January 23, 2002
Volume 4, Issue 4
Midwifery Today E-News
“Facing Midwives' Burnout”
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UPCOMING CONFERENCES

Guangzhou, Guangdong, CHINA, "Healthy Birth": June 7-9, 2002
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Facing Burnout
5) Check It Out!
6) Midwifery Today Online Forum: Breaching confidentiality
7) Question of the Week: Placental Tear (repeated)
9) Switchboard
10) Connections
11) Classifieds

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1) "To respect the instinctual nature of birth, we must allow the process to unfold for each unique individual. As midwives, it is our job to facilitate, not control this process."

- Joanne Dozor

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2) The Art of Midwifery

Occiput posterior and how to get baby to change positions: Have the mother stand and swing her hips in a wide circle as if she is using a hula hoop. Alternate with other positions such as pelvic tilt, squatting and lunging with one foot up on a chair.

- Chelle Goodfriend, IBCLC, CCE

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3) News Flashes

A study of 242 children who had been prematurely born and are now young adults were evaluated in a study in Cleveland. They were born after six to eight months in the womb and weighed less than 3.3 pounds at birth. The study found that babies born prematurely continue to have neurological and developmental problems well into early adulthood. The group had lower IQs, more learning disabilities, and higher rates of such disorders as cerebral palsy. There was a clear correlation between the extent of prematurity and the extent of disability. Researchers also noted, however, tremendous reserves of resilience and adaptation in the children and their families. The group was less likely to indulge in risky behaviors such as drug taking and early sex and less likely to get into trouble with the law - thought to be the result of more-watchful parenting.

- New Eng J Med, 17 Jan. 2002

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4) Facing Burnout

While achievement in midwifery is surely a worthy goal, it's unfortunate that pushing our own endurance seems to become the end as well as the means. And sometimes, it's quite literally "the end." For when midwives ignore the scope and extent of their own limits, when midwives neglect the basic tasks of self-knowledge and self-care, they face burnout. For those of us who have made great sacrifices to build our practices, it's a bitter surprise to find ourselves growing frustrated and unhappy with the very work we were once deeply committed to.

We could take a cue from our medical OB counterparts. Working in group practice would undoubtedly increase some midwives' longevity. Scheduled monthly off-call weekends and a professional exchange of services are only the obvious benefits. The chance to shore up one's standards of practice within the support of peers, the opportunity to honor one's limitations and ensure that we don't take risks - these are invaluable gains.

The key to building these liaisons is learning to see ourselves as contributing members of a larger community, a community whose health and future depend on our health. It's also time to ask some questions of ourselves, questions like:

- Am I taking honest account of my limitations?

- Am I practicing consistent self-care?

- Do I have a support network? Do I pursue sabbatical?

- Am I just "all out" for myself or am I thinking and acting in a way that will benefit midwifery as a whole?

- What can I do to ensure that other midwives make it, that other midwives last?

- How can I contribute to the strengthening of midwifery in my area?

- Caroline Eustace

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Tips to Help You Handle Burnout

1. Do something nice for yourself once a day: Sit in a hot tub; walk on the beach; exercise; bird watch; stop and smell the roses; rent a funny movie; read a good book; play with your children.

2. Just say no. Take on only what you can handle.

3. "If you don't love the profession, get out of it, because you don't do it any good."

- Sr. Angela

4. Take care of your spirit. Attitude is everything.

5. Take breaks when you need them and reassess your needs regularly.

6. Free your emotions: let yourself laugh and cry, share, sing, get and give hugs, dance.

7. "Burnout is not when you're too busy, too tired, or overworked. Burnout is when you lose the passion for your work."

- Carla Hartley

8. Attend a Midwifery Today conference.

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The preceding excerpts were taken from LIFE OF A MIDWIFE,e a Midwifery Today book. Read about the realities of being a midwife. Midwifery Today's best-seller! To order your copy, go to
http://www.midwiferytoday.com/products/ C514LOM.htm

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I live in Vancouver, BC Canada. I have been in the birth business for 23 years and I love it. Recently I have been convicted of criminal contempt of court. I accepted an injunction from the Honourable Mr. Justice Curtis two years ago because I knew I could obey it. His ruling allowed for:

- Women to help other women at births and earn money doing so.

- Me, specifically, to teach midwifery.

Obeying the injunction meant I would have to absolutely discipline and train myself to not use the word "midwife" to describe myself. I did this and the judge in the contempt matter noted this. I have no problem with giving up the word. It seems to be the thing that always created trouble for me - I just can't understand the meaning some people have for it. In my province it has come to mean "good team player who covers her butt." Although my pursuers are called the College of Midwives, they are not educators and they are not "with woman." It is a regulatory and disciplinary body. The 60 members must follow College protocols and maintain hospital privileges. Having happy, satisfied clients is not required, and complaints from the public fall on deaf ears. The sum total of personnel is the registrar and a part-time secretary in a small office in an old hospital. Registrants of the College are terrified of their governing body and they have been cautioned in writing by a woman lawyer not to go near that office without a lawyer beside them. They have hired three different investigators that I know of to spy on my activities. I feel flattered they're so interested in me.

