|May 11, 2011|
Volume 13, Issue 10
|Midwifery Today E-News|
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In This Week’s Issue
Quote of the Week
The events in our lives happen in a sequence in time, but in their significance to ourselves, they find their own order…the continuous thread of revelation.
— Eudora Welty
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The Art of Midwifery
Taking the placenta as a powder, particularly in the first nine months after giving birth, is an old custom. It helps the uterus return to its original shape and size and speeds up the mother’s recovery as well. It prevents depression, which can occur even after several months, as a result of fluctuating hormones.
— Cornelia Enning
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 firstname.lastname@example.org.
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Apprenticeship, working with a midwife in a helper role, being able to help more and more as you get experience, is the most direct and, in my opinion, the absolute best way to learn midwifery.
The greatest teachers we have are the women we serve. It is through continuity of care that you get to know the uniqueness of each motherbaby. By observing your senior midwife ask questions, talk to the baby, palpate and the many other lovely experiences of prenatal visits, apprentices learn the most. It is through getting to know motherbaby prenatally that you can best offer your help at the birth. It is important to work with more than one midwife or midwifery practice so you can learn different ways of working but maintain continuity of care, which really is the humane approach to birth.
So very much of birth is in the mind. Many of my midwife friends have stated that if you get the prenatal course right, you are almost assured the birth will go well. The mind of the mother is most important, but if the midwife undermines the woman’s confidence or puts negative thoughts in her mind, the midwife bears responsibility. I think we are seeing more and more of this, as midwives bend to protocols that do not follow the midwifery model of care, such as the myth that you must have a baby at 42 weeks. (See my editorial on dating a pregnancy here.) Oh, how subtle birth is. To learn great prenatal care, apprenticeship is the best model. To learn birth care, apprenticeship is the best model. The same goes for postpartum care!
Didactic learning is important, too, and can be done along with apprenticeship to bring alive what you learn, seeding you with new ideas and insights. Books can also be an excellent resource for self-starters. Elizabeth Davis’s “Heart and Hands: A Midwife’s Guide to Pregnancy and Birth” is a great starting point. Elizabeth also runs a school, and there are many others, at least in the United States, that student midwives are enjoying. A few of my Facebook friends have shared their positive experiences with midwifery education. Homebirth midwife Celesta Rannisi said, “I cannot tell you how much I appreciate Ancient Art Midwifery. They are truly the last of the real homebirth midwifery training that is not polluted by the medical model of midwifery, not to mention it is very reasonable. … I studied the apprentice academic curriculum back in the 80s and still keep learning the real meaning of midwifery through the writings and sharing of truth. And Erika Obert posted, “Michigan School of Traditional Midwifery is the same way. Excellent academics and traditional philosophy.”
There are many others. I recommend you choose your program carefully. What goes into your mind when you are an aspiring midwife is ever so important and I personally want you to be the best midwife you can be, truly in service to motherbaby! To get you started in your journey to midwifery, check out two of our resources: Becoming a Midwife page and our book Paths to Becoming a Midwife.
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
Jan on Twitter: twitter.com/jantritten
Domestic Violence and Birth Outcomes
A new study conducted by a researcher at Malmö University in Sweden concludes that midwives “need both updated knowledge and tools with regard to abused pregnant women who are victims of domestic violence.”
The study, which included 2652 first-time moms, found a link between experiences of violence (as well as alcohol consumption) during late term pregnancy and a higher risk of labor dystocia. This link was not found at full term. Labor dystocia, or slow, difficult labor, is responsible for half of unplanned caesareans and has a significant impact on labor outcomes.
Statistics show that between 1.3 to 11% of pregnant women in Sweden experience physical violence, and previous research reveals that a high percentage of midwives never disclose violence against the women they worked with. Finnbogadóttir, who was inspired to conduct the study based on her own clinical experiences as a midwife, hopes her work will draw more attention to the problem of domestic violence during pregnancy.
