March 30, 2005
Volume 7, Issue 7
Midwifery Today E-News
“Building Client Community”
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Attend the full-day Second Stage Workshop with Marina Alzugaray at our conference in Copenhagen, Denmark, 18–22 May 2005. The class will include a review of second stage research from a midwifery point of view, as well as a demonstration of hands-on skills to use in a variety of situations during the moment of birth. This class will help you safeguard the integrity, beauty and power of birthing mothers and newborns. Go here for info.


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In This Week’s Issue:


Quote of the Week

"Take a look at your hands. Have they been the hands of God to someone, brought life and healing, ministered love and peace?"

Jennifer Hall


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The Art of Midwifery

When I was a student midwife at the Garden of Life Birth Center in Michigan, a woman who had just had her baby asked my mentor midwife, "When can we have sex again?" I was surprised she was asking the question and even more surprised by Val's response: "You can have sex anytime you want to, as long as I am not in the room!" I was astonished, having been previously told that a woman had to wait until she stopped bleeding or at least until six weeks postpartum.

When women have had a wonderful birth and have no injury to their vaginas, some want to celebrate the joy they feel by being close with their partners. Years ago, I would ask my clients at their two week visit if they were feeling "sexy" or "interested" yet and found that quite a few of them said yes and that a portion of them sheepishly admitted that they hadn't waited for my "green light." One woman said, "We couldn't wait, we were so happy!" I realized that I shouldn't wait until the two week visit to discuss the subject. I remembered that after my cesarean I did not want to make love for months—almost as if my vagina didn't work since it didn't birth a baby. After my VBAC in the hospital, I *couldn't* make love for months—I'd had an episiotomy the size of Montana. With my homebirth, I was ready *the next night*—24 hours after the birth! I loved my female body so much and was so proud of it!

While there is of course a wide variation in interest among new mothers and much to discuss with them—so they make the decision in their own comfortable time—I now tell them basically that they just have to wait until I am out of the room!

Nancy


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

Research to Remember

Homicide is a leading cause of traumatic death among new and expectant mothers and ranks only after automobile accidents, according to a U.S. Centers for Disease Control and Prevention study. Women younger than 20 and black women are at highest risk. The study, which documented 617 deaths occurring between 1991 and 1999, used data from more than 30 states, although many states do not keep reliable methods for tracking such deaths.

American Journal of Public Health, March 2005


Building Client Community

One of the deep satisfactions of being a midwife has been facilitating the creation of community. Modern prenatal care, even with midwives, is often given and received in the vacuum of "your appointment/your chart/your next appointment." To help clients celebrate motherhood and foster community, consider the following:

  1. If you have an independent or small practice, have prenatal days when you schedule your prenatal visits with your clients so they overlap and get a chance to meet. If you have a busy practice, have lots of chairs in the waiting area, a pot of tea and a bulletin board with photos of your women while they are pregnant and after birth with their babies. Clients can post announcements of help wanted, classes offered, birth news, etc. I help clients become aware of other clients ("I know someone near your due date/having a homebirth/interested in yoga. Would you like to meet her?")
  2. Encourage family members, birth attendants, whomever your women want to share their birth with, to attend one prenatal visit, preferably far along in the pregnancy.
  3. Hold an open house every month or two and invite every pregnant woman, her support people, and recent postpartum women to watch birth movies, share stories, listen to a speaker, drink tea and eat snacks. This is an opportunity for apprentices and aspiring midwives to enter the circle too. The idea is to be informal. I especially like having the woman who gave birth most recently come and share her story.
  4. When you meet, place an exchange box near the door for maternity and baby clothes, furniture, etc.
  5. Have a lending library of books and magazines about birth, parenting, wellness, vaccinations, grieving—anything you and your friends find helpful.
  6. Have a signup sheet at prenatal classes so women can sign up to bring a hot dish postpartum for their classmates. Make sure everyone exchanges phone numbers.
  7. When a client has a blessingway, naming ceremony, christening or postpartum party, be sure to include the other women who were pregnant around the same time.
  8. I am not above old-fashioned matchmaking if I find clients with special needs or interests in common. This could include matching an aspiring doula with a pregnant woman who has no money to pay a labor companion. In many cases, match-ups become best friends for years. Or even when they only have a passing friendship, they are always grateful to find someone else who understands what they are going through.
  9. Encourage clients to have a blessingway instead of or in addition to a baby shower. I offer to hostess it or to explain it to others who will do it for them. There is nothing like a blessingway to welcome the woman to motherhood and to deepen the understanding of her relatives and friends to the spiritual components of her passage.
  10. You can start your own circle of women to study midwifery to read, practice and discuss together.
  11. Those who bonded from these experiences often form play groups together when their babies are older. Others form study groups about homeopathy or home schooling or another shared interest.

