February 14, 2001
Volume 3, Issue 7
Midwifery Today E-News
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THIS WEEK'S ISSUE

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Midwives, OBs, NPs, Neonatal Nurses

Maternal and Infant Health Program:

Pristina, Kosovo
Positions include training and lectures in hospitals and birthing centers, as well as training of community-based health providers. OSE preferred.
3 or 6-month contracts (longer assignments preferred).

Please send CV and cover attn: MIH Recruitment either by email to tecosko@dowusa.org with subject "MIH Volunteers" or fax (212) 226-7026.

Quote of the Week:

"Joining hands and hearts around the world has a deep effect on our personal practices."

- Jan Tritten


The Art of Midwifery

When I practiced midwifery in the Houston-Galveston, Texas area, I had the opportunity to learn this technique from the parteras in the region: to nudge a woman into labor, have her drink comino (cumin) tea that has a little wedge of raw potato in it. This is especially good for the woman who is post-term and has contractions that are frequent but not quite effective enough to get things going. Comino is gentler than castor oil and usually did the job. I always wondered, though, why the little potato wedge was included. The parteras didn't seem to know the rationale, either, just that this is what you did.

- Marla Webster, CPM, RNC

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News Flashes

A Spanish study of calcium consumption found that women who don't consume enough calcium in their last trimester may have less of the mineral in their breastmilk. Women who took in less than 900 milligrams daily during the last part of pregnancy produced less calcium in their milk compared to those who consumed more than 1,100 milligrams daily in the last trimesters.

- Fit Pregnancy, Fall 1999


Since issue number 40 of Midwifery Today, we have dedicated an average of 15 or more pages to global issues. Three issues were dedicated entirely to global midwifery. Number 25, International Midwifery. Number 32, Weaving a Global Future. Number 53, Global Midwifery In the New Millennium.

Midwifery Around the World

Midwives of the Central Coast of New South Wales, Australia

Our hospital has 40 midwives trained in reflexology, a 40-hour certificate course on reflexology and uses in midwifery practice endorsed by our midwifery national body (ACMI). This accounts for one-quarter of the total midwifery staff.

Our teacher was Susanne Enzer, a retired midwife and reflexologist, originally from England and now living in Australia. Susanne facilitates seminars, workshops and the accredited course "Maternity Reflexology." She is also the co-author of "Maternity Reflexology: a guide for reflexologist" (1997) and author of "Reflexology: a tool for midwives" (2000).

Reflexology is a therapeutic system of pressure-oriented massage to feet, hands or ears in the belief that all organs and glands have corresponding reflex points to the body. Reflexology elicits painful or tender areas with actual or potential disorder. It is a gentle, nonthreatening, noninvasive effective therapy. It has the potential to balance and maintain equilibrium, relax and increase vitality, and balance energy and move blockages.

A complementary therapies working party (3 midwives, 1 pharmacist, 1 midwifery childbirth educator) forged a policy which has been accepted by the hospital ethics committee to practice reflexology at work.

We use reflexology in our antenatal clinics and midwife clinics for various discomforts of pregnancy like leg and ankle odema, constipation, anxiety, and prolonged pregnancy. In childbirth, reflexology is useful to help enhance contractions, increase relaxation, retained placenta. Postnatally, reflexology can assist after epidural, forcep or LSCS and urinary retention. Difficulties relating to breastfeeding can be helped with reflexology. Also, with exhaustion, postnatal depression. There are few contraindications- severe PE, APH, severe PPH.

We are conducting a randomised single-blind controlled trial on the effect of reflexology on foot and ankle oedema in late pregnancy (over 32 weeks pregnancy). All women who met the criteria and are attending the clinics are invited to participate in the trial. The women are randomised (after informed consent obtained) into one of the three groups: normal pregnancy visit (control), relaxation reflexology (placebo,) or lymphatic drainage reflexology (treatment). The sessions are 15-20 minutes at least once a week. The information gathered are pre- and post-treatment measurements of ankle and instep, and blood pressure.

The women answer a questionnaire at each session about comfort, changes in mood/feelings, and changes in relationship with midwife. The study commenced in August 1999 and is due for completion in August 2001. Unfortunately we will fall short of the 120 women needed as we have had only 80 women enrolled. The difficulty of the study is the midwives do not always have the time to give the reflexology as it is within work time and there is no research assistant.

In a separate part of the trial, 12 women were treated with lymphatic drainage reflexology and refused randomisation but wanted reflexology. The characteristics of the women were mostly primigravidas (91.6%), 24-39 years old (mean of 30 years), at 33-39 weeks gestation (mean of 37.5 weeks). The results show all measurements decreased after lymphatic drainage reflexology. The women's blood pressure decreased (42%), increased (21%) and/or remained unchanged (35%).