— “Domestic Violence and Pregnancy.” Medical News Today. April 15, 2011. http://www.medicalnewstoday.com/articles/222450.php
Types of Midwifery Training: An Anthropological Overview
Apprenticeship learning involves the whole human being—body, emotions, mind, spirit—and therefore is the most powerful form of learning there is. We all learn to be full members of our cultures through this kind of experiential learning. Pure apprenticeship learning is connection-based, as opposed to didactic learning, which can seem to take place in a vacuum, with no apparent connection to anything. If the apprentice attends a birth with her mentor, for example, during which the woman hemorrhages, the apprentice will spend the next day studying every book she can find on postpartum hemorrhage and quizzing her mentor about its management. She knows, in an immediate and visceral sense, why this knowledge matters.
Because birth turns out well most of the time, apprentices attending home and birth center births usually are not exposed early on to pathology, and have the time to build up a profound trust in the process of birth and in women’s ability to give birth. Their training gives them a much broader experience of the wide range “normal” birth can take when it is not technologically controlled. The establishment of this kind of trust can have a great deal to do with the relationship between the apprentice and her mentor. I have interviewed a number of apprentices and mentors around the country, and am always impressed by the special quality of their relationship. Most mentors care deeply about the apprentices they take on, get to know them intimately, become committed to making sure they obtain the best education possible, and work to bolster the student’s trust both in birth and in herself as she learns.
To fear birth is to generate complications that result from the fear. Midwives who trust birth profoundly tend to help women give birth more effectively: to trust a woman to give birth is to help her trust herself—this is part of the magic and the great strength of apprenticeship training. Another part of that magic and strength is continuity of care. In high-volume programs, continuity of care can be very hard to achieve. But it constitutes part of the essence of apprenticeship training, where the student accompanies her mentor not only to the birth of a given client but also to every prenatal and postpartum visit. It is apprenticeship training that establishes the midwifery ideal for continuity of care, an ideal that other training programs do the best they can to emulate.
As Wells indicates above, pure apprenticeship training, which includes few didactic elements, is increasingly rare. Today’s apprentices are developing experiential trust in birth and learning continuity of care in the context of semistructured curricula that their mentors design to make sure the training meets the standards set by NARM. These curricula include a tremendous amount of reading and often involve weekly classes taught by midwives in their communities, which may be supplemented with college courses in the basic sciences and other relevant areas. Many apprentices complete their training by working in high-volume clinics in the United States or the Third World where they can be exposed to multiple complications of birth and can learn to deal with them effectively.
An additional benefit is that apprenticeship is both financially and geographically accessible. Women who do not have the money or the mobility to attend a private school or university-based program can still learn how to be competent practitioners and build an economically viable business to support their families while serving their communities.
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Birth Wisdom from the Web
Editor’s Note: This issue’s Birth Wisdom comes from a Facebook discussion of the apprentice model.
I have recently been taken on as an apprentice. I am thrilled! One huge thing I appreciate about this midwife is that she encourages us to learn from other midwives…. I feel that this will be key to my being able to customize my learning experience to best suit my own desires, beliefs and goals. Being able to learn from various sources will broaden my learning and make me a well-rounded midwife. Hopefully, I will also be able to enrich her knowledge as I bring to the table things I have learned from others. She is humble enough to accept this, and strong enough to stand her ground when necessary.
— Kathy L. McRae
The art of midwifery is more than catching babies: It’s the knowledge of the structure and function of the human female—physically, emotionally, spiritually and scientifically. Apprenticeship is absolutely necessary in the development of a midwife to fine-tune her spiritual connection to midwifery and to master the skill set of her mentor.
— Brandy Harris
Apprenticeship is the only way in my opinion. Too many students come out of schools looking for a preceptor to get their clinicals in but then they discount what the preceptor has to say because they know it all from schools. As for me, I will never accept another student who has been to “school” for midwifery.
— Jennifer Rector
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to firstname.lastname@example.org.
Think about It
Babies are astonishingly responsive to being “seen” and noticed when they are in the womb. Paying them attention, sending them love and actively imagining how they look, feel and respond on a soul level is rewarded with a very real sense of their appreciation. This appreciation is expressed not only with responsive kicks, but also with a feeling of well-being that emanates from them and is fed back to us through the invisible pathways of thought and a felt sense of connection in the body.
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