April 16, 1999
Volume 1, Issue 16
Midwifery Today E-News
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Broaden your education in the United Kingdom and Jamaica!

Make plans now to attend one or both of these conferences:

United Kingdom, September 9-13, 1999
Evidence Based Midwifery
Program available now.

Ocho Rios, Jamaica , December 2-6, 1999
Birth Without Borders--Weaving a Global Future
Program available in May.

For your copy of the printed programs send your full name and postal address to inquiries@midwiferytoday.com. Please mention code 940.


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This issue of Midwifery Today E-News is brought to you by these sponsors:

- Baby T's Gifts for Families
- Juneau Family Birth Center
- Missouri Birth Center/Diane Barnes
- The Keeper
- Waterbirth Website

Look for their ads below!


In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Obtaining an Education
5) Question of the Week
6) Switchboard
7) Commentary: Apprenticeship
8) Coming E-News Themes


1) Quote of the Week:

"You can't get a diploma for sitting and waiting patiently. You can't get a degree for talking someone through a stressful and painful experience in a supportive way. You can't get a doctorate for knowing in your bones that something isn't quite right. And so it is that one of the greatest problems for midwives is that their knowledge and skills are often indefinable, instinctive and sometimes not easy to describe."

- Caroline Flint, president, Royal College of Midwives


2) The Art of Midwifery

Fact Cards

Break information down into smaller units. Cut 3 by 5 cards in half and put a vocabulary word on each, the definition on the other side.... Or write facts on these cards; for example, "The normal range for a hematocrit is... " and put the answer on the other side. Keep the cards in your purse. Test yourself with them whenever you're waiting somewhere: during long labors, at the gas station, when you pick up your kids at school, and so on. When you answer the question correctly, put a little dot in the corner of the card.

- Carolyn Steiger, "Becoming a Midwife," Hoogan House Publishing 1987

Guest Speakers

Invite professionals in your community to make a presentation to your study group. When I was first studying midwifery and was part of a study group, a pediatrician taught us about newborn exam, jaundice and so on; an obstetrician taught several courses by request, and a nutritionist, an herbalist and practicing senior midwives also advised us. One hint: When professionals first move to town they are especially good resources to tap because they are not overloaded, and you can help them establish their practice by bringing them clients. Don't forget to invite help from other professionals such as lactation consultants, perinatologists, La Leche League leaders, nurses in many specialties, birth assistants, childbirth educators and doctors. Most people will be honored that you asked them.

- Jan Tritten


At Midwifery Today, we have lots of tricks up our sleeves! Purchase our two volumes of Tricks of the Trade and you'll see what we mean: Save $5 when you purchase both Tricks of The Trade Volume I and Volume II. Only $40 plus shipping! Call today to order: 800-743-0974. For more information, visit the links above.



Midwife directed non-profit birth center seeking an experienced midwife to join two midwives and two midwifery students in beautiful Juneau, Alaska. Email birthcenter@juneau.com or send resume to 3225 Hospital Drive. #106, Juneau, Alaska 99801, attention Kaye Kanne, CDM. Check out our website: www.juneau.com/birthcenter

============THANK YOU!==============


3) News Flashes

A long-term study of more than 10,000 women who underwent tubal sterilization indicates that the procedure often fails. This is especially true in women who undergo tubal sterilization before age 28. The overall failure rate is 1 in 50, and in women under 28, as high as 1 in 20.

- American Journal of Obstetrics and Gynecology, 1996; 174




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============THANK YOU!==============


4) Obtaining an Education by Judy Edmunds, excerpted from Paths to Becoming a Midwife: Getting an Education, a Midwifery Today book

Looking back over twenty years of practice and many hundreds of births, certain things stand out as especially useful in learning the art and science of midwifery.

- Organize a midwifery study group and meet regularly to share information and materials, circulate textbooks and journals, review births attended, critique your methods, and learn from each other's mistakes. Invite guest speakers. My group conducted topical research projects and presented reports.

- Seek formal training for key subjects, such as anatomy and physiology. Nutrition is the foundation of a healthy pregnancy, so the more you learn about it the better. Many colleges offer basic nutrition courses that can be supplemented with personal research. Holistic, at-a-distance modules are available... but be cautious of product-oriented programs.

- No matter what you do, document everything.... Besides its utility as a blueprint for obtaining requisite skills and knowledge, the credentialing process provides a convenient means of recording where, when and how competencies were achieved. By combining a variety of select college courses and workshops, regular conference attendance, an active apprenticeship, volunteer work, and lots of independent study, a motivated student can progress toward primary practice efficiently, even outside a formal program.

- Consider learning in unique ways. Think "outside the box." I took college weight-training classes, which covered weightlifting, applied muscle movement, postural dynamics, diet, metabolism and sports injury rehabilitation. These courses provided a broad understanding of body mechanics and paved the way for in-depth study required for my massage practitioner license.... alongside structural concepts, I highly recommend studying botanical medicine. Pursued on or off campus, you'll find herbolgy, homeopathy, and other complementary therapies indispensable. Watch for workshops, conferences, lectures, intensives, and correspondence programs covering areas you're interested in.

