February 7, 2001
Volume 3, Issue 6
Midwifery Today E-News
“Apprenticeship, Week 2 of 2”
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Quote of the Week:

"The midwife is often the instrument for change within a family because the family members are empowered by the prenatal and birth experiences, and they begin to believe in their own bodies and intuitions."

- Sharon Wells


The Art of Midwifery

When I was pregnant with my third child, she was not completely head down, but sort of at an angle in my pelvis. Her head was pushing against the left side of my pelvic bone. To get her to move completely head down, I put a bag of frozen veggies on the area of my abdomen where her head was. I left it there for twenty minutes (I did this right before bed); in the morning she was head down and I was no longer in pain!

- Heidi Basford-Kerkhof, AAHCC
Oshkosh, WI

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News Flashes

A panel of tests developed by Stanford University Medical Center researchers can better gauge a pregnant woman's risk of transmitting toxoplasmosis to her fetus. According to the study, 60 percent of the pregnant women who underwent the standard IgM test for toxoplasmosis either registered a false-positive or had their test results misinterpreted. The newest test is the avidity test, which measures how strongly IgM antibodies bind to the toxoplasma antigens. A strong bond indicates the infection is not recent. This applies to women tested within the first three to four months of pregnancy who have a positive IgM test. The tests have been used with a high degree of success at the Palo Alto Medical Foundation. Because faulty tests and incorrect interpretations persist throughout the country, the U.S. Food and Drug Administration has suggested that other laboratories send serum from IgM-positive tests to the foundation's lab for more accurate testing. The foundation is the only site in the country to offer the battery of new tests.

- Amer J of Ob & Gyn, January 2001

CONTACT: Stanford University Medical Center, Krista Conger, kristac@stanford.edu or M.A. Malone, 650/723-6912 mamalone@stanford.edu


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Apprenticeship

E-News received the following question about apprenticeship and numerous responses.

I am a midwife in training with an impressive record as a childbirth educator, DONA-certified doula, certified infant massage therapist, and a keen interest in normal birth. Four months ago I moved to a new area with my family and began the process of trying to make contacts. I am having a difficult time finding a midwife who is willing to talk with me about the steps necessary to secure an apprenticeship. Frankly, I feel a little like I'm crossing into a territory that belongs to someone else. I have emailed a vita to many well-respected midwives in my area asking for assistance, that they pass my name along, etc. I haven't had as much as a telephone call from anyone, even to say that they couldn't help.

Is the society of midwives so closed and myopic that they have lost sight of the idea behind traditional midwifery, that midwives teach parents as well as other midwives, that they give the gift and pass along the art? My grandmother learned from her mother, and she learned from her aunt, etc. After all, wouldn't we all like to see more homebirths? This can be accomplished with more midwives who are well trained. It is difficult not to feel disheartened. What do I do? Do I need to know the secret handshake?

- Jackie McMillan

Call them in person (midwifery is a very personal vocation) and ask if you could meet with them, maybe take them to lunch, etc. I have taken on lots of apprentices, some I wasn't sure of but was willing to give them a chance. Remember these are busy women and it is your job to push, not theirs--they have already done their time.

Our society feels like somebody, somewhere owes it to them. I am a strong woman who pushes and works for what I get. I never had anyone to help me when I started and never felt a great desire to complain about that. It has made me stronger. As far as family passing down trade/skill, isn't that a natural process? It is not always a natural thing to take a stranger into your space; it is something we do by influence or decision, not by nature.

- Anon.

Think of your letters as an introduction to who you are, and then follow up with a phone call. Even put in your letter that you would love to hear from them, but that you plan to call them on such and such a date. Never put people on the spot by asking for an apprenticeship right then and there. Think of it all as networking. Prepare a few questions regarding the climate of midwifery in your new area, and how an aspiring midwife might put herself in the right place at the right time to be invited to apprentice. Finish your conversation by asking for the names and contact info for others you should talk to, and ask about any meetings of midwives or doulas in the area.

Midwives love to help, but you need to be more proactive. I am a new CNM about 9 months into my first job, and used this technique when I was job hunting. Not only do I have a great job, but I am better connected with midwives around the Northeast.

- Eliza Barton, CNM, MSN
West Hartford, CT

My gut reaction to your inquiry was, "First, get rid of your sarcasm from anger." Tired midwives don't need to be treated as if they are "supposed to" help anyone who demands it. Have you made offers to enable the time spent teaching you to be compensated? An on-call life style is very demanding, especially if a midwife has a family.

