Photo by Caroline Brown
Wisdom of the Midwives – Issue 147
Midwifery Today, Issue 147, Autumn 2023.
Join Midwifery Today Online Membership
On Gratitude
Gratitude does not silence my voice. Gratitude leads my advocacy. It reinforces my circle of strength and protection for my clients and their right to a safe and sacred birth. Gratitude does not mean being mild and acquiescent. Gratitude helps me find the person on the team who will step up, support, bend—or apply—the rules so my clients get better care. Gratitude can help my clients stay clear and focused. Gratitude might create a space for change on an individual level that creates an institutional memory of a different way to function. Gratitude can change a single birth in a single moment and can help make an inroad in the big picture. It’s life work. It’s heart work.
—Sena Johnson
Thoughts about Labor Pain
Pain is an output of the brain—not the uterus—and parents can do a lot to modulate pain perception.
—Tracy Donegan
Usually, pain means something is wrong. Labor is the only positive pain that exists.
—Christina Zingrich Gazdag
It’s pain with a purpose. It’s a physiological, not pathological, event in most cases. It’s blood, sweat, poop, vomit, and tears sometimes. But that’s okay. When women come into labor expecting that if they just do some method right, there won’t be pain, they are completely unprepared for reality. For some women, there isn’t as much pain, discomfort, intensity, etc., as for others. But painlessness is not something that you can study your way into.
—Kate Aseron
Talking About Postpartum Sexuality with Clients
One of the biggest things that I impress upon them is to not have sex, including anal sex, until mom is 100 percent sure that she feels comfortable physically and emotionally. I instruct partners to take extra-special, gentle care, including using extra lubrication and to wine and dine her as though they are trying to get her in bed for the first time. I talk about how, while things get stretched out, they typically go back to normal. There may be things that the couple didn’t like before that they may like now or things that they liked before but don’t like now. It is a time of exploration and experimentation with each other again. I try to impress upon them the importance of making sure that they take it slow and that, even if breastfeeding, they need to continue to use a form of barrier or natural family planning until they decide to have another baby.
—Ranee LaPointe
Once the tear is healed (if applicable) and the bleeding has stopped (signaling that the uterus is healed), then couples can resume sex when it sounds good. Some people are ready at two weeks and others aren’t ready at two months! Also, lube is your best friend if breastfeeding, and loads of foreplay, which includes partner doing dishes, laundry, giving massages, etc.
—Kat Barron
I tell them to beware the morning knock and always use protection.
—Barcelona Midwife
I tell them to resume only when mom is ready, use lubricant, expect milk release, and let’s discuss contraception first.
—Pamela Golliet
Interventions
You should not have to justify not doing an intervention but, rather, justify why you need to intervene. The question should be, what research do you have for going against physiological norms?
—Jane Wines
Delayed Cord Cutting
Dozens of studies and hundreds of articles support delaying clamping until the placenta has fully drained. Since this generally takes longer than five minutes, the placenta is frequently delivered before clamping. But there’s an excellent and very large comparison study of physiologic third stage from Australia, which defined physiologic third stage as cord clamping after delivery of the placenta. It showed that this reduced maternal hemorrhage by about half, compared to active management. So, most of the studies are looking at benefits in babies but that one is very clearly related to the mothers.
—Gail Hart
I wait at least an hour, especially at my Amish births. Typically, once the cord is cut, the grandmas feel the immediate need to bathe baby (barely lukewarm water, usually) and get baby dressed. Then, it’s hard for mom to get her baby back. When the cord hasn’t been cut, baby is still attached and that keeps baby skin to skin and breastfeeding.
—Rebekah Knapp
I worked with Robin Lim during the Typhoon Yolanda response. Her cord-cutting protocol was four hours after birth. Hundreds of birthing women just walked into the tent clinic with no prenatal care and during the worst natural disaster ever to hit the planet. We saw no postpartum hemorrhage because we also let placenta come in its own versus managed care or Pitocin. We saw no issues with babies or breathing, no jaundice, easy breastfeeding, and no infections. That was all I needed to reconfirm the way I felt and practiced. So now I wait until the newborn exam occurs unless I am asked otherwise. But generally, women are excited to leave it that long.
—Kelly Milligan