On a scale of 0 to 5, The women found a decrease in stress, tension, anxiety, pain, tiredness, discomfort and irritability. The majority felt "very relaxed" or "relaxed" during and after the reflexology. Most noticed a difference in their feet after the reflexology: "more movement," "not as tight," "less swelling." Additional comments made by the women included "more at ease with midwives," "feel better about myself," and "relaxed whole body."

Although this sample is small, the many midwives have had similar comments from women receiving reflexology. It demonstrates that reflexology has a place in midwifery practice.

- L.M.

Papua New Guinea

Ode to Garlic

I lived and worked among the Kumboi people in the highlands of Papua New Guinea during 1997-1998. I was the first white person they had ever seen and was affectionately named "mbiny kuloi ai yande," the albino daughter. I spent most of my time there alone except for a couple of visits from my younger brother, "mba kuloi," the albino boy. I was there to teach literacy and compile a translation of the New Testament in their language, but healthcare inevitably took up some of my time. I have had no official training in healthcare; however, my mother is a midwife and herbalist and I learned much from her during my years of homeschool on the Tennessee farm.

The main health problems in those mountains were infections of all sorts, from skin boils and abscessed wounds to lung conditions like pneumonia--and of course, malaria. Rather than destroy their precariously built immune systems with antibiotics I planted a huge garlic garden and explored the uses of that smelly herb. The village ladies were enthusiastic and we tried everything from garlic poultices on external infections, internal doses for parasites (we also used pumpkin seed for that), enemas (what a job explaining the civilized reasoning behind enemas!) for pretty much everything, a clove in the ear for ear infections, hot, garlic chest poultices for lung infections, a few drops of diluted garlic water on an infected umbilical cord and a warm washcloth of garlic water on the baby's belly, garlic poultices and ingested garlic for mothers that could develop any after-birth infections due to prolapsed uterus, etc.

I cannot give garlic all the credit for the success we had; I'm sure God was working some miracles that we might not otherwise have had. The most encouraging thing about the use of garlic in rural conditions is that, when I left the village, my medical care did not go with me; it stayed in a little patch in the middle of those thatched huts and has continued to heal.

Kumboi Birth Traditions

Among the highland Kumboi people in Papua New Guinea, a laboring woman must leave the village and go to a banana patch some distance from the village. A sister will accompany her and build a crude shelter to keep them out of the rain. The baby is born on banana leaves and kept outside the village with the mother for about two weeks, or until the cord has dried up and the mother's bleeding has stopped. There are many taboos that go with this process: foods the mother may not eat, gardens she may not enter for at least three months, people she may not talk to.

Birthing in the banana patch is mainly for the purpose of keeping the mess outside of the village, and also serves to give the baby a better chance to avoid infection from the chickens and pigs that run around the village. As soon as the baby is born, the midwife/sister takes it to a cold mountain stream and washes it in the frigid water. Along with the high altitude and the lack of warm clothing, the baby is often cold and more susceptible to sickness. If the child lives for about two years, it is given a name, because the chances of long-term survival are now greater.

- Rebekah Joy Anast

====

I have a client who will be moving to Narobi, Kenya and wants to connect with homebirth midwives there for her continued care. If anyone should know of any, please e-mail me.

- Sarah Carson
Reply to: sarahandshields@hotmail.com

====

I am a new doula/aspiring direct-entry midwife in California. I am just beginning my training here, but I am keeping an eye on the international midwifery scene, as both my husband, who is Belgian and does quite a bit of work in Europe, and I would like to move to Europe some day (I speak French and Spanish).

I am passionate about midwifery and committed to getting the training I need as a direct-entry midwife without going to nursing school, but I worry about using that information in Europe. What is the status of direct-entry midwives in Europe? Will I need to redo training once we have relocated? Would getting a nursing degree help, or would I need to get a European degree anyway?

- Alison Williams
Reply to: amvenice@mediaone.net

====

I am a 2nd year degree student in England, UK. Our training lasts for 3 years, combined of practical and theory-based practice. We have 3-4 weeks in college and then go out onto placement for 7-8 weeks at a time to consolidate our knowledge. It's really hard work, but so immensely enjoyable and extremely hard to get a place in college! I really feel that I have found my vocation in life at the ripe old age of 38!

Sadly, most British births are conducted in hospital as childbirth is getting medicalised here. Some midwives encourage and deliver women at home but doctors are not so keen! Only 1-2% of our births are at home. I hope to change this when I qualify, as researching this subject has led me to believe that it is safer, quicker and less traumatic for women to birth at home. So why won't they?!

I am going to Spain for 3 months from Sept-Dec 2001 to appreciate how midwifery differs there. If there are any Spanish midwives who would like to correspond before I go there, I really would appreciate it. The place I am going to is in the south, Murcia region.