- Beth

I was a registered nurse who had studied homebirths for two years while finishing my BSN degree. I did my best to prepare to start an apprenticeship, I went to The Farm to take a midwife assistant class, I read all the books I could find, I went to Midwifery Today conferences. I was awaiting the day when I could start apprenticing and enter the beautiful sisterhood of midwifery. Boy, was I ever let down. I was very willing to move so I sent my resume out to lots of midwives in several different areas with no response. I thought for sure that when I went to the next Midwifery Today conference I would meet someone who could help me or who knew of someone else who might but the reality is that I was shot down every time and had my heart broken that week. These women were not like I had imagined and I was very disappointed. I truly thought about giving up. I didn't. I did find a midwife 3000 miles away who asked me to join her within the month and so off I went and it was a magical experience I believe for both of us. I have since gone back for my CNM degree and hope to some day join her homebirth practice.

Don't give up. Midwives are very busy women who have a lot on their plate. I believe that they all have it in their hearts to "teach one" but that takes time and patience and a lot of hard work. Keep trying and keep selling yourself--there is someone out there for you. I am certain you have so much to offer to women and to the community of midwives. Be patient, keep studying and keep looking for opportunities. You are not alone!

- K.

I am also an apprenticing midwife with a host of credentials who recently moved to a new state. Here, most midwives are trained through a large and well-established midwifery school. I had been apprenticing with two midwives, one who is licensed and one who is not. I have taken many courses and participated in midwifery study groups, but never have had a desire to complete the majority of my learning in a classroom setting. I wanted to be a truly apprentice-trained midwife.

Now I find that the only way to secure a midwifery apprenticeship in my area is to attend the midwifery school. I called no less than 25 midwives and contacted local midwifery organizations. Most of my calls went unreturned and the midwives I did manage to speak with offered no help other than to tell me to attend the school.

- Anon

I too am very interested in becoming a midwife in my community. I have met with a couple of midwives in my area and talked to several on the phone. I had to just start calling and asking them individually about direct entry and apprenticeships. While I didn't always get the answers I wanted or expected I did learn more about what is in my area and how to get involved. Also, one of them had a list of midwives I could contact. The thing most often repeated was to stay in contact and to keep learning. Another thing that was often recommended to me was midwifery birthing centers.

- Jasmine

Entering a new community of midwives is not that hard. Know the bottom line: clients. If you can give them clients while you work as a doula in the meantime this would be beneficial for both apprentice and midwife. Ask what are the benefits of the engagement/partnership to both parties. Come out with a flyer or newsletter listing yourself as resource and referral and list the other midwives as midwives (with their permission). In the local paper, advertise birth bags ($99) and when birthing couples call you tell them that you can work as a doula and would be happy to refer them to midwives in the area if they need one. A doula friend of mine hangs out in the labor dept. of hospitals and advertises herself as a doula and she gets clients that way.

- Connie Dello Buono

It is common for people to call or email me wanting answers about how to become a midwife, as if there were a recipe, and not liking what they hear, never respond. Because I remember the agonizing and frustration and burning desire to become a midwife I *always* take the time from my overextended and busy life to answer questions to those starting down the midwife path.

First and foremost, midwifery is about patience and humility. It can take years for an apprenticeship to open up in a community. That is the reality for aspiring midwives, especially those with partners and families who cannot relocate for training. For those of us with dependents, being a partner and a mother is also part of our midwife training. It may take longer, but it all equals out in the end.

When you enter a community or have heard "the call," or when you have made the decision to become a midwife, it is best to start practicing some midwife techniques. For example: When I go to the home of a laboring woman, I enter her place quietly and respectfully. I take off my shoes and set my equipment down. I gently ease myself into the energy of the birth. I use my senses, intuition and experience to "see" what is going on before I say too much. I look for ways that I can be of assistance before I take care of my own needs.

Maybe you can think about how you have approached your quest. If you aren't getting a response or the responses you desire, maybe it is not about them not hearing you--maybe it is about how they hear what you have to say. Most midwives routinely get calls from aspiring midwives. How does one choose? There are as many screening techniques for students as there are for homebirth momma candidates. In many ways it is a combination of timing and chemistry. Speaking from the heart, offering something to a midwife and the birth community is a wonderful way to establish credibility. I love to give aspiring midwives opportunities to learn more about birth, but I can't take everyone who wants to see a homebirth or professes the desire to become a midwife to the private and intimate space that most couples want.

There are many ways to learn midwifery until an apprenticeship opens up. You start studying. You can also get involved in a midwife group or consumer group and help with fundraising, politics, education. Midwifery is a way of life, not a finite point that we strive to *learn how to do* as the ultimate goal. We birthing mothers and midwives want and need your support--sometimes you have to give first before you receive. Sometimes we have to earn our way spiritually before we are allowed to practice. I am not saying that if it takes a person a longer time to find an apprenticeship she had more spiritual work to do. What I am saying is that we who attend pregnant women are being honored to walk in what is divine and holy, we should constantly strive to make ourselves worthy of this opportunity.