Notice none of these ideas is about exchanging money, selling anything, charging fees, collecting dues, etc. Nature nurtures us every day, always and for free.

Alison Bastien, excerpted from "Midwives: Creators of Community," Midwifery Today Issue 70


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Web Site Update

Read this review from Midwifery Today Issue 73 now online:


Forum Talk

What is the going fee you would charge, or pay, to have another CPM be on call to attend births with you as an assistant? No prenatal or postpartum visits. Would you pay the assistant a set fee for a set number of hours, then an additional fee for anytime over that? In these parts, homebirth CPM fees average $2400–2800. Doula services average $500–700.

Anon.


Share your thoughts and experience about this topic.
**Please do not send your responses to E-NEWS!**


Question of the Week (Repeated)

Q: I was blessed with a wonderful homebirth under the watchful eyes and in the warm hands of a two local midwives in the state of Illinois. This was my fourth homebirth and sixth pregnancy. The birth of my eight-pound, four-ounce baby went beautifully. It was not until I got out of the birthing pool and on to the birthing stool to release our placenta that my uterus prolapsed. My midwives did their best and gave me all the information they knew about uterine prolapse. I am reaching out to the bigger midwife community for additional advice about how to treat a prolapsed uterus and maintain uterine health through the rest of my life. I am only 24, and who knows what is in the future. If we choose to have another baby, what will likely happen? Your support, knowledge and resources would be greatly appreciated.

— Jahmanna


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


Question of the Week Responses

Q: Are there any sources of information regarding the relationship between the throat and perineum during birth—when the throat is tight, the vaginal floor will also be tight?

— Giselle E. Whitwell, doula, board-certified music therapist, Birth Works childbirth educator, certified prenatal parenting educator

A: Ina May Gaskin writes in her book, Spiritual Midwifery, of loosening the mouth and therefore loosening the perineum. She writes to kiss your partner or express your feelings to him/her. She cites many examples of how well this technique works.

— Daphne McIntosh, LMT, nursing student and aspiring midwife, Nashville, Tennessee

A: I am a labor and delivery nurse, massage therapist specializing in pregnancy, and a childbirth educator. I teach childbirth classes that are sponsored by a large inner city teaching hospital. When I am teaching relaxation techniques, I use a lot of touch, I always tell the women and their support people to feel if the woman's jaw is clenched. A loose jaw is a loose cervix, and this is another technique to help her dilate.

— L.I.


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Feedback

Natalie Bjorklund's rebuttal of Ruth Trode's views on preterm labor [Issue 7:5] was no more evidence-based than the ideas she was opposing. Ms. Trode didn't claim to be presenting a review of research, but rather a common-sense response to her observations as doula and childbirth educator. She didn't claim that her recommendations would prevent preterm labor, but rather that preterm labor is a symptom, a "cry" of the body for some attention. She believes that the kinds of attention in pregnancy listed in her comments would address that cry. I don't see how it could be a disservice to women to acknowledge that they deserve special care in pregnancy.

