strong and mutually supportive. Gandhi said, “If someone can lead you out of the forest, someone else can lead you back in.” There wasn’t anyone else to trust but ourselves, and that served us very well. The same instincts that guided our ancestors and the animals in the woods around us became our guideposts. My daughters and the children of my friends birthed powerfully at home and those births included the modern-day terms of postdates, small for gestational age, large for gestational age, gestational hypertension, gestational diabetes, premature and prolonged rupture of membranes and meconium-stained fluids. When I was having babies, we didn’t know the names of those conditions, and I believe that lack of professional or official education was to our advantage. We watched for things like general well-being, general happiness, capacity for handling stress and presence of fear. We watched to see if the pregnant mother was feeling better or feeling worse, and we circled close when her time came near. She knew us by name and we knew how she slept, pooped and what she ate. We knew if she had made peace with people and circumstances that surrounded her birth and her baby. It never occurred to us that her body couldn’t do something that her mind was clear about. We didn’t have a point to prove; we had a baby to birth. Many of those stories are in a book I wrote about my nearly 30 years of experiences with instinctual birth, called The Power of Women.

My…intention when I began to seek out midwifery education in the late 1970s was to find a midwife with whom I could apprentice. I wanted to learn how to get to know a mother in seven or so short months so that her honesty, love and power would be comfortable revealing itself in my presence. I followed my mentor everywhere, including the grocery store. After every prenatal appointment and after every birth we would sip tea as I asked questions and she asked me questions. I would ask, “Why?” and “What if?” She would answer straightforwardly and then ask me deeper questions about what I would do and what I was thinking.

If a mother was in labor for three days, my mentor and I lived with that family for three days. We fed children and dogs and farm animals and talked and laughed as I asked more questions. The greatest learning was during those long observations and watching my mentor (as she appeared to be napping on a sofa) say clear as a bell, “Mary Ann, take two steps at a time when you go up and down the stairwell. John, hold her arm as she goes and feed her a bit of banana at the top and bottom of the stairs.” During one shoulder dystocia, as I sat on my haunches and watched a wee one’s head turn dark purple like a rapid sunset, my mentor took a deep breath and said, “Ruth (who was on hands and knees by choice), breathe like I do…” and then she whispered to me, “Put your hands on my hands.” I felt a mountain lion’s power in her hands and wrists, yet she never pulled back with her elbows or arms. That education is still in my mind and vibrates in my body to this day and not a book was opened in her presence. I never brought questions to her from the books I read—the life experience was far richer.

Sister MorningStar
Excerpted from “Midwifery Education?” Midwifery Today, Issue 105
View table of contents / Order the back issue

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Website Update

Read this article excerpt from Midwifery Today magazine, now on our website:

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Birth Q&A

Q: What do you think is the best approach to midwifery education?

— Midwifery Today

A: I have been inspired to see a shift towards a more holistic approach to midwifery education, including the acknowledgement that pregnancy, birth and early parenting is a whole-of-family event, while keeping women at the center of their experiences. I see motherhood, parenthood, relationships and fathers making their way in and the midwifery education space formally expanding. Midwives have been informally doing this work forever.

— Darren Mattock

A: I am working within an African context, so that is the perspective I am coming from. There needs to be a balance between life-saving skills, specifically for low-resourced settings, as well as an emphasis on compassionate care. There needs to be respect and an honoring of cultural customs/beliefs.

— Ruth Ehrhardt

A: Hands-on apprenticeship.

— Jeanne Ohm

A: I say apprenticeship! Work with as many people as you can with a heavy emphasis on a classical midwifery model! And of course study, read, study! Ask questions. Buy a doll and pelvis to practice maneuvers with, and feel as many pregnant bellies as possible. Allow each birth to teach you, and contemplate and learn from every resourceful event. From the beginning, learn how not to be afraid.

— Carol Gautschi

A: The educational component, meaning the academic portion of midwifery with free knowledge, is actually small compared to the physical, emotional and interpersonal components of helping a woman to birth. The academic portion truly could be done in a few months if it were combined with real life care and labor and birth experience. The perfect model would be a very large homebirth practice with school a day or two a week, and then assist at birth the other days, eventually doing birth under supervision over and over and over again. After about 50 births, you will begin to get the hang of it, but it will take at least 100 before you really begin to get a glimmer of how birth works.

— Gail Hart

A: I think the best approach to midwifery education is apprenticeship. There is no better place to learn than by the sides of highly skilled, wise women. No amount of schooling prepares you for real-life situations like first-hand experience can!

— Rachel Curnel Struempf

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