Even in areas where there are more aspiring midwives and midwives than birthing women, there will always be a place for good midwives--I mean good in skills, community, her own family and in her heart. Many of us believe in teaching and do so on a regular basis. Be careful about labeling a community because your individual needs have not been met. If it was quick and easy it might not be worth the convenience. Midwifery will try you to your very soul, you will experience every human emotion as a midwife, from sheer terror to divine joy. Part of your training might just be about being the very best human being you can possibly be in the meantime.

- Kerry
Minnesota

I too have had to fight tooth and nail to get in my internship. I went to a birth school and have been apprenticing for over five years. I have assisted midwives for over 100 births, I have been primary at six. I too have not been able to get the apprenticeship I needed. But don't give up. Be available. Attend all workshops and meetings. You eventually will get to intern.

- Anon.

The most important step is to first become a part of the community. That means showing up for regional meetings, classes, lectures, volunteer events, etc., and letting yourself become known to the birth workers and families of the community. I am not sure if as an aspiring midwife you realize how common it is for senior midwives to be approached by women who either idealize the calling of being a midwife or are simply passing through a community for a short time. By showing your commitment to the birth community in your area, you allow there to be an unfolding of relationships and trust in a way that is much more gentle, more akin to the nature of the work we do at home, which allows women to open up and trust. Homebirth is the crown jewel of a few, in a nation besieged by women's distrust of their own bodies. Your work in your own community to change this and make more options available does not go by unnoticed and is sure to produce more clients, more midwives to attend them, and therefore more opportunities for learning. I have rarely seen a woman who faithfully knocks not have the door opened for her, but I have see way too many midwives short of time or energy at the end of the day to return another call.

- Cindy

I myself am an apprentice-trained midwife. I am now a midwife who is approached by women who want to apprentice. I find myself making the requirements of apprenticeship narrower and narrower. This is the reason:

I have put my heart and soul into several women in the past to train them. We have spent countless hours together. I have not only given them what is in my head but also my heart. I have changed the way I approach apprenticeship each time I see one lose her commitment or each time I see that when it really gets down to it, she didn't have the commitment to begin with. I tried teaching for free, teaching for a fee, buying books and supplies for them, requiring them to buy their own books and supplies. I have tried taking apprentices from midwifery schools. I have felt used in the process.

I have not seen one go on to be a midwife. Their personal lives have always been met with drama and they cannot blend the commitment of midwifery and family. I now have consented to only train women who have children over 4 years old, who have supportive husbands and excellent childcare, and those who have had babies with me. I know this sounds very exclusive. I have to do it this way to preserve my own sanity and feelings. Many schools around the country offer book training. If you have shown the commitment to finish a training program and then seek an apprenticeship, this may be another way to secure an apprenticeship.

When mothers and aunts teach daughters, there is a different relationship already formed. This may contribute to the success of this model. My mentor indeed felt like a mother or aunt to me because of our close relationship. Maybe the secret handshake is the trust and love built up over some years of commitment and loving someone, not just that you have many qualifications.

Try to build a relationship with one or more of these midwives. I know that I am turned off by someone meeting me for the first time and asking for an apprenticeship. I always feel that "She doesn't even know me! How can she ask me that?" It is a very personal and intimate thing. It would be kind of like asking someone to marry you whom you just met; sending them a resume or list of your accomplishments is not going to woo them. Keep that in mind in your search to be a midwife.

- Cynthia Luxford
Otis, OR


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Mamatoto: Motherbaby

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Switchboard

E-News acknowledges and thanks Rachel Westfall for her thoroughly researched information on shepherd's purse in Issue 3:5. We sincerely regret having omitted her name at the end of her text. Great job, Rachel!

- Editor, E-News

I was very interested in the advice given about shepherd's purse. I do not have trouble with hemorrhage, but do bleed for the entire six weeks following birth. Sometimes I stop for a day or two, but then start again. I nurse often, and this does not seem to make a difference. Would a tea of shepherd's purse help me the next time? My fourth baby is due in July.

- LD

====

In the late 1980s, an American midwife spoke at a MANA conference on the difference between the two different strains of red raspberry (rubus ideaus and rubus strigosus). She noted that the rubus ideaus is commonly available and recommended as a uterine tonic for the birth. John Lust's book on herbs lists this strain as helpful for the lungs only and that the rubus strigosus is the one to use for the uterus. She found that women drinking red raspberry didn't have particularly well-toned uteri, something that I have seen as well.

