July 5, 2006
Volume 8, Issue 14
Midwifery Today E-News
“How Fear Affects Labor and Birth”
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Learn about First and Second Stage with Ina May Gaskin and Marina Alzugaray.

Attend this full-day workshop to discover ideas and techniques to help the mother move through the first stage of labor. This discussion will include prolonged rupture of membranes, failure to progress, abnormal labor patterns and non-medical intervention. Ina May and Marina will then review second stage research from a midwifery point of view, focusing on how the standing, squatting, kneeling, hands-and-knees, supine and other maternal positions affect childbirth outcomes. They will demonstrate hands-on skills to use in a variety of situations during the moment of birth that safeguard the integrity, beauty and power of birthing mothers and newborns.

This class is part of our conference in Bad Wildbad, Germany, October 2006. Go here for info.

Learn about midwifery from

  • Barbara Harper
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  • Anne Frye
  • Robbie Davis-Floyd

Attend our Eugene conference in March 2007! Go here for more information and a complete program.

In This Week’s Issue:

Quote of the Week

"Much of the stress of labor is preventable because many of the stressors are not inherent to labor."

Penny Simkin

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The Art of Midwifery

Watch the laboring mom's rectum to help determine her progress. The rectum will tell you a good deal about where the baby's forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the mother must be in hands and knees or side-lying position.

Gloria Lemay
Midwifery Today Issue 55

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.

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Passionate Midwifery Education

The Jumping Off Point

I just returned from Costa Rica. We are planning a conference there in May 2007. The midwifery situation there is unusual in that the government decreed 20 years ago the elimination of midwives. A midwife friend of mine, who does homebirths there made the statement, "Your education is just a jumping off point for what you want to do." I have been really reflecting on this concept in relation to you and the unknown direction of your midwifery life. This midwife, Rebecca, got her nursing degree then her CNM and a doctorate. No one can challenge her credentials but her relaxed style and humility remind me of my favorite lay midwives. She knew she would be living and working in Costa Rica. If you know what you want to do as a midwife think about crafting your education to fit your goals.

Please do not be concerned by the many different and sometimes conflicting ideas I am sharing in this column. As pregnant women are all different with a few similar threads, so aspiring and student midwives are all different, with similar threads. I am just putting forth ideas that might help you on your midwife adventure.

I also believe in the legacy we already have as women. Women own the knowledge of birthing babies. We have just forgotten it in western cultures. Fear has invaded and blinded us to our spiritual birthright. We are already midwives as soon as we are called. We only need to find the way to draw out the gift we have received. Midwifery belongs to the women, not to education systems, not to obstetric practices, not to nurses or doctors. Its first home was with the women of the community. Indeed that is where it still belongs.

love, Jan
Jan Tritten, Mother of Midwifery Today

To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.

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How Fear Affects Labor and Birth

The emotional state of fear on the part of the birthing woman can have a negative impact on the progress of her labor and her overall experience of birth…. Slowing down or arrest of labor [is a] physiological phenomenon observable in animals, whose bodies instinctively cease to labor when a threat is perceived. …The same [response is] noted in women upon arrival at the hospital…. Emotional changes are shown to affect the physiological state of the birthing woman…. This is a difficult concept to accept and integrate into current US culture, where the separation of mind and body has been universally accepted under the tenets of Cartesian Dualism…. Modern US biomedicine is deeply entrenched in this concept and rarely focuses its care on the mental side of medical situations.

…Scientific studies, however, indicate that certain hormonal changes take place in the presence of fear, stress and anxiety…. Adrenaline has been referred to as the antithesis of oxytocin, the naturally produced hormone that stimulates uterine contractions.(Gaskin 2003) Another category of hormones (catecholamines, which include epinephrine, norepinephrine and dopamine) is indicated by other studies as one of the causative factors in fetal distress as well as problematic labor. Catecholamines…circulate when the pregnant mother is anxious or afraid [and pass through the placenta to the baby, affecting] the baby's environment. [Under these conditions, the risks of fetal distress during labor are increased, and medical intervention ensues.]

The level of fear experienced by women today may be in part due to the removal of birth from the natural feminine realm…. The medicalization of birth in part causes fear, which causes the rising hormone levels, which in turn causes complications that lead to medical intervention. The resulting circular logic normalizes birth as a medical event.

— Colleen Bak, excerpted and paraphrased from "The Role of Fear in the US Birthing Process," Midwifery Today Issue 67


  • Kitzinger, S. 2000. Rediscovering Birth. New York: Pocket Books.
  • Klaus, M., J. Kennel and P. Klaus. 1993. Mothering the Mother: How a Doula Can Help You Have a shorter, Easier, and Healthier Birth. Cambridge, MA: Perseus Books.