As bad as it gets in the court system, every day I give thanks that I did not register with the College of Midwives. I have had four years of the best experiences ever as a birth attendant. I have not had to hurt or "strip membranes" on anyone in order to retain a license. No baby received erythromicin eye cream or vitamin K injections from me. I have not had to please any physician or hospital administrator. I have been able to look my clients and myself in the eye. I have been forced into a simpler, less invasive style of practise and now find it to be full of wonder. My clients and students love and respect me, and none would testify for the ones who wish me in jail. Few people in the world ever get to experience the kind of joyful work I have had in the past four years. No one can take that away from me. When I go into court it can be harsh, but I would rather face a judge with some skills in human rights and tenets of law than face a disciplinary committee in a professional body that has to produce a few sacrificial lambs each year in order to justify its existence to the government. Please don't feel angry or worried about me - feel inspired about how strong we are.

- Gloria Lemay, Vancouver, BC, January 2002

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5) Check It Out!

~~~WWW.MIDWIFERYTODAY.COM~~~

A Web Site Update for E-News Readers

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AUIDOTAPES FOR THIS ISSUE'S THEME

Effective Group Practice in Midwifery: Tape No. 971T741
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Realities of Being a Midwife: Tape No. 981T762
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Realities: Midwifery and the Profession: Tape No. 961T350
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BACK ISSUES OF MIDWIFERY TODAY print magazine
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complete your library.

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6) Midwifery Today's Online Forums

Some practitioners have been kind enough to put my name out as a doula. But I find many of them feel that because they have done me a favor, I should do them a favor: breach confidentiality and give them details when there is a strain between them and their patients. Has anyone else had this problem? How do I refuse to give out information and still maintain a relationship with these providers?

- Anon.

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TO SHARE YOUR THOUGHTS AND EXPERIENCE ON THIS TOPIC, go to
http://www.midwiferytoday.com/forums/topic.asp?TOPIC_ID=1687
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7) Question of the Week (Repeated)

Q: What can be done to repair a small placental tear in the third trimester? A client lost her baby in the seventh month of pregnancy as a result of a tear in her placenta. She is pregnant again and due in May. Her OB told her he could see a small tear on her placenta. Apparently there was only a 10 percent chance of this happening again. Is there anything she can take or do to help correct this problem?

- Anon

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SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line.

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9) Switchboard

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International Connections

Mexico, along with the School of Professional Midwives of CASA - a project dedicated to the formation of new midwives to be included in the evolving and emerging Maternal/Infant Health Care Systems - will host a global symposium in June 2002 entitled La Partera Profesional y Certificacion Internacional. We are searching for contacts within every Latin American country who are native to her/his country and are active and currently practicing professional midwives in whatever practice site, whether hospital, clinic, posada de nacimiento, domicilio o otra. Simultaneously, we are searching for contacts for educational programs dedicated to the formation of new native midwives to be included as independent practitioners within the evolving/emerging maternal/infant healthcare systems in the country in which they are trained. Anyone with information regarding the above is invited to correspond with Sandra MorningStar, starbaby@cdoc.net or Peggy Cook, peggy@windsweptsolutions.com

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Re: Postpartum protocols in the UK [Issue 4:3]:

Hire doulas! There are several agencies around England, although mostly in London, and many doulas specialise in birth and postnatal care and support. We want to work with parents and babies and as anyone who has seen the NHS maternity profession knows, there is a huge need. The hardest thing for us (outside of London) is the mothers who really need our support have no money to pay us and so without proper funding, many doulas find this a difficult profession to devote themselves to full time.

American research has shown that having a doula improves the birth experience physically and emotionally and makes breastfeeding more likely to be attempted and continued. I think women are also less likely to get postnatal depression, and mother-baby bonding is strengthened.

- Debra, doula
Birmingham, UK

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In New Zealand there are no deliveries in private hospitals, only in public ones. You must obtain your own doctor and midwife previous to your delivery (the hospitals help tremendously in giving you contacts), you visit your doctor and the midwife visits you at home. As your time gets closer the midwife's visits are closer together. When labour starts you call your midwife, she advises the hospital and doctor, and the midwife meets you at the delivery section of the hospital (behind the scenes the midwife has arranged the room).The midwife stays with you and advises the doctor of the stage he is needed. The doctor signs any paper work. The midwife does the rest. No one is admitted unless there are complications. I left to go home with my daughter two hours after she arrived. The midwife visits that evening and twice daily for two days, daily for three days, then weekly for two weeks for a total of 10 visits. Obviously if there are problems you call ASAP.