- Debbie

====

Does anyone know of a midwife or clinic in Latin America interested in taking apprentices? I have been apprenticing as a midwife in Colorado for the past year and a half. A friend and I, both studying midwifery with Ancient Art Midwifery Institute, are interested in going to Latin America about a year from now to help deliver babies. Our preference would be to work with a midwife doing home deliveries, but we would also like to look into birth clinic or other options.

- Misha Roell
Reply to: ebroell@juno.com

====

Editor's Note: If you enjoyed reading the above postings from E-News readers, Midwifery Today has news for you. Read on for our latest efforts:

International Alliance of Midwives

With the goal of birth renaissance in mind, Midwifery Today brings you our newest baby: the International Alliance of Midwives (IAM). All practitioners and activists interested in birth change and international midwifery are welcome to join. As an expression of this goal, our next international conference is titled "Birth Renaissance." This conference will be held October 18-22, 2001 in Paris, France.

The time has come to bring childbearing out of these most recent "dark ages" and into the light. In some Spanish-speaking countries, the word for light is part of the phrasing used in labor and birth terminology. The phrase for labor is "sacar a la luz," to bring to the light. "Dar a luz" means to give birth. Now is the time for midwives and childbirth activists to bring the whole family-centered birth movement "a la luz"--to the light.

IAM is a Web-based organization. We will have opportunities to meet face-to-face at conferences. We have a directory for members on our Web site. To join this directory, go to www.midwiferytoday.com/IAM and follow the simple English instructions on how to enter. Spanish and French instructions will be coming soon.

The charge for a yearly IAM membership is $20 U.S. You can pay by Visa or MasterCard billed in U.S. dollars, or by check or money order in U.S. dollars or British sterling. If you cannot afford to pay for a membership, you can become a member by writing an article for the online newsletter, by translating material into another language, or by carrying out other volunteer tasks the alliance will need to have done.

What do you get for your membership?

- An organization that will work in sisterhood with International Confederation of Midwives (ICM) and other organizations, but will operate on a personal level, meanng the individual midwife or activist is a member
- A non-bureaucratic, grassroots, responsive organization where your voice is important
- Access to a searchable directory of IAM members, where you can:

* contact other members
* tell other members how to contact you
* learn what other members are doing to improve birth and what you can do to help
*describe your own birth change projects and solicit the involvement of other members
*seek quick assistance from other IAM members to apply political pressure where needed

-An online forum for the exclusive use of IAM members, where you can:

* communicate with other members about their projects and yours
* share birth information
* establish links with the worldwide birthing community
* forge new friendships

- A subscription to the IAM newsletter, sent to you each quarter by email, with information about:

* birth and midwifery around the world
* issues, techniques and opinion pieces
* the activities of IAM
* other international news affecting birth and midwifery

- Email updates as needed but at least quarterly

Goals and Beliefs

1. Preserve, honor and learn from traditional midwives.
2. Redefine the term midwife to be inclusive of all the world's midwives.
3. Include in our membership midwives, doulas, parents, childbirth educators, doctors and activists.
4. Value equality and diversity and strive for a communal structure.
5. Work for birth change that includes partnership with the families we serve.
6. Glean from the strengths of each country, organization and individual throughout the world to energize and fortify midwifery and further the birth renaissance.
7. Strive to de-medicalize midwifery and birth and promote evidence-based care.
8. Protect motherbaby and strive to "first, do no harm." The key is to nurture all women, including the midwife.

For information on this organization or its philosophy go to www.midwiferytoday.com/international and read:
"Global Alliance of Midwives" by Jan Tritten
"Let's Work Together" by Jan Tritten
"Technology in Birth" by Marsden Wagner
"Anthropological Perspectives on Global Issues in Midwifery" by Robbie Davis-Floyd


Check It Out!

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

INTERNATIONAL ALLIANCE OF MIDWIVES (IAM): To join, click here

MIDWIFERY TODAY GOES TO PARIS! Join us at our international conference October 18-22, 2001.
Click here for more information


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Midwifery Today's Online Forum

I am a student midwife and I am doing an International Midwifery module. I have chosen to concentrate on midwifery education in Romania. I have one or two leads but desperately need more information. If anyone can help it would be greatly appreciated.

- Sue

Go to our forums to share your thoughts and experience.


Question of the Week

I have recently been supervising a German midwife in Manitoba who uses Xylocaine 2% jelly to numb the perineum prior to repairing perineal tears. Is there anything in the literature to back this practice up? I certainly was impressed at the benefit that it provides of not distorting the tissue as does injectable Xylocaine and the mom feels no pain. However when I checked it out in our Pharmaceutical Reference book, it instructs us to not apply over broken skin, etc. Do any of you use this jelly? Have there been any negative outcomes? allergic reactions? How much should be applied to the perineum?

