March 31, 2000
Volume 2, Issue 13
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Changing Birth Globally
5) Check It Out!
6) Question of the Week
7) Question of the Week Responses
8) Switchboard
9) How I Became a Midwife
10) Classified Advertising

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1) Quote of the Week:

"We are only now discovering the long-term destructive effect on human beings and families of treating women as if they were merely containers, to be opened and relieved of their contents; and of concentrating attention on a bag of muscle and a birth canal, rather than relating to, and caring for, the person to whom they belong."

- Sheila Kitzinger

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2) The Art of Midwifery

It is not unusual to find hard spots on the cervix during examination of a woman in labor. If the woman does not have condylomas, most often what you are feeling are small cervical scars from previous births or gynecological procedures. The use of instruments for dilating the cervix or delivering the baby often causes small tears to occur, as does pushing a baby out prematurely (before complete dilation). These adhesions most often will break down during the active phase of labor. If you feel they are causing a lack of progress (the woman remains at 5-6 cm for over an hour), you might consider simply pressing the adhesion against the presenting part during a contraction. You will feel the adhesion break up under your finger. This causes no pain and readily resolves the problem. There may be a spot of blood as this is done, but this is of no concern. The labor will usually progress rapidly after the adhesion is gone.

- Valeria El Halta, Midwifery Today Issue 46
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Read Valerie's wise comments on sixteen different causes of prolonged labor, in Midwifery Today Issue 46. Mention Code 940 when you order your copy and receive $1.50 off the regular price of US$10. Please add shipping & handling: US$2.50 in U.S.; US$3.00 Canada/Mexico; US$3.25 all other international. Ordering information is at the bottom of this newsletter.

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3) News Flashes

In the wake of reports from England that one third of that country's female obstetricians would prefer a cesarean birth, a survey of 135 English midwives was done to determine their preference. Ninety-six percent of those surveyed would prefer a vaginal delivery. Authors of the study said that female obstetricians were more likely to opt for a cesarean because they rarely attend an uncomplicated delivery, and that witnessing traumatic deliveries drives them to preferring a cesarean. Midwives, on the other hand, have a well rounded and realistic view of birth and are in a superior position to judge the best way for a baby to be born. In addition, midwives are far more involved than obstetricians with care after cesareans, making them aware of the difficulties a woman has nursing and caring for an infant following what amounts to major abdominal surgery.

- British Medical Journal 319, October 9, 1999

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4) Changing Birth Globally by Sara Wickham, RM

This action list of small things all midwives can do to change societal attitudes about birth and promote midwifery and the midwifery model was derived from some research I carried out a few years ago. All the suggestions are either free or very low cost, and none will take too much time or effort. Some things on the list won't be new ideas to you, but they might act as a gentle reminder that simple, everyday things might have a positive impact on the way our society sees birth and midwifery.

  1. Get a bumper sticker that supports midwifery and gentle birth.
  2. Wear a T-shirt that does the same!
  3. Talk to everybody you meet about what you do and why you do it.
  4. Be able to cite the evidence for midwifery care, homebirth and so on.
  5. Offer women free/low cost experience of midwifery services (free tours, short talks or pregnancy testing). This can enable women to meet midwives for themselves or bring potential clients into a birth center to see what they could be experiencing.

Read the entire article and the full list of twenty-six things you can do to promote midwifery around the world at:

http://www.midwiferytoday.com/Library/articles/changebirth.htm

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5) Check It Out!

~~~WWW.MIDWIFERYTODAY.COM~~~
A Web Site Update for E-News Readers

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Coming Soon to the Midwifery Today Website!
Pictures, poems and other mementos from Midwifery Today's recent
Philadelphia conference. Stay tuned!

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New Articles Continue to Go Up! Check them out at

http://www.midwiferytoday.com/Library/articles.htm

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Midwifery Today's Product and Services Directory--The Birth Market--has opened its doors for birth practitioners to join! We are asked every day for help locating birth practitioners of all kinds--here is Midwifery Today's savvy solution!

ON SALE: For the cost of $25 and a static banner on your web page, you may join our listing. This means if you have a web page that is EXCLUSIVELY about your practice and DOES NOT SELL A PRODUCT, you may add our banner to your site and pay a $25.00 registration fee to be included in the Birth Market. This is a special price to you--a regular entry to the Birth Market costs $150.00 for businesses/websites that sell products. See

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If you don't have a web page, call or e-mail Cynthia the WebGirl@midwiferytoday.com. You may also read more details at

http://www.midwiferytoday.com/birthmarket

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Birthing From Within
by Pam England, CNM and Rob Horowitz, PhD
http://www.midwiferytoday.com/Library/Reviews/template5.html

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Are you a birth enthusiast? You need a web page! After all, isn't a picture worth a thousand words? Have a web page created that you can hotlink from Midwifesearch.com, Midwife Link and Midwifery Today as well as your paper marketing! We even register your site into search engines! Contact Cynthia the WebGirl@midwiferytoday.com for more details.

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6) Question of the Week

I did a search on varicose veins and came up with only a brief reference to a connection between them and a diet high in sugar and meat, and living at a high elevation. I am 23 weeks pregnant with my third child, and this is my second experience with this, only it has become apparent much sooner in the pregnancy. Does anyone have any insights into causes, or have helpful suggestions? Herbs, diet, exercise, support garments? And just how common is my complaint, anyway? In all the lay literature I've read, vulval varicosities have only been mentioned a couple of times.

- Cathy Killough
Kamloops. B.C. Canada

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(Repeated) Does anyone know of any natural remedies for blocked fallopian tubes? The woman in question has already had two children and is not aware of having had an infection that could have caused this.

- Julia Duthie

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Send your responses to mtensubmit@midwiferytoday.com

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Aspiring & Apprentice Midwives - ReSourcing Birth offers midwifery teachings & personal development in the wisewoman tradition. Exercise your mind, intuition, & heart to fully embody the midwife that you are. Birth Overview Course - 10 Correspondence Modules plus 2 four day Intensives. Also: Reiki, Herbs, Birth Companion training, other womanly healing arts.

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7) Question of the Week Responses

More on LEEP and dilation:

In response to women who have had cervical surgery such as LEEP, I have two experiences as a childbirth educator. One mother had so much cervix removed that every GYN or midwife who examined her commented. She had a shorter than average, unmedicated, spontaneous vaginal delivery with her first and a long early labor but rapid late labor and second stage with the second at home. The other mother had a LEEP procedure and stalled at about 9 cm for four or more hours with all three of her births, refused augmentation. She had all three, allowing labor to progress at its own rate without any problems.

- Cindy S.

=PLEASE SUPPORT OUR SPONSORS!=

"Doulas help families create happy memories...one birth at a time" according to a bumper sticker. If you have a heart for laboring women and families,train to be a doula. Bring emotional, informational and comfort support to birthing families. Attend a DONA approved doula training May 19-20, 2000 in Waterloo, Iowa. Contact Debbie at 1-800-648-3662 or theyoungs@trxinc.com. On the web: http://www.welcome.to/mothercare

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8) Switchboard

In response to the question about treating the cord stump and baby bathing [Issue 2:12]:

My nephew's cord took over six weeks to fall off as well. My sister scrubbed alcohol all over the cord several times each day as recommend by the hospital nurses. His cord stayed wet and icky.

Several years ago we discussed this on a midwifery list. Seems in other countries nothing is put on the umbilical cord, or only a medicated powder is used. Few other countries recommend dousing the cord with alcohol, which is over 80% water. When the cord is allowed to dry out, it kind of rots off. One doctor told me the only thing that should go on the cord stump is sunlight. Some midwives use goldenseal or rosemary powder; these help the cord dry out.

- Camellia May