You can read the rest of this article by ordering MIDWIFERY TODAY ISSUE 67

Research to Remember

A study undertaken at Aydin Maternity Hospital in Turkey sought to identify the sources of and prevalence of postpartum back pain. Study participants were 88 pregnant women ages 14 to 46 who reported back pain during pregnancy. The participants were followed through pregnancy and to six months postpartum. Review of questionnaires showed that 59.1% of the women had had back pain at the time of delivery and 43.2% reported back pain at 6 months postpartum. A higher number of previous pregnancies increased the prevalence of postpartum back pain, especially in the younger respondents. A history of back pain before pregnancy also increased the prevalence of postpartum back pain, but degree of physical demand in their everyday work before pregnancy did not.

Eur J Obstet Gynaecol Reprod Biol, September 1998

Products for Birth Professionals

If you work with laboring women you need Midwifery Today's Second Stage Handbook.

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What causes breech birth and what can you do about it?

Read Breech Birth: Woman-Wise by Maggie Banks to learn about incidence and types of breech, reasons for breech presentation, diagnosis, positions for labor, assisting breech birth, and more. Go here to order your copy.

Learn "About Physiology in Pregnancy and Childbirth"

A compilation of eight articles by Verena Schmid, an independent midwife from Italy, this book will give you a unique view of pregnancy, birth and related processes. Verena applies her nearly 30 years of midwifing homebirths to providing you with a deeper understanding of the complex biological processes that make up the perinatal period. This book is must reading for informed midwives and mothers-to-be.

About Physiology in Pregnancy and Childbirth

Midwifery Today Magazine Issue 71MIDWIFERY TODAY magazine: A 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more.

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Forum Talk

My daughter will be eight months old in a few weeks and she's still only nursing. My doctor suggested that I hold off on introducing food to her up to 12 months if my milk is coming in okay. She weighs 23 pounds and is growing, so I'm not having a problem producing enough milk. I've also been giving her liquid vitamins to make sure she's getting anything she might need since she's not eating solid foods yet. He said it is better to wait with the babies because it helps reduce the chances of allergic reactions. Is this okay? I'd never heard of this before.


Go to our forums to share your thoughts and experience.

Question of the Week

Q: My stepdaughter's doctor told her if she didn't drink more water that she could go into premature labor. She is due in mid-August. Is this true, and if so, why?

— Tammie

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: What can we do to have the art of midwifery be more in the consciousness of our culture? As we know, most of the youth in our society think, as many adults do, that "having a baby" means "going to the hospital." I have been pondering lately what changes might take place in our society if midwives made a point of visiting their local middle and high schools (private and public) to speak with the health/science teachers and volunteering to come into the classroom to give a workshop (or whatever term you wish to use) as a professional expert when the class is studying human reproduction. Wouldn't it be wonderful if natural birth was presented to the youth of our society so that it is thought of as a very normal thing when, later, they are adults preparing to have children?

— Kathryn Balley

A: I am scheduled next week for my third annual presentation on birth to our local high school advanced placement (AP) biology students. I started this when a teacher (a family member) requested people to come in to fill class time after these students completed their AP exam. It was initially supposed to be more of a "career" discussion, routes of education, income, etc., but has become a tradition that the kids love! I show Suzanne Arms's video "Choices in Childbirth" after presenting natural birth as the truly physiological process that it is, and have a question and answer discussion afterward. These students are intelligent and excited about these discussions and truly ask the BEST questions. For example, a young man headed to Stanford picked up on the use of "sexual play" in the list from the movie {to naturally augment labor} and opened up a very matter-of-fact discussion about that. I have presented to about 100 kids now. The kids have not had children yet but when the time comes will certainly remember and be aware of the choices that truly are available! The teacher does send home a permission slip for the kids' parents to sign mentioning "brief frontal nudity" in the birth video, but as of yet, we've only had one student opt out. I have to think slowly but surely getting the word out to our youth will only make things better.

— Hilary Biesecker
homebirth mom, birth assistant, birth educator, aspiring midwife

A: It should be a requirement for them and for the students to graduate from middle or high school. This should happen all over the United States, Canada, and the rest of the world. I wish this had happened while I was in high school during health, child development and parenting classes I took.

— J.B.

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.

Think about It

To the baby, birth is about being received. We unfold to the world and know our value when received with love and acceptance, in our own perfect timing. If someone yanks us out of a place intrusively, we naturally recoil and go within in order to maintain balance against this outside force. The difference of being "received" compared to being "forced" results in opening to this world or shielding ourselves from it. Out of this experience comes baby's first decision: either "the world is a friendly place" or "the world is a hostile place." This decision is the initial filter that determines if baby opens to or shields herself from the world, from then on.

The experience of birth determines the vibration of life that a soul will live and filters the way that person experiences the world. This vibration becomes their blueprint. Only by creating a birth of absolute safety, gentleness, warmth and acceptance, internal peace, love and a state of wonder can we have a baby who knows within, "I am all this. I am secure and loved."

— Sunni Karll, excerpted from "Making a Difference: A Blueprint for Harmony," Midwifery Today Issue 58


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