- Subscribe to a variety of journals and newsletters. I cannot overstate the value of this! Share subscriptions with a friend if money is tight, and see what your public library carries. Plan to spend all your extra pennies on pregnancy-related texts. Set goals and read every day.

- Learn to respond calmly and efficiently in a crisis. Maintain certification in first aid, neonatal resuscitation/professional rescuer CPR, PALS, ACLS, and other first-responder type programs. Taking these courses also allows you to meet members of the local emergency response team.... Advanced Life Support in Obstetrics (ALSO) covers a wide variety of perinatal complications and emergency technique.... This stimulating program is guaranteed to improve your professionalism and self confidence.

- Investigate nursing training. Even if you decline to take the full program, you can take individual courses in pharmacology, intravenous therapy, phlebotomy, injections, enemas, catheterization, charting, medico-legal issues, infectious disease updates, and so on. Some urban universities, medical centers and research facilities also present classes on a variety of healthcare topics.... Keep up to date with the latest diagnostic techniques, trends and treatments. I highly recommend advanced levels of HIV/AIDS training, including serologic treating certification and partner notification courses.

- Study suturing diligently. Perhaps you might start privately at first, with textbooks and videos. Closely observe experienced practitioners at work. Confer with senior midwives to help you select your equipment. Begin practicing on inanimate matter. Foam models have their place, but repairing living vascular tissue, sensitive to pain, in the confined space of quivering thighs after you've been up all night is much trickier. At least, work on a chunk of fish or chicken flesh since the texture is much more realistic. Then refine your technique at a midwifery school or conference workshop. (I also worked in a high-volume spay-neuter veterinary clinic where a kind DVM taught me his quick and sturdy stitching style. Think outside the box!)

- Attend as many births as you can because this is where real learning takes place. To students who'd like to be invited more often: Be utterly reliable, helpful and discreet. If you volunteer to be on call, mean it. A valued apprentice works hard on her own studies, not expecting to be spoon-fed and led by the hand. She strives to add something unique and worthwhile to the birth team, not just be a spectator. she prepares creatively in advance and brings her own equipment.

- Judy Edmunds, Paths to Becoming a Midwife: Getting an Education, edited by Jan Tritten and Joel Southern, a Midwifery Today book, 1998


We'd like to help you find the best way possible to realize your dream. Do you want to learn how to be a doula or a midwife? Or change your practice to include new techniques?

Midwifery Today has been helping midwives and aspiring midwives find their way for over twelve years through our magazine, newsletter and books. Paths to Becoming a Midwife: Getting an Education is the second edition of our popular manual, but it's a whole new baby. A big baby. We've revised it from 90 pages to more than 300. University of Texas anthropologist Robbie Davis-Floyd was our midwife, and helped see us through this birthing process. What had seemed at first a short-term project--revising an old standard--became far more.

Our new standard includes articles by many of the midwives and birth educators you know and love: Elizabeth Davis, Diane Barnes, Robbie Davis-Floyd, Judith Rooks, Sharon Glass Jonquil, Judy Edmunds, and many more.

We've emphasized childbirth education and direct-entry programs as well as mapped out certified nurse-midwifery and apprenticeship programs. We've also included chapters on getting started, politics and philosophies, and midwifery into the future. Our resource guide includes a directory of schools and programs as well as valuable information on childbirth organizations.

ISBN: 1-890446-00-9; 332 pages; 7 X 10; $29.95. Order by May 7, 1999 and pay just $25 plus shipping. Be sure to mention code 940.

To order or for more information, email
inquiries@midwiferytoday.com, or call: 541-344-7438,1-800-743-0974 (USA only) FAX 541-344-1422


Learn more from these Midwifery Today issues:

No. 4, The Education Issue
No. 20, Birth Education
No. 21, Education & Training, Part 2

Get these back issues for only $6.00 each plus shipping. (Regular price: $7.00) Call 800-743-0974 to order today! Mention code 940 and save $1 per issue. Expires May 7, 1999.


5) Question of the Week: What are the strengths and weaknesses in your educational path to midwifery? Send your response to: mtensubmit@midwiferytoday.com



Visit the multiple award-winning WATERBIRTH WEBSITE for the most complete waterbirth information available on the net!
Includes a Photo Gallery, over 50 firsthand waterbirth stories from moms, dads and waterbirth practitioners, a tutorial, information on great products you can order, and lots more.

============THANK YOU!==============


6) Switchboard

I am planning to apply to and take courses for lay midwifery through Utah College of Midwifery. Has anyone heard of them? What is the opinion on them and their curriculum?

- Mischa


Thank you to fellow readers who were kind enough to respond to my last letter [E-News Issue 12]. I am pleased to announce that New Hampshire, USA has taken an important step by submitting an amendment in our own state legislature that makes it legal for women to breastfeed in public. Prior to this, a woman could be arrested for indecent exposure while breastfeeding! Thanks for your support!