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There's no reason whatsoever not to bathe a baby normally prior to the cord falling off. In fact, it will tend to encourage the cord to detach earlier, much like the softening and re-drying of a scab. Swabbing a cord with alcohol on a regular basis actually prolongs the time until it falls off. Simple normal hygiene, with attention to abnormalities (redness, swelling) is generally all that is needed. My kiddo's cord fell off at one week; we bathed her immersed from the time she was five minutes old. As she loved water and it soothed her immensely to be buoyant, I can't imagine depriving an infant of that particular joy. I've seen four babies in my limited practice and personal experience who have had a Leboyer style bath after birth, and each of those babies has been extremely calm for months afterward, no colic, no fussiness.

- J.R.

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I know it is common practice in some countries (notably the US) not to bathe babies until the cord falls off. Here in Australia babies are bathed on (shock horror) day one! *And* we don't do "cord care" anymore!

- Kirsten Blacker

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In my experience, the best thing to do to the baby's cord is...nothing! Just leave it alone. My son's cord fell off at just three days, but my mom told me that my older brother's took five weeks. So it seems like it varies by baby. Just don't worry about it unless it somehow gets infected.

- Michal Lynn Moyer

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Starting from attending waterbirths twelve years ago, we realized there is no reason to keep newborns out of the tub (at home of course; I don't recommend bathing babies at all in the hospital as the vernix is protective and there are a lot of dangerous germs around).

But right from the start newborns can go into the bath with their moms. The best way is to undress the baby and wrap him in a cotton blanket. That way he feels secure. Then have someone pass him to mom who is already sitting in a tub full of nice warm water. If he is a bit apprehensive he can be nursed for comfort while he gets used to the water. Most little ones love this kind of bath. Within a few minutes the blanket can be allowed to drift away. There is a good big supply of warm water, not a little tub that is cooling off as the babe is undressed. The mom feels secure so the baby is calm and a good time is had by all. And once the baby is enjoying baths, dad can be the bath-giver. The real purpose here is pleasure, not hygiene.

Bathing causes no problems with the cord. If anything, water helps the oils dry up and the cord falls off more quickly.

- C Ruskin, RM

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If alcohol is used to clean the cord, it will take longer to fall off, since alcohol is a preservative. Alcohol-cleaned cords can take several weeks to fall off, whereas those cleaned in water alone tend to fall off within the first week. There is no need to avoid bathing when the cord is still present; just wipe it gently with a wet cotton ball or clean cloth and then carefully pat dry.

A study is underway at BC Women's Hospital, looking at bacterial colonization on alcohol-cleaned vs. water-cleaned cords. So far, they've found (I believe--maybe someone out there has more details) that there are more bacteria present on the water-cleaned cords, but no greater incidence of infection in the newborns.

- Jennifer Landels
Vancouver BC

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In response to the question about Anti-C [Issue 2:12]:

Your friend's doctor must have ordered a type and factor test to look at her blood factors more closely. I imagine that this was ordered because of her previous losses. Anti-C means that she carries antibodies to the rhesus factor "C". My understanding is that she must have been exposed to the C factor with one of her previous pregnancies, probably due to the fact that her partner is a carrier of C, and so one of the babies was as well. Sometimes mixing of the baby's and the mother's circulation occurs at birth, and more infrequently in pregnancy. This makes a rare incompatibility occur between this woman's blood and her baby's blood if the baby is C positive like its father. The mother, whose body sees the baby's blood as "foreign," sends the anti-C antibodies, which eventually destroy the red blood cells of the baby, and can then terminate the baby's life.

Can't antenatal rhogam be used here to prevent this from occurring, or am I misled in my beliefs? I am curious why her doctor was so sure that this sensitization wasn't the cause of her two miscarriages. I also would like to hear more on rare sensitization, as this is of personal concern to me.

- Jenny Johnson

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The website address for the latest news and information on the Kansas City area chapter of the International Cesarean Awareness Network's picket, phone, fax, and media protest of an ob/gyn conference has been changed to:

http://members.aol.com/_ht_a/icanofkc/hospitals_response.htm

See Issue 2:12 for details.

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Does anyone know where I can obtain the Spanish for Midwives tapes,
preferably used? Please email oomen.white@ns.sympatico.ca

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http://www.birthwithlove.com/Resources/newswapmeet.asp is a swap meet page for midwives. It is really cool, and I would like it see it get HUGE! What a good idea!

- Leighza

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At the hospital where I am currently working, the bath is inaccessible for mums in labour "because of infection control." Some young midwives are trying to get baths installed in at least a couple of the six birthing rooms. Originally we were trying for a tank for waterbirths, a couple of years back. Wow!! That was toooooo radical!

I would like to know if anyone knows of any research documents about infections(in both mother or baby by bathing during labour), that we might use to "gain ground" with the older midwives, registrars and consultants, the CNC, and DON, who appear to feel bathing is not beneficial to mums for pain relief and while in labour, because.... There are no baths allowed in post-natal either; the bath is covered so as not to be recognizable--for the same reason: cross-infections.

