July 20, 2016
Volume 18, Issue 15
Midwifery Today E-News
“Second Stage”
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In This Week’s Issue



Take advantage of the Weekly Special and save $8 on the Beginning Midwifery Audio CD Set

MT storeWhen you order this set, you’ll be able to listen to four inspiring and experienced midwives as they share their wisdom on a variety of topics, including prenatal care, nutrition, trauma, diet, depression and sexual abuse. This vital information will help you get a good start on your midwifery education and will introduce you to some of the most important things to remember about working with women and how to do it with integrity and compassion. Offer expires August 1, 2016. No coupon needed. To order



Get second stage advice in e-book format!

MT storeDownload Second Stage: The Pushing Phase of Labor, a collection of 10 articles from Midwifery Today magazine. Articles include “Understanding Stages of Labour after the Paradigm Shift” by Michel Odent, “Midwifing Second Stage” by Sister MorningStar, “Supporting Motherbaby in Second Stage Waterbirth” by Cornelia Enning and “Getting to Second Stage” by Carol Gautschi. To order

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Quote of the Week

There is no other organ quite like the uterus. If men had such an organ, they would brag about it. So should we.

Ina May Gaskin


The Art of Midwifery

The second stage of a waterbirth is indicated by prolonged breaks, up to 10 or 15 minutes, and changing fluid intake. Many laboring women drink tea or juice during the first stage, but demand fresh water at the beginning of the second stage. Having the woman soak in slightly cooler water will help relieve an early urge to push; the baby’s heartbeat won’t drop and the safety of motherbaby will be supported during birth. Finally, a prolonged crowning and birth of shoulders caused by a stable placenta supply will enable mother and baby to come to initial eye-to-eye and skin contact.

Cornelia Enning
Excerpted from “How to Support the Autonomy of Motherbaby in Second Stage of Waterbirth,” Midwifery Today, Issue 98
View table of contents / Order the back issue



What is a rebozo and what do you do with it?

Strasbourg conference Attend the Rebozo Techniques and Practice class to find out! Mirjam de Keijzer, Eneyda Spradlin-Ramos and Thea van Tuyl will show you how to use a rebozo, demonstrating simple techniques that promote healthy pregnancy and birth. You’ll be able to practice these techniques yourself during the hands-on portion of the full-day class.

Learn more about the Strasbourg, France, conference.



What is the Heart and Science of Birth?

Eugene conference Attend our conference in Eugene, Oregon, next April and find out! You will have the opportunity to learn practical skills and discover important new information, including information about the Microbiome. And, as always, our hope is that you return to your practice refreshed, renewed and ready to help moms and babies.

Learn more about the Eugene, Oregon, conference.



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Editor’s Corner

Hospital Changes

I’m hopeful that new scientific evidence regarding birth, such as information about the microbiome, will have a positive impact on hospital protocols. Recently, there was an encouraging article published about the hospital in my town. The local paper’s headline read, “Friendly Greeting: Hospital Does Things Differently to Help Newborns.” It was the story of a cesarean birth, but what was different is that the baby was put right into mom’s arms, skin to skin, and not taken away immediately to be washed, weighed and scrubbed—although the baby did have a bracelet on in the photo. According to the article, keeping this mom and baby together was done to promote bonding and to initiate breastfeeding (three cheers for my local hospital!).

This is such good news because the article stated that this hospital is one of 340 baby-friendly hospitals in the US. Since most American women still have their babies in a hospital, it is of utmost importance that hospital policy makers understand the impact of the microbiome. The article stated that the hospital’s biggest barrier to change was the attitudes and behaviors of the staff. But, they were persistent and it paid off. A definite victory for motherbaby!

The hospital said they also refuse to accept baby formula samples. Refusing to accept these samples is costing this hospital $35,000 since they now have to buy their own formula for the babies who really need it. That is very commendable. It gives me more hope in our hospitals. I hope many of these baby-friendly hospitals will also become mother-friendly. Read about the Mother-Friendly Childbirth Initiative.

— 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

A Full Day with Michel Odent

In mid-October of this year, Midwifery Today will be traveling to France for our “Birth Is a Human Rights Issue” conference. What an event this will be! From our impressive roster of teachers, including Michel Odent, Gail Tully and Ágnes Geréb, to our informative classes on topics such as breech birth, twins and tear prevention, this conference is sure to ooze with technical information, encouragement, classical midwifery knowledge and buckets of love and support. It is always Midwifery Today’s goal to provide you with a rejuvenating experience so that you can go back to your home and be ready to affect positive birth change in your community.