This system was wonderful. My first child was born in Australia 1991 and it was your doctor until delivery, five days in hospital (not much help on the how to do things side). The maternal healthcare service in Australia is run by councils and is only available after the baby is six weeks old. You take the baby there once per month to be weighed and measured have a chat then leave - you get 15 minutes!

- Vickie

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Re: Nursing triplets [Issue 4:3}, excerpts:

I have never heard, read, seen that there is a latency time after a
breastfeeding session (not at all the conclusions of the studies from
Hartman et al); the more breasts are emptied, the more they rapidly
produce milk. For articles about breastfeeding triplets on the LLLI site go to:

http://www.lalecheleague.org/NB/NBSepOct92p135.html
http://www.lalecheleague.org/bfinfo.html with "triplets" in the search function.

- Fran?oise Railhet
LLL France Medical Associates Program

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For a few days, rotate them so that they all get a chance to be first, middle, and last. Don't use supplements or pacifiers - mom needs to provide every minute of contact with the breast that she can. The exception would be to give the third a pacifier while waiting! She could hold both nurslings in the football hold, or both in the cradle hold, or one each. "The Womanly Art of Breastfeeding" is an excellent resource.

- Anon.

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Breastmilk is produced much like tears: If you are distraught, you can cry all day and the tears keep coming. As long as a baby is doing nutritive sucking, the breast, at that moment, pulls water, nutrients etc. from the mother's blood stream and produces milk. Read La Leche League's book on breastfeeding multiples, "Mothering Multiples." It has detailed descriptions on how moms have exclusively breastfed multiples, including triplets.

- Chelle Goodfriend, IBCLC,CCE

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The breast manufactures milk continuously during a feed. When the breast is stimulated the hormone prolactin is released and signals the brain to produce more milk. There are several milk ejections during each feed where the high fat hind milk is produced. I recently heard of a mom who successfully nursed her quads exclusively!

- Shawna Becker CD, former certified breastfeeding support provider

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She should contact her local LLL AND a certified lactation consultant (preferably one with experience with multiples) before her babies' birth. She'll need lots of support and lots of help because she must spend the first several weeks focusing on breastfeeding. Since it's more likely that her babies will be premature and need to spend some time in the NICU, she should also look into renting a hospital-grade pump and pumping milk if she cannot breastfeed at first.

- Anon.

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The wife of our governor, John Engler of Michigan, successfully nursed her triplets several years ago. It was mentioned in the news because he was the governor at the time.

- Linda, LLLL and doula

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Do you have guidelines for eating (or not eating) soft cheeses during pregnancy and while nursing? What about if they are pasteurized? Cooked? Also, what about honey? It is my understanding that it is OK during pregnancy but not while nursing. What if it's cooked into muffins?

- Amy V. Haas, BCCE
Fairport, NY

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Healing tears {Issue 4:3}: My mothers often have a bath straight after being sutured and in the days afterward. They have not had problems with infections. The quality of the water may need to be taken into account. My mothers are encouraged to bathe after going to the toilet, but I believe the routine use of antiseptic is not necessary. As the vagina is moist it is best to heal without dry heat applied; heat lamps are too drying, although a few minutes in the sunlight is probably good, careful not to sunburn.

- Terry Stockdale, independent midwife
Hobart, Australia

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For perineal tears I use a New-Zealand honey called Manuka Honey. In Australia we can buy it in healthfood shops or at Safeway. It is thick and goes on easily. It should be put on at every pad change or every time the woman goes to the toilet. The woman should keep her legs together, not go up and down stairs or take big steps. Otherwise I use a poultice of comfrey, calendula, adding St John's wort when in season (chop the plants very fine, wrap in a piece of gauze, place on the tear and change regularly). So far women have told me unsutured tears are less painful than sutured ones, and I have not seen problems with healing. I need more information about seaweed for tears: What seaweed is used, what is it called, what does it look like, where can you get it?

- Kusum
Australia

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EDITOR'S NOTE: Only letters sent to the E-News official email address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER email addresses will be destroyed.

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10) Connections

If you have experienced a mother with female circumcision (FGM) I would be interested in hearing your story. I am doing research and am interested in the traditional midwives experiences and the possible effects on the child. Send responses to rowcoe@proaxis.com

- Sue

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11) CLASSIFIED ADVERTISING

The International School of Traditional Midwifery in Ashland Oregon is accepting enrollment for 2002 classes that start in May. For information contact: ISTM Catalog-MTEN, 3607 Hwy 66, Ashland, OR 97520 or call 541-488-8273.

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