September 14, 2011
Volume 13, Issue 19
Midwifery Today E-News
“Birth Emergencies”
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Welcome to Midwifery Today E-News !

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Are you ready for birth emergencies?

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As a home or birth center midwife, you may rarely encounter emergencies, but when they do happen, you need to know what to do. Birth Emergency Skills Training: Manual for Out-of-Hospital Midwives gives you the information you need. It takes you from the initial steps of intervention though definitive care, balancing a friendly tone and visual appeal with authoritative and clinically useful information. This book belongs on the shelf of every practicing midwife.
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Brush up on your midwifery skills!

Germany conference

Attend one or both days of the two-day Traditional Midwifery Skills pre-conference class at our conference in Bad Wildbad, Germany, 19–23 October. You’ll learn from teachers such as Elizabeth Davis, Carol Gautschi, Ina May Gaskin and Gail Hart. Topics covered include Essentials for a Normal Birth, Preventing Complications with Prenatal Care, Labor and Birth Complications, Holistic Complete Exam, Helping the Slow-starting Baby and Suturing Overview.

Your registration must be received in-office by 27 September 2011; please do not mail registrations to be received later than this. If you can’t make that deadline, walk-in registrants are welcome.

Midwifery: Skill, Wisdom, Culture, Love

Harrisburg conference

Come celebrate who we are and what we do! Come to the Midwifery Today Conference in Harrisburg, Pennsylvania USA, April 11–15, 2012. Meet and learn from great teachers, including Ina May Gaskin, Stephen Gaskin, Mabel Dzata, Robbie Davis-Floyd, Carol Gautschi and Michel Odent.

The full program is now available online!

In This Week’s Issue

Subscription Sale for Students!

Special prices on Midwifery Today magazine! This offer expires September 30, 2011 (postmark or fax by the expiration date). More information.

Quote of the Week

A calm, watchful, loving presence protects the fragile harmony of birth; frantic coaching has never been part of nature’s plan.

Pam England

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The Art of Midwifery

Put mother’s milk in the baby’s eye to cure infections. Put it on the cord to help the cord fall off faster. Mother’s milk contains lysozyme, an enzyme that kills bacteria and is abundant in a number of secretions, such as tears and saliva, and is also found in egg whites.

Judy Slome Cohain

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Jan’s Corner

Toward Trust in Birth

I was talking with my conference planning partner, Eneyda Spradlin-Ramos, the other day about the importance of the mom trusting birth and trusting her body during birth.

As Eneyda and I discussed a class I’ve been asked to teach in Turkey called Positions for Birth, she said, “That is exactly what I am trying to get everyone to understand. Get the mom out of that semi-sitting position where she is on her coccyx and into any other position she chooses.” As a massage therapist, Eneyda understands the body well. She went on to quickly recount a recent hospital birth that went so well that the baby moved right down and out. Eneyda told the staff midwife, who commented on how well the birth went, that when you get the mom off her coccyx the baby can and will move out much easier, and without damaging mother or baby. It occurred to me that birthing more babies this way would leave the craniosacral therapists with fewer damaged babies to help, but I’m sure they would be very happy about it!

If you trust in your body and in your baby, the birth journey changes. And this trust must also be placed in a non-interventionist environment. In fear, a rush of hormones can really slow the process of birth down. The best place to facilitate both the hormones and the trust is at home. To me, homebirth is the gold standard. This doesn’t mean hospitals cannot facilitate a normal oxytocin high during birth, they just don’t. It would take a revamping of everything they do, including a retraining of all personnel.

I visited a hospital in Poland many years ago that had a maverick doctor who changed everything in the hospital. She revamped her hospital to be like a birth center and retrained all of her staff in supportive natural birth and waterbirth practices. It was an oasis in a desert of birth destruction. It was a small hospital and she had complete control of how it was run, but her work does show it can be done. Though it would be very hard to achieve something similar in huge hospitals so common today, that doesn’t mean we shouldn’t keep trying to change birth practices. Toward Better Birth! Toward Trust in Birth!

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.

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News and Research

Drop in US Birth Rate

New research confirms that the US birth rate has dropped around 10% since its peak in 2007. States with the largest decline in income have had the fewest number of births in recent years, while states with more income growth have had high birth rates. Many women cite economic uncertainly as a primary factor in the decision to delay childbearing, and “since 2007, the rate of women of childbearing age who had three or more children also fell 5%.”

Dickler, Jessica. “Anti-baby boom: why US birth rate keeps falling” CNNMoney, August 16 2011.

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Featured Article

Second-guessing an Unexpected Outcome

We were 20 days postdates with an average size baby who was active and had good heart tones. The mother, a nurse, listened daily to her baby and kept careful track of daily fetal movement counts (FMC). In fact, until the labor, this baby seemed totally fine.

Labor began spontaneously. The first indication that there might be a problem was a severe dip in heart tones, down to the 40s, at 3 cm. I put the mother on oxygen and monitored her closely. Everything seemed to resolve. I weaned her off the oxygen to find yet another severe dip in heart tones. I put her on oxygen again and we transported to the hospital.

There, the monitor did not pick up another dip for more than an hour but the monitor line did reveal a moderately depressed baby—a definite concern.

The doctor decided to break the bag of waters to see the color of fluid. It was thick pea soup-colored meconium. An amnioinfusion was suggested and accepted. Pitocin was offered, but refused because she was progressing nicely. Within one hour, she was complete and pushing began.

The baby was born an hour later—naturally, no episiotomy, in severe distress. Within twenty minutes, the baby was put on a respirator and airlifted to a hospital with more sophisticated equipment. There, she fought for her life. We watched and waited as this child took one step forward for every three steps backward.