- Robyn J Aulmann
Darwin, NT Australia

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I am an aspiring midwife and have dreamed of becoming one for 14 years. I am 31 and if I need a bachelor's degree and then a master's degree it will take me many years (I have 3 young children). I have recently found out that this is not the only route to becoming a midwife and that I may be able to do it another way. I am already an LPN and have had experience on the maternity floor and with laboring women. Thank you in advance for any advice readers may be able to give me.

- Kenya Yopp
New Haven, CT

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"Paths to Becoming a Midwife: Getting an Education," compiled, edited and published by Midwifery Today, Inc., can help you fully understand what midwifery is, what kinds of midwifery are practiced in the U.S. and the kinds of education and training each path requires. It lists and describes resources, schools, programs, standards; it charts programs and the state by state legal status of midwifery; and it includes a comprehensive chart of midwifery schools and programs. No other book has ever been published that can give you all the answers about how and why to become a midwife, from the philosophies to the realities to the training.

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Unless otherwise noted, share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com. If an e-mail address is included with the letter, feel free to respond directly.

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9) How I Became a Midwife, by Ollie Ann Hamilton, LDEM, CPM

How did I become a midwife? What a question! Why do I breathe? Why do I live?

I think I was born a midwife. I was the fifth of six children, and by that time, my mom thought her loss of menses was menopause! Because for six months my three sisters were having babies, she kept her pregnancy a secret until a month before I was born. After sixteen years it was another daughter for her, and I was her first hospital birth. Although she never talked about such things, I caught the sense that she was disgusted with her hospital birth. To her, birth was a normal event and was therefore not to be talked about. She had even birthed twins at home during the Depression.

I grew up in a large extended family and had great parents and a wonderful childhood spent roaming the woods of Missouri. My mother had been the oldest of twelve children and mothered all of them because her parents died early in life from the Spanish flu. In fact her mother had her last children at the same time my mom was starting her family, so my mom raised her siblings, too. When anyone had a problem, they were at our home. My sisters tried to mother me but I resisted the idea of having four mothers!

Babies were always around-my sisters and brothers were having them and were more than happy to let me play with them. I began to baby sit at a young age and starting when I was five, worked in the church nursery-I loved babies!

I ended up marrying the nursery teacher's son when I was eighteen years old. We waited three years to have our first child. It was 1966 and we were on our own in Okinawa, Japan. We went to the library and ordered books about natural birth from publishers in the United States. Our friends thought we were crazy. We ended up going off base to a Seventh Day Adventist hospital where we were allowed to do pretty much what we wanted. I had a nice birth and afterward nursed my baby. Suddenly, all the friends who thought we were crazy came to us to find out how we had done it. I started speaking to couples' groups and generally spreading the word about natural birth.

I birthed my second baby five years later in a small town in Idaho. By that time I had helped several friends educate themselves about birth. Quite by chance I met a newly arrived midwife in my eighth month of pregnancy. I was quickly hooked, and readily changed my plans to having a homebirth. I loved it! And I thought this was all quite normal-I wasn't aware of the political statement I was apparently making. Sixteen months later our next was born, this time in Denver. By then I had begun to realize a normal birth was pretty hard to put together.

Within a year friends asked me to help them do what I had done, and I jumped in head first. I started teaching classes and attending hospital and homebirths as a doula. A year later a couple asked me to be their midwife for their first baby and I dove right in. I had great help from another midwife and a doctor who had attended my last birth and both were happy to be there for me. Within five months, however, we moved to Billings, Montana and I was on my own. In the eight months we lived there I attended eight births, then it was on to Cheyenne, Wyoming for the next three and a half years. It took me seven years to do a hundred births. Twenty-three years later I have attended over six hundred births and am still counting. I love babies, mothers and fathers-I love it all. I believe in birth and love to see the transition from girl to woman in first time moms.

For the past eight years I have worked with the Hutterite community in Montana. It has been a special privilege because these women are only one generation away from home birthing and they have lost it so badly. It is wonderful to see them be empowered again.

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How did you become a birth practitioner? Or why do you aspire to become one? Share you thoughts and experiences with E-News readers! Send your submission to mtensubmit@midwiferytoday.com

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