I have spoken with herbalists and nobody seems to see a distinction between the two types of red raspberry. Does anyone have information on this? Any research at all on the use of red raspberry tea in pregnancy/birth outcomes? If indeed the rubus strigosus is the preferred type, where can it be obtained?

- Shawn Gallagher, RM, C.Ht
Toronto, Canada

====

Regarding heating up when exercising [Issue 3:5]: I agree with your naturopath that it would be pretty hard to raise your core temperature sufficiently by exercising. One of the reasons you are feeling so hot when you exercise is that the blood vessels at the surface of your body are dilated in order to get rid of excessive heat, so your core temperature will remain stable. At the surface is where you have the most receptors for temperature sensation. However, if you are getting uncomfortably hot, swimming or water aerobics are good alternatives because the water keeps cooling the surface blood vessels as you exercise. The water is really nice, especially as you get bigger, because you are buoyant.

- Pushpa

====

Sharon [Issue 3:5], I highly recommend either of the books by Dr. John Lee on natural hormone balance: "What Your Doctor May Not Tell You About Pre-Menopause" or "What Your Doctor May Not Tell You About Menopause" --not because you are menopausal, but because he explains how hormones function, and specifically how natural progesterone supports pregnancies where a mother is prone to miscarry. You can also get info from his website at www.johnleemd.com. One of his approaches, in addition to excellent diet, is to use natural progesterone cream before and well into pregnancy to sustain it. It is the sudden drop in a mother's progesterone level that causes some miscarriages in otherwise normal pregnancies, (not talking about unviable fetuses, however). Natural progesterone is NOT to be confused with the prescription drug, artificial progestin. The natural cream I use (and recommend to my clients) is Prolief, made by Arbonne International. It is inexpensive at $29 and lasts a few months. You will need guidance on its proper use - you don't want to risk losing your baby due to not having all the facts.

- Nancy Capo

====

More on perineal massage: In Europe midwives and educators often suggest to pregnant women that they 'discover' their own perineum and maybe help it stretch by massaging with a natural oil, after a bath, in the last month of pregnancy. I have just seen a review of a study in The Lancet (No 9200, Jan 2000) that summarises five published controlled trials on perineal massage. Only one was considered a valid trial (Labrecque M, American Journal of Obs and Gyn): the authors found that for women who had a previous vaginal delivery there was no significant differences in intact perineum rates between massage and control groups. For those without a previous vaginal birth the 9% higher rate in the massage group was significant. They conclude that current evidence supports the use of perineal massage in women completing their first pregnancy. Surely it can't do any harm, so long as a good oil is used? As an educator I feel women get significant benefit from feeling and becoming familiar with this area of their anatomy, helping them to believe and trust in their body.

- Hilary

====

I am the pregnant mother of a nursing 3-year-old. Can anyone tell me how colostrum will be provided for the newborn when the older child is drinking it up?

- S.LaPorte

====

Read an article from the Los Angeles Times at (I believe the Times charges for access to their archives so I'm not sure how long it will be "up" at no charge). I'd heard of elective cesareans, but the story's predictions of what's going to happen in the near future make me ill.

- Kathy Nesper

====

More on postpartum hemorrhage:

I recently attended a woman with a retained placenta and ensuing hemorrhage. We started with remedies but pretty quickly resorted to Pitocin. It worked for her previous birth, too. The best herbs I've heard of for this may be cotton root bark (tincture), trillium (not sure how to serve it), and angelica (tea). However, I don't like messing around with retained placentas combined with a hemorrhage and, feeling a whole lot more comfortable when they're out, like to use what I have the best success with.

- Anon.

One of the best things I learned from my preceptors was to ask the mom to tell her uterus to stop bleeding. I would also do some work with the mom ahead of time using hypnosis or visualization. If you are not comfortable doing this yourself, you might look for a hypnotherapist or psychologist experienced in working with pregnancy to assist you. Make sure the person you choose is OK with homebirth.

- Pushpa

====

I am a women's studies major and a midwife apprentice. For my final senior project I would like to conduct a workshop that encourages at-home, natural birth. I also would like to design a pamphlet that briefs readers on the advantages of homebirth and the disadvantages of hospital birth. Please offer some insight and/or sources that would be useful to my cause! I need opinions on what the most important topics are so I can put them in the pamphlet. Also if anyone can suggest a book that refers to the medical advantages and disadvantages, that would be useful.

- Meggan
Reply to: lvmeggy@hotmail.com

Editor's note: Readers, please help Meggan educate the public about the advantages of homebirth. A bit of your time could influence several women for the rest of their lives!


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