It was two weeks before she began to rapidly improve with the help of much technology, much love and much spiritual care. Doctors, midwives and healers agreed unanimously that all those forces working together had healed this child.

What happened here? Why was this baby compromised? What can we learn? First, from everything I have learned this baby was fine until labor. This baby started having problems during labor. Because she was in distress she started swallowing amniotic fluid, trying to breathe, until she passed meconium, and then started swallowing meconium. No amount of suctioning or intubation could have saved her from this serious aspiration.

What we think happened, and what is most likely, is that the placenta sustained this child through her postdates but could not sustain her through labor. I saw the placenta; it had no integrity and was in pieces. The baby, however, did not look like a typical postdates baby. There was no weight loss, she was not too big, and there weren’t a lot of wrinkles. Due to daily monitoring of heart tones and good movement counts, we did not opt to do a non-stress test/biophysical profile. Could this have made a difference? We aren’t so sure. However, when a diagnostic test is offered to assess potential problems in high risk situations, one cannot help but question decisions after a traumatic outcome—food for thought in a world full of options.

As a lay midwife, I feel good about informing parents of their options and swaying the way that best meets the family’s needs. This baby’s total recovery was a truly unexpected outcome. I am thankful every day for all of our options and for this baby who worked so hard to be here and be whole.

Jill Cohen
Excerpted from “Second-guessing an Unexpected Outcome,” Midwifery Today, Issue 29
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Fill Your Birth Library with Midwifery Today Back Issues

Midwifery Today back issues

Each quarterly issue of Midwifery Today print magazine is packed full of birth news, insights and information. You’ll also get an in-depth look at an important topic, with several articles devoted to the issue theme. Look over the list of available issues, then order the ones you need to help improve your practice. Order yours.

What is optimal fetal positioning?

How Will I Be Born?

Why is it important and how can you help your clients achieve it? You’ll learn this and more when you read Understanding and Teaching Optimal Foetal Positioning by Jean Sutton and Pauline Scott. Succinct and thorough, this manual includes brief descriptions of the various ways a fetus can present, information on how a fetus can be encouraged to rotate into the optimal position during later pregnancy and postures the mother should use or avoid during actual labor. Optimal Foetal Positioning features numerous black and white line drawings that illustrate and illuminate the information in the text and is a must-own for anyone who works with pregnant women. Click here.

The Shoulder Dystocia HandbookLearn shoulder dystocia management, techniques and experiences.
The Shoulder Dystocia Handbook will help prepare you for this complication. Authors include Marion Toepke McLean, Gloria Lemay, Gail Hart, Mayri Sagady, Sara Wickham and Jill Cohen. Buy the book.

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Learn about midwifery education!

Are you an aspiring midwife who’s looking for the right school? Are you a practicing midwife who would like to learn more? Visit our Education Opportunities page to discover ways to start or continue your education.

Birth Wisdom from the Web

The training is an opportunity for midwives and paramedics to learn more about each other’s scope of practice…. Paramedics and midwives are the only two professions that need obstetrical skills outside of a hospital setting, so it makes sense for midwives to provide this kind of training. The feedback has been positive and it’s been a fun day for both the midwives and the paramedics.

— Judy Rogers, registered midwife, on midwife-led training of paramedics in the Toronto area.

In present day Kerala, 99 per cent of the delivery cases are institutionalised with 80 per cent of the births being done by c-section. A “back to natural way” with the assistance of midwives is what I am advocating owing to the immense health benefits for the mother and her baby such as fewer post partum complications, lowered stress levels as well as the intense emotional bond between the mother, father and the baby.

— Priyanka Idiculla, of Birth Village, a Southern Indian birth center that follows the midwifery model of care.

I would have become a nurse but I didn’t like the fact that nurses had to treat people with wounds and that is the reason I resolved to become a midwife.

— Ugandan midwife Aidah Nalule Semukutu, known locally as Musawo, on her 60 years as a midwife.

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

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Expanding your personal library?

How about expanding your local library with books that encourage natural and instinctual birth? How much information about natural and instinctive birth is at your library? As a patron of a library, you have a say about what books they carry. Let your library know you want natural birth and midwifery materials to be available. Your library is your resource. Use it.

Conference Chatter: Upcoming Conference and Country Contacts

It is exciting to see where all the registrants for the Germany conference are coming from. We just had 13 midwives from Finland register. It will be fun to meet them. Our diverse registrants make me think that it would be great for Midwifery Today to have even more country contacts.

Our country contacts help us in many ways. It is our goal to have a contact in as many countries as we can. A contact basically lets us know what is going on in midwifery and birth in her country so that we can let our readers know. She also lets midwives in her area know about Midwifery Today projects. Sometimes women are looking for a midwife and sometimes midwives are looking to meet other birth workers in a particular country, so our country contacts are a great resource.

Maybe you’d like to be a country contact? You do not have to go to a conference to join this part of our team, but it helps if you know a bit about Midwifery Today, and conferences are a great opportunity to connect with our contacts from other countries.

Our country contacts are housed on the International Alliance of Midwives (IAM) page on the Midwifery Today Web site . The IAM is a good page to explore, especially if you are interested in international midwifery. If you would like to be a country contact, please visit our Web site at to learn more about what we’re looking for in a country contact. We hope to meet you in Germany, at another Midwifery Today conference or somewhere else in the birth world.

— Jan Tritten

Think about It

The effects of birth traumas are far reaching and mostly unrecognized in our culture. An infant who has suffered birth anguish may seem withdrawn. She or he may have trouble bonding or making eye contact. A traumatized infant may wish to be held all the time or not at all…. As midwives, it is important we do all we can to prevent birth trauma and know how to heal it when it does occur.

Autumn Gentry
Excerpted from “Preventing and Healing Infant Birth Trauma,” Midwifery Today, Issue 96
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