June 11, 1999
Volume 1, Issue 24
Midwifery Today E-News
“Educating the Public”
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Broaden your education in the United Kingdom and Jamaica! Make plans now to attend one or both these conferences: London, England, 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 now.
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Principles for Educating the Public
5) Question of the Week
6) Question of the Week Responses
7) Switchboard
8) Coming E-News Themes

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1) Quote of the Week:

"The best education of the public on childbearing and midwifery is the conscious practice of motherhood and midwifery-being who we are in a way that is respectful of life."

- Marion Toepke McLean, CNM

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2) The Art of Midwifery

One of the first things to tell your new assistant is that if there is any disagreement between you about method or protocol, to please wait until both of you are alone together before the matter is discussed. Never disagree with each other in front of a couple or a person who is not involved in midwifery.

- Debbie A. Diaz Ortiz

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Inundate with letters all television stations that show a birth, either praising the particular program's portrayal, or offering constructive criticism.

- Lani Rosenberger

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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!
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3) News Flashes

Results of a 16-year study by the Medical Research Council [U.K.] have proved that nutrition plays a key role in early brain development, and that optimum nutrition for preterm babies can significantly influence their mental ability in later life. The first segment of the study assigned 400 preterm infants from birth to 18 months old to two groups, one receiving standard formula and the other a nutrient-enriched preterm formula. The biggest difference between the two groups was in motor development, but mental scores were also better in babies who had received the enriched formula. The benefits were particularly striking in small for gestational age infants and in boys. In the second segment of the study, the same babies were tested again at the age of 7 1/2 and 8 years. Infants fed the standard formula had a significantly reduced verbal IQ, while those fed on the nutrient enriched preterm formula performed much better. Analyses on children of both genders showed that verbal IQ below 85 and cerebral palsy were both more prevalent in the group fed standard formula.

- Professional Care of Mother & Child, 9:1 1999 (Editor's note: Imagine the positive results if the babies had been given breastmilk.)

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4) Principles for Educating the Public

How you deliver a message is largely determined by who you intend to reach or what your target audience is. There are some universal health education principles to keep in mind, however, regardless the number being educated. Health educators improve the reception of their message by using a brief reminder known as KISS, or "Keep It Simple, Stupid." Remember that any message, no matter how important and applicable, loses impact if it's too complicated, full of jargon or overwhelmed by detail. Clear, concise and consistent messages serve you well and are less likely to be misconstrued. Another essential mantra for educators is that of "primacy and recency." Target audiences learn--and best retain--what they are taught first and last. Throughout the delivery of your message, utilize any opportunity for modeling. If you can get someone to practice a behavior or even recite an argument through role playing, he or she will be much more likely to change behaviors. Finally, repetition of your message helps reinforce it. We refer to this as "Tell them what you're going to teach, teach them, then sum up what you just taught them."

- Chris Hafner-Eaton, Ph.D. "Birthing Our Message," Midwifery Today Issue 35

Learn more from these Midwifery Today issues: No. 14, Keeping Midwifery Alive (Regular price $7.00) No. 35, Educating the Public (Regular price: $7.00) No. 43, Birth Change (Regular price $10.00) Save $1.00 on each of these back issues! Call 800-743-0974 to order today!
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5) Question of the Week:

Is there any evidence that laboring in the tub after the bag of water has broken increases the rate of infection in mother or baby? I have been unable to find any research to indicate this is so, but every nurse, doctor, and even a couple of midwives are convinced that this is so. What's the real story? Fact or theory?

- Amy Jones, Henderson, NV

Send your responses to mtensubmit@midwiferytoday.com If you would like to submit a Question of the Week, please write to the above address.

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6) Question of the Week Responses

Q: What is your favorite technique for educating the public about midwifery and natural birth? Word of mouth. I tell everyone who will listen (and even those who won't) about my homebirthed baby. I may be at grocery stores, shopping malls, the DMV. When anyone comments on my beautiful son, I make sure to share that he was born at home with a midwife. I wear T-shirts that speak of midwifery, and dress my homebirthed baby in clothes that say "I was born at home."