Here is some evidence available on the ACOG Web site from a news release in November 2002 by Dr. R.L. Goldenburg summarizing his article in Obstetrics and Gynecology:

  • Causes of preterm labor are unknown.
  • Infection is associated with, but not a proven cause of, preterm labor.
  • Other factors associated with preterm labor are "young maternal age, black race, low educational and socioeconomic level, being underweight pre-pregnancy, gaining too much or too little weight during pregnancy, smoking, a history of previous preterm deliveries, and having too much or too little amniotic fluid." These aren't listed as causes either, since the causes are unknown.

In other words, a potentially compromised immune system and factors associated with stress from many sources seem to have a lot to do with preterm labor, though medical science doesn't have a research-based explanation for the biological mechanisms.

Trode's recommendations address these factors as well as any of the traditional treatments, which both writers agree are increasingly ineffective, according to research. I suspect that if every woman could be treated with respect and physical and emotional support in pregnancy, her health would be better in many ways, including a reduced chance of preterm labor. Can I prove it? No. Can Ms. Bjorklund disprove it?

Susan Lane, CD DONA, LCCE


I just read Donna's survey [Issue 6:24]. I too received Rhogam loaded with thimerosol in the seventh month gestation by a certified nurse-midwife. My son (born 1/21/98) has been diagnosed with Asperger's Syndrome (a form of autism), dyslexia and dysgraphia (learning disabilities). I've been watching NBC's specials this week on autism and I am appalled that they continue to deny the medical evidence linking mercury in vaccines with neurological disorders in infants and children (they sure don't hesitate to tell us not to eat fish because of the mercury). And I'm even more appalled that no one is warning pregnant women who are Rh negative of the dangers of thimerosol. It would be so simple to request a single dose vial (thus no need for a preservative) and so inexpensive when you consider that we have spent more than $100,000 (out of pocket—insurance covers very little if any of these expenses) over the last three years on therapies, treatments and education. *Please* research this yourselves and provide us with some responsible journalism on this vital topic!

Lisa Mask


I had a high-risk birth and delivery five years ago. I had a classical t-shaped incision as my baby (who is wonderfully healthy now) was born at 1.5 lbs after PROM and bleeding during pregnancy. Last year I had uterine surgery via a hysterscope to remove a uterine septum and two fibroids (one over my cervix, and one on the upper left of my uterus.) Consequently, one year later my fibroids have grown back to a mere 2 cm. The septum is nonexistent.

My question is that my high-risk perinatologist wants to take the baby at 37 weeks. Although I would like a VBAC, I concede that even my dear midwife has felt that it is unadvisable. So with that, my worry is that *I do not want my baby taken at 37 weeks*. I have heard a range of weeks out there that doctors will take babies. I am agreeable to 39 weeks. Can anyone help me find information that would support waiting until 39 weeks gestation? My perinatologist is a lovely guy but frankly malpractice shy and conservative and insists on 37 weeks.

I breastfed my little 1.5 lb baby for three-plus years, and I believe it made a difference in who she is (as healthy as she is) today. I want to wait until 39 weeks gestation because I believe that the longer one waits the healthier, more robust, and ready and willing to nurse the baby will be. I had to breastfeed Jordie every 20 minutes for 10 months and it was a struggle but worth it.

Can anyone offer advice? I would appreciate it. And if worse comes to worse does anyone know a perinatologist in the Connecticut/New York area who will allow me to wait until 39 weeks? I am currently 25 weeks pregnant with no problems at all.

Jo


Our newly formed midwifery advocacy group needs international support. Here in Bermuda obstetrics has the monopoly on pregnancy and birth. There is no midwifery model. We do not even have a birthing centre. Please sign our petition and spread the word about it. Visit www.gopetition.com/online/5243.html

Our group would like to make contact with Caribbean midwives. Right now we have only limited information about the Family Birthing Centre. I just e-mailed Seattle Midwifery School about their St. Lucia contacts since I will be visiting there as well. If you have any contact information for midwives and midwifery-run birthing centres in the Caribbean, we would greatly appreciate it.

Nicole Stovell


Editor's Note: Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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