One of the classes we are very excited about is the full-day workshop with Michel Odent, “A Thousand and One Questions.” Going with the theme of this E-News of Second Stage, Michel has a lot to say about physiologic pushing and how best to support a mother as she goes through the second stage of birth. You won’t want to miss this class from a man who has decades of experience supporting women in natural birth. Plus, France is his home country, so he is sure to be in his element!

Please note: The deadline for a discount on conference prices is Monday, August 1. (However, registrations are accepted until as well as at the conference, October 19–24.)

— Nancy Halseide, managing editor

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Featured Article

Getting Pushy

The final question on the final exam for the Obstetrics I class I teach at our local midwifery school is this: A mother is in labor and has reached full dilation. It seems the contractions have slowed almost to a stop, and the mother appears to be almost resting—what is happening and what should you do? After a full year of classes, a few students still answer, “Dystocia—get her up and moving.” Or, “Apply oxytocics.” Or, “Tell her it’s time to push.” To my relief, the rest will give the correct answer: “Mother is in the interim phase; all is normal, and when she is ready and the baby descends, she will push.”

Midwifery education often trains future midwives to look for and be experts in spotting problems, so they can prevent and treat them over learning to really know and honor what is normal. In the rushed nervousness of the final exam, one may first assume the scenario is a problem—but this is part of my point. We’ve become pushy about when women should push. It’s been ingrained in our training, and in childbirth preparation classes, too.

We tell pregnant women, “…then you’ll reach 10 cm and you’re ready to push.” And push and push and push! We seem to have stopped wondering why we do it like this.

“You’re 10 cm—do you feel like pushing? Feeling a little pushy? Let me know…give it a try…”

In many hospitals, medical staff still use the Kristeller maneuver to help labor along, having a nurse or doctor press down as hard as they can on the uterine fundus to “bring the baby down.” Midwives and doulas coax in a kind way. We sternly and steadily coach women to push push push! And they will push for hours—frustrated, exhausted, strong.

According to Michel Odent, women have a “fetal ejection reflex” in which the baby and the mom move labor when they are ready. I have found, in over 30 years of assisting childbirth, that sometimes a woman will dilate fully, then have contractions and not experience the “urge to push” for up to a few hours. And when she does, the baby crowns in a matter of just a few contractions, whether or not the mother was “pushing.” What’s happening?

I think that when we agreed upon the stages of labor we forgot a stage or two in between. Stage 2.5, say, which midwife Whapio Diane Bartlett, in her workshops, eloquently identifies as “the quietude”—that phase of inner resting and integration for both mother and baby that happens after fully dilating and before descending. Some mothers and babies require very little time for this, while others—especially larger babies, those in compound or posterior positions and first-time mothers need a little time to prepare for the next moves and find their way.

Alison Bastien
Excerpted from “Getting Pushy,” Midwifery Today, Issue 98
View table of contents / Order the back issue


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Featured Products

Mandala Pendants make lovely and inexpensive gifts

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Do you work with laboring women?

MT store If you do, you need Midwifery Today’s Second Stage Handbook. This book explores how to best serve women at this crucial stage. You’ll learn from expert practitioners as they reveal their observations on when to push, what works and choices available for the mother. To order



Are you ready for birth emergencies?

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Learn tricks and tips from practicing midwives

MT store Birth Wisdom (Tricks of the Trade, Volume III) is packed with information that will encourage a natural approach to safe childbearing. Topics covered include remedies, pregnancy, birth and postpartum. To order



Gain a fresh insight into the amazing journey each woman takes in becoming a mother

MT online store The Big Stretch DVD presents women in different stages of pregnancy as they prepare for a natural birth and reflect with their partners on how they are “stretched” in every way—emotionally, physically and spiritually. Topics explored include breath awareness, pain and the intensity of birth, body awareness, relationship and personal transformation, asking for help and women’s challenges. To order



Website Update

Read this article excerpt from the Summer issue of Midwifery Today magazine, now on our website:

  • Prevention of the Primary Cesarean Section: Facts, Myths and Tips—by Vijaya Krishnan

    Midwife Vijaya Krishnan gives the readers of Midwifery Today a helpful article that will educate them on how best to avoid a primary cesarean. Excerpt: “Not long ago, when a woman conceived and had a healthy pregnancy, she took it for granted that she would give birth naturally, the way nature intended. However, we have come to such a tipping point now that when women give birth naturally at our birth center, relatives and friends are surprised that she had a normal delivery.”


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