- Anita Woods

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Following are some of the ways we are educating the public in Kentucky:

1. An active consumer organization. Our Kentucky Alliance for the Advancement of Midwifery (KAAM) is a consumer organization with dynamic leadership. KAAM's web site http://www.childbirth.org/k aam/html offers information. KAAM purchases vendor booths at local health fairs, neighborhood fairs, and professional conferences. KAAM cultivates relationships with news people and sends press releases to major newspapers and television stations for all midwifery events. All these events are staffed by consumers and midwives. We have found that this team approach to public speaking works extremely well. Consumers answer the "why have your baby at home?" questions, and the midwives answer the "what if something goes wrong?" questions.

2. Contact local newspapers. Small town papers make a great impact. Their reporters are LOOKING for stories. Some homebirthers contact their paper and ask to have a story done on their newest arrival. The midwife can also attend the interview to again answer the "what if" questions. Baby pictures in small towns sell newspapers. Then have the couple cut out the article and send it to their state legislators. I still have people come up to me and mention they saw me in our local paper three years ago!

3. Speak to high schools. I have a standing invitation each year to speak at our local high school. My former preceptor and I speak to several classes studying parenting, childhood development, etc. We bring homebirth videos and provide a chance to meet a midwife. Educating young women and men provides an opportunity to counter the message that birth is painful and replace it with the possibility that it can be a powerful life changing event.

4. Wear a name tag. I have a name tag listing our midwifery association under my name. I wear it to all my speaking engagements. Many of my one-on-one conversations have arisen from wearing that name tag while getting gas or stopping at the store on my way to an engagement. You never know who you will run into.

5. Set up a speaker's bureau. Pool the resources in your midwifery organization. We provide speakers on a wide variety of topics to local groups, churches, colleges and organizations. While I speak on other topics, I always tell people I am a midwife. Usually at least one person will come up to me after the presentation to talk about midwifery.

6. Join or visit other organizations. We attend other conferences, meetings and seminars. Look for goals you have in common with that group, and wear your name tag. At a Women's Advocacy Meeting and at a luncheon for legal professionals, my former preceptor and I became the focus for discussions on midwifery.

7. Print up business cards and hand them out. I keep business cards in my checkbook and wallet next to my cash and hand one out every time I hand someone cash or a check. It always sparks a conversation. I handed one to my veterinarian's secretary. She kept it for over a year and called me when she became pregnant. These one on one discussions have opened so many opportunities to speak to larger groups.

8. Contact the local health department. I have a background in public health, but anyone could use this as well. I visit the health education coordinator at health departments in various counties and offer speakers for their health fairs. We offer to teach classes on prenatal care, nutrition, and breastfeeding. These departments are usually understaffed and overworked. They are usually thrilled. Never turn down a chance to speak. I sometimes feel I'm a slave to my offer to talk to anyone at any time, even two little old ladies who get together for tea every Thursday. It does get frustrating at times. I dare not leave the house in a ratty T-shirt, because that will be the day I meet a potential new client in the grocery store. I love my profession and I love to talk--what a great combination!

- Candy Hall Brunk, midwife

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7) Switchboard
I think if we had some really good posters to put up in offices and waiting rooms where women would see them every visit, we might be able to get the word into women that drugs affect not only them but their babies as well, and not always positively. This is not something I have a talent for, but I think the posters would really sell.

- Debby S. (Editor's Note: Does anyone have ideas, art talent, marketing skills to lend to Debby's idea? It's a potential educating the public project.)

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One of your writers described the insertion of a Foley catheter into the uterus as a method of cervical ripening [Issue No. 23]. I recommend using caution with language and question the use of the word "ripening" to describe the process of irritating the mother's body by inserting a foreign object. This should properly and descriptively be called Foley catheter invasion and irritation. Prostaglandin gels applied to the cervix should be more honestly described as chemically altering the consistency of the cervix. There is no ripening happening with either of these methods. Midwives have used the term ripening to describe a natural process of the cervical changes of late pregnancy. We take a word from the plant kingdom because it is similar to the slow, harmonious process that happens to a plum as it turns from green and hard to darker and darker purple, soft, mushy and sweet. If one puts a whole bunch of plums in a box when they are green and hard and sprays them with chemicals, it is possible that in a few days they will look like dark purple ripe fruit. However, one taste will tell you that nature had nothing to do with the end product. Let's not fool ourselves in birth either. This whole hospital induction thing has got to stop. Whatever area we work in we can call these invasions by their proper names--irritation and chemical altering. Lying about what's going on perpetuates the practice.

