Where do we learn the most about birth? I think we learn most from the mothers and babies on their journey. Can we separate core midwifery skills from the face-to-face meeting of the mothers and getting to know them and walking on their journey with them? Our core midwifery skills must attach directly to the kind of prenatal care we provide, our attention at births and our encouragement and care postpartum. There is no substitute for experience.
Preventing and dealing with complications are also the core of midwifery. We need to know what to do when a mom actually needs assistance. Hemorrhage and shoulder dystocia prevention and treatment are key skills. Since there are so many different ways of dealing with each of these, I think they need to be taught and studied over and over. New remedies come up. Old ones resurface. I believe the use of the placenta, membranes and cord to stem hemorrhage is one of the best lifesaving re-discoveries I have learned. The Gaskin maneuver for shoulder dystocia is another skill that has been re-added to the midwifery knowledge base in the last 20 years.
Newborn resuscitation knowledge is another lifesaving skill. Sister MorningStar, one of our fairly regular speakers at conferences, has developed a new course. It incorporates using the mother and her voice and touch alongside other mainstream techniques.
We concentrate on core skills in our magazine and at conferences. Because our knowledge in midwifery is expanding constantly, Midwifery Today’s goal is to to bring these new and old ideas to you so you have many ideas that can work into your knowledge base and decision making.
Another core skill involves knowing when to transfer care; this is tied in directly to knowing your limits. This can also be lifesaving. Some babies need more help to be born. Some need a cesarean to save their life or their mother’s life. Though there is a cesarean epidemic, some babies still must be born that way. The ability to know when to transport is key to a homebirth midwife’s skill set. This requires knowing a lot about birth. Again, experience is the best teacher here.
There are even core skills we may seldom use as a midwife. Many of us do not do breech births but we all need to know what to do if we are surprised by one. We teach this at each conference along with other core skills.
There are so many lifesaving tips we can learn, which is why we have always had Tricks of the Trade in our magazine and also at conferences. These tips may not be core skills but knowledge of just one can save a life. We never know when we will need something we learned, even though we thought, “Well, I would never do that!” There is so much we can learn from each other that I would add listening as a very important key skill.
Love, kindness, integrity and respect are necessary qualities to have at birth for midwives, doulas, doctors and anyone else who is touching or dealing with the sacred ground of pregnancy and birth. Whereas these are attributes and a bit difficult to teach, respect is one that might be able to be taught.
This little story might aid you in that effort. My dear friend Mabel Dzata from Ghana used to tell this story at conferences. When she first came to the US, she had already attended 2000 births. In the late 1970s, we could barely imagine being a midwife who attended that many births, and so we really looked up to her. When she was a student midwife, she and all of her fellow students were so excited about gaining experience. They needed to do a dilation check on a woman and all vied for the chance to do it. Mabel won out and stuck her hand in the woman and suddenly felt an awful pain. She pulled her hand out, took her glove off and her finger began to swell to twice its size. She was scared and horrified, so she went back to her village and told the story to her grandmother. Her grandmother, not very sympathetic, said, “Did you ask permission?” Well no, she indeed did not. Her grandmother told her that when you go into a place that private, or when you do anything to another, you ask permission. It is a lesson in respect Mabel learned very graphically and kinesthetically. She never forgot it and indeed has taught it to many of us.
Always ask permission to touch a woman. We do not know what she has been through, and it is disrespectful not to ask permission to do something to someone. Another area in which we could use respect is how we treat each other as birth practitioners. We should always have respect for each other and the work we do. What would the midwifery world look like if this one act of respect were truly given to women? Together we can change the world but not when we devour each other. Let’s join forces and be a safe place to land for others in our field.
Toward better birth,
— Jan Tritten