- Gisele Fontaine, CPM

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Coming E-News Themes

1. BONDING: What have you observed? What do you know? What do you think? What have you read? Read the below letter for inspiration.

A pregnant friend believes that if she cannot stay home all of the first 6 years of a child's life, she should work the first, and stay home the next 3 because the baby won't notice that she's gone in the first years of life. My response is
emotional and moral, not scientific at all. I hesitated to tell her my opinion, deferring instead to what studies may have been done on the impact of leaving a child in early years. Have you heard anything, read any books or studies on this topic?

- Margaret Wallis

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Know a strong woman? Helping empower one? If you haven't already done so, please forward this issue of Midwifery Today E-News to one or two of your friends or business associates. Thanks so much!


QUESTION OF THE QUARTER for Midwifery Today magazine

Mamatoto: Motherbaby

How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?

Deadline: March 31, 2001

Send your response to:


Switchboard

Elenie asked: "I would love to know where the women are who want a non-interventive pregnancy and birth." [Issue 3:4]

I have a constant parade of them coming to my home for childbirth classes. The listserve at waterbirth@yahoogroups.com has hundreds more. The doulas at doula@yahoogroups.com and doula@fensende.com know hundreds more who agonize over the lack of women/baby-centered caregivers in their communities. In short, they are everywhere!

I was in a shanty town of Tijuana at the new year. The homes were of cardboard. No phones, no plumbing, and often no beds. The only resource I saw, in fact, was the women's innate concern for their babies' well being. I accompanied a partero on his rounds and by day's end 16 of these families were committed to a homebirth rather than contend with the indignities of the public health hospital. Is there a true alternative in your community?

You mentioned:
" We are also working with a very low socio-economic group who are not nurtured and are not able to do so themselves." Please don't perpetuate the myth that poor women are any less concerned with their babies than women who are more financially secure. I have worked for 3 years with the poorest women of the Mexican state of Jalisco, some of whom speak indigenous languages and understand little Spanish, others who are illiterate, and all of whom must rely on the free government-regulated birth machine for prenatal and birth care.

Showing up at the hospital and offering to accompany these women during their labor is the best education I could offer them. Having a stalwart woman by her side who constantly provided a role model for position changes, shared a cup of sweetened tea with her, and suggested alternatives to the prevalent cookie cutter mentality was the surest way to affect change. Why don't you consider hiring doulas to accompany your ladies?

You state: "We have women begging for induction prior to due dates and many are skeptical that they can birth without epidurals, or at least some narcotic. The demand for ultrasound in this population is high and no matter how much a midwife TALKS (emphasis mine) about the lack of medical need for one, these ladies are insistent." Sounds to me as though your ladies aren't going to accept your *theories* without seeing some real-life examples first! Why not keep an album that highlights the births that have occurred in your practice without all the intervention. Your ladies can leaf through this album and see these examples. In turn, they can take strength from knowing that other women with little resources from their same community have experienced the kinds of birth you are promoting to them. Sadly, sometimes poor women think that these kinds of births are only within reach of their financially secure sisters.

While I don't know Alto Pass, Illinois, I have participated in childbirth education & midwifery in a southern corridor of your state. In each of these communities there was always someone who found that the message about non-interventive birth resonated with her inner wisdom of what would serve her baby best. Keep offering it and you will have takers!

- Un abrazo, Joni
Guadalajara, Mexico

====

On tandem nursing [Issue 3:6]:

Many children stop breasfeeding during the last trimester. That is when colostrum is starting to replace your milk and also when your milk production is decreasing. If you toddler is still at your breast when the baby comes, you must give priority to the newborn, so the baby has enough to drink. But as you continue to breastfeed both, your milk production will increase.

- Marie-Helene Lessard

====

About 5 to 6 months of pregnancy, milk will become colostrum, exactly as if the mother was not still breastfeeding a toddler. After delivery, the lactation will have exactly the same course as usual : colostrum, transitional milk, and mature milk.

- Françoise Railhet
Manager, LLL France Medical Associates Program

====

If your 3-year-old is nursing often, be sure your newborn gets first priority at the breast. If you have extra help at home during your newborn's first weeks, dad or another household helper can give your 3-year-old extra attention so that it will be easier for you to see that your newborn's nutritional needs are met.

- Dianne Oliver, LLL leader

====

Your toddler is not draining anything that will take away from your newborn. When the baby comes you might want to try the agreement that I had with my toddlers, that the baby had first go at the breast and then they got to finish it off. However, since newborns usually get sleepy after one complete feeding on one breast anyway, you can often have one on each side. This works great for later when your milk comes in. Set up the communication with your little one now, explaining that she/he got the breast all to her/himself as a tiny new baby, and now it's the new baby's turn, but how about we share.

- Amber


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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.

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Midwifery Today: Each One Teach One!