In response to Rayner Garner's request in E-News Issue 15 for a suitable book in which there is a good description o of the anatomy and biology of the uterus, there is a very good chapter on this topic in a book I have. I have no idea if it is available in the U.S.A. because it is written by a childbirth educator here in Australia. It is: The Midwife Companion: The art of support during birth by Andrea Robertson, Published by ACE Graphics, 1977, ISBN 0 9588015 3 3

- Andrea Q.


I look forward to receiving E-News every week. I find it interesting and informative. I have decided to venture out into the community and offer a variety of services. This is a big step for me as my midwifery background has been hospital based (as it is for the majority of midwives in Australia). I have been providing community based prenatal classes for a number of years. I have enjoyed this as I was not bound by hospital policies and politics. I was able to provide quality information and options for expectant parents.

Providing midwifery services such as prenatal care, homebirth, birth support and postnatal care is exciting and a little scary. I would be interested in hearing how others faced the challenges that independent practice presents.

If you are interested, I have decided to enter cyberspace and start up a website as one of my new ventures. My address is http://member/rivernet.com.au/janepalm/index.html. Let me know what you think.

- Jane Palmer
Pregnancy, Birth and Beyond
Midwifery and Childbirth Education Services


Four weeks ago I had to undergo surgery to remove 2 large cysts from my ovaries (one on each one). They had to take out one of my ovaries because the cyst was so twisted throughout it. I was wondering if there was anyone out there who has been through this, or knows someone who has been through it? If they were able to get pregnant? If they had complications, or if everything went smoothly? It is a very emotional thing that I would like some insight on. I appreciate any comments or thoughts.



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============THANK YOU!==============


7) Commentary: Apprenticeship by Jill Cohen, midwife

It has taken me a long time to reach the point in my midwifery practice where I feel I have something to truly offer an apprentice. I myself was hands-on trained. I had the great privilege to work with midwives, doctors and nurses who wanted to share their knowledge and were willing to teach me in a way that could help me effectively retain and use what I learned. My successful practice reflects what good teachers I had. In turn, it is my dream to pass my knowledge on and preserve the midwifery model of care.

There are many aspects to shaping a good midwife. To me, the most important is the power of observation. Each pregnant woman and her environment is unique, and unless we spend proper time and use good listening skills, so much can get past us. The apprentice must be able to notice in detail what she has in front of her and process that observation quickly. This starts with carefully watching the midwife at work. At each prenatal she will see how the midwife gets to know the pregnant woman as a whole entity. The physical, emotional and spiritual dimensions reveal themselves more and more through touch and talk as time is spent together.

The more the apprentice sees the more she can begin to help. After awhile it becomes second nature to get out the chart and start to document. Soon she is getting the equipment ready for the prenatal and after awhile, she is doing more of the hands-on things such as taking blood pressure, doing urine checks, palpating, and listening to heart tones. At the same time, it is important that she remain patient. The attitude and response of both the midwife and mom dictate the pace at which she advances in these areas, and the apprentice must stay attuned to that and respect it. There is always something to learn and if she is not in a hurry to do so, the time she spends becomes more effective. The birth works in the same fashion. First the apprentice observes, then slowly but surely she incorporates her knowledge and puts it to work.

This kind of slow, careful and thoughtful apprenticeship is incredibly valuable because it ingrains knowledge while it builds confidence. It is concrete and in the present, not abstract and removed. Didactic learning is a natural part of the apprentice's work; it is not set apart in a classroom. She sees, researches, asks questions and formulates her midwifery thinking and accompanies it with solid book learning. Many people propose that because you don't go to school your experience isn't structured and you don't learn as well. But I have found that hands-on experience combined with didactic learning creates better understanding because it is simultaneously gained on many levels.

It is to the apprentice's advantage to work with a variety of midwives in a variety of settings. By the same token, it is every midwife's responsibility to pass on her knowledge. I encourage my apprentices to work as doulas in the hospital, attend postpartum mothers and work with other practitioners when the opportunity arises. I am only one perspective in their education. Our best tricks and techniques are learned from working with many. It takes a lot of time to become a good midwife--practice makes perfect. After years it becomes second nature, and those years pay off if the apprentice is serious. Her skills and abilities will finally be secure and her judgment sound, and she will be fully ready to receive the next generation into her hands.



Missouri Birth Center needs help! Looking for CNM willing to work part time working into full time. Rural practice, full scope, benefits available. Great schools, recreation includes lakes and outdoors to local music, crafts, and Branson entertainment. Call Diane Barnes, 417 272-8845 office, 417-338-5431 home.

============THANK YOU!=============


8) Coming E-News Themes

Coming issues of Midwifery Today E-News will carry the following themes. You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to these themes:

- tear prevention (April 23)
- International Midwives' Day (April 30)
- CIMS (May 7)
- drugs in labor (May 14)
- premature rupture of membranes (May 21)
- doulas (May 28)
- induction (June 4)
- educating the public (June 11)
- episiotomy
- epidurals
- breastfeeding
- waterbirth
- breech birth
- nutrition
- homebirth

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.


This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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