- Gloria Lemay, private birth attendant, Vancouver, BC Canada

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It can be horrendously painful for the mother to have a foreign object inserted into her *closed* cervix and left there for hours on end. I have only seen one birth done this way. The woman was started on the Foley and Pitocin and found the start of labor hideously painful. There was no gradual easing into the contractions, no opportunity to build up endorphins to minimize the pain. It hurt like crazy from minute one and didn't stop until they removed it when she reached 3 cm. It took her another five hours and an intrathecal to get to 5 cm, at which point the doc got bored and did a c-section so he could carry on with his evening plans. She decided to skip labor next time and had a repeat c-section with her next child. As a doula, there was very little I could do for her. My "take" on Foley induction is that it is much like being continuously examined for hours on end--very painful for some women. The whole method is based on the way the catheter and the fluid irritate the cervix. Medical staff need to remember that an irritated cervix is attached to a feeling, living woman who may feel that irritation as pain. I also worry about having a foreign object lying in the vagina and providing a conduit for bacteria into the uterus.

- J.R.

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Thank you for chronicling both the dangerousness of drugs in birth and the apathy so many people seem to be burdened with in telling the truth about the horrific effects of medicating families in childbirth [Issue 20]. Drugs have corrupted the culture of childbirth almost irreparably. Epidurals have become the accepted elixir of the pregnant woman's consciousness, the escape that leaves her numb, deadened and remote from the sensations of birth itself. Yet how can a woman have true informed consent for an epidural when it is given under the extreme duress of birthing in confinement? And what parent would possibly permit her baby's tissues to be numbed and deadened right alongside her own? Induction drugs are the twisted partners of epidurals and other pain relieving agents: they bring on birth sensations so fierce in their artificial pulsing that salvation can only be found in substances that women in their right minds would normally abhor: toxic substances administered in the needles, tubes and catheters that women would normally abhor as well. Blue hands and feet have become expected; emergency resuscitations on newborns are often not even considered causes for alarm anymore. One birth attendant says prostaglandin gel is being used like Vaseline in North American obstetrical units; another says that in her hospital, the obstetrical anesthetist is referred to as the "candy man" among certain staff, and even to pregnant parents coming on hospital tours. Drugs poison bodies; drugs poison the perception of what birth is intended to feel like. Drugs also poison women's perceptions of being able to give birth without them: women have become addicted to obstetrical drugs in the way they've come to believe that birth can't be given without them. It has come to be believed that childbirth and drugs are interchangeable. It's boggling to me that people eschewing a drugged birth, and the proselytizers of drugged births, are considered "irresponsible." It is astounding to me that giving birth at home is considered dangerous when giving birth in hospitals leaves people drugged, wounded, even dead. Drugs kill.

Where is the Hippocratic Oath when drugs kill babies?

Who exactly is "doing no harm" when babies are born unable to breathe?

Is no harm done when needles pierce women's spinal tissues?

Is no harm done when women are stripped of the belief in and love of birth itself?

- Leilah McCracken leilah@birthlove.com\

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This is in response to Mary Ann Watson's recommendations [Issue 23]. She is quoted as saying that women don't grow babies bigger than they can birth, that this would be going against natural selection. My understanding is that obstructed labor, which can arise sometimes because of a large baby or a large head, has been a leading cause of maternal mortality for centuries, long before women were made to lie down to deliver. (The first Chamberlen invented forceps in the late 1500s to deal with this very thing.) Humans have had to develop their birth techniques to deal with the consequences of the upright posture, which has made our pelvises more rigid than those of the quadruped. Humans have also had to deal with the very large head of our species, which can be another complicating factor in birth. In homogenous populations, parents often are closer in size. When there is cross-cultural contact, situations occur where the dad can be a foot taller than the mother. This has been identified as a potential problem for a comfortable fit between baby and mother.

- Nikki Lee RN, MSN,. Mother of 2, IBCLC, ICCE, CST

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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:

- episiotomy (June 18)
- autonomy (June 25)
- is breastfeeding a feminist issue? (July 2)
- Group B Strep (July 9)
- homebirth (July 16)
- epidurals
- breastfeeding
- waterbirth
- breech birth
- nutrition

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.

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