August 29, 2012
Volume 14, Issue 18
Midwifery Today E-News
“International Issue”
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Enjoy the birth stories of three couples

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Just $18, this 42-minute DVD will show you various ways of giving birth, including waterbirth and squatting. The couples also discuss why they decided that homebirth was the best option for them. The audio in Homebirth Stories is in Hebrew, the subtitles are in English.
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Bring natural remedies into your midwifery practice

Germany conferenceSign up for the full-day Herbs, Homeopathy and Alternative Practices class with Lisa Goldstein. This class includes slides for plant identification and demos for making herbal tinctures, oils, salves and homeopathic solutions. Plus, you’ll be given an extensive reference book to take home. Come and learn new tips and uses for your favorite remedies. Part of our conference in Bad Wildbad, Germany, this October.

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Attend the full-day Spinning Babies Workshop with Gail Tully!

Gail Tully will discuss how you can spot a long labor before labor begins and turn it around to a shorter labor. You’ll learn about the 3 Principles of Spinning Babies: Balance, Gravity, and Movement in pregnancy and in labor. You’ll compare anterior and posterior fetal position and practice labor progress techniques appropriate to the level of descent. Part of our conference in Eugene, Oregon, April 2013. Plan now to attend!

To receive a printed program by mail when it becomes available, please e-mail with your name and postal address.

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In This Week’s Issue

Quote of the Week

Birth is as safe as life gets.

Harriette Hartigan

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The Art of Midwifery

After the cause of hemorrhage is recognized and differentiated, herbs can be used to act on the cause. In TCM (traditional Chinese medicine), herbs are described in terms of categories with certain actions such as blood quickeners, wind-heat resolvers, qi boosters and so on. Herbs can also have a taste. Pungent herbs are usually dispersing, sweet herbs are supplementing, and bitter herbs are cooling. Herbs have property, which is their temperature. They have direction: dispersing, moving up and out, contracting, moving in and down, descending and ascending. And finally they have functions, some primary and some secondary.

Valerie Hobbs, excerpted from Birth Wisdom, Tricks of the Trade, Vol. III, a Midwifery Today book
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Jan’s Corner


When we look at the condition of birth practices around the world there does not seem to be much hope. I am generally quite an optimistic person, so I want to talk about the hope that I see. We all know the horrifying situation of birth practices so I won’t spend any words now on that.

Let’s look at China for an example of hope. It seems the government there wants to lower the cesarean rate and also do more natural birth. The places I have visited in China don’t seem to have a problem with the epidural epidemic but they do with the cesarean epidemic, so it is very hopeful that they want to lower that rate. We discovered one reason for their high cesarean rate—if we could change that one thing, it would lower the rate. They do cesareans for cord around the neck of the baby, which is discovered a lot since ultrasound is used so pervasively. About 33% of babies have a cord around the neck, which is generally protective because then the cord won’t wash down in front of the baby’s head in what is known as a cord prolapse. So getting the information out that there is no need to do a cesarean for cord around the neck is really important. Carol Gautschi and I were able to that when we went to Guangzhou to do a five-day training. There were 150 midwives, mostly heads of maternity units, in attendance. Great ideas will go to eight different provinces in China via those attendees!

I also have experienced the strength of activists in many different countries, from Bulgaria to Croatia. Nearly every country has these activists spreading the word about great motherbaby-centered birth. When we are at a conference like the upcoming one in Bad Wildbad, Germany (October 17–21, 2012), we will meet many more. These beautiful seeds—planted all over the world, from Australia to Zimbabwe—give us great hope. We birth watchers are seeing a revolution happening. Look at the proliferation of birth websites, blogs and social media users. On my Facebook page we ask questions and we receive answers from all over the world immediately. The responses are often brilliant.

There are projects in India, Philippines, South Africa, each European country, and almost every country I have been privileged to meet midwives and activists from. There are many plans that have not yet been manifest, but if we encourage each other to “just do it” there will be many more.

In the USA there are so many midwives, doulas, childbirth educators, birth networks, Facebook pages and Twitter users. There seems to be a shaking of the earth with the idea that we need good births. As Jeannie Parvati-Baker said, “Peace on Earth Begins with Birth.” Our calling has far-reaching effects. I encourage you to keep up the good work you are doing for motherbaby. We are all needed to help manifest better births everywhere. The speed of social media enables us to share ideas instantaneously. Use it to brainstorm projects. Let everyone know what you are doing and how they can help. With hope in our hearts and minds and the hard work each of you are doing, we can change the world of 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

Flood at Mercy In Action, Philippines

After a disaster flood in the Philippines, the Mercy In Action clinic and birth center in Olongapo was mostly destroyed. Everyone on the Mercy In Action team is alive and safe, but many of the center’s supplies were damaged or destroyed.

Mercy In Action is in the planning stages of purchasing a house on a large piece of land much higher off the river where it will not flood. They desire to purchase this land in order to construct a new birth center and have more living space for staff and visiting interns.

Please consider donating to the building program. The land and existing house at the new location (where it will not flood in the future) is being sold for US $84,000.

One of the Mercy In Action staff members wrote, “And during the mucking out and cleaning up phase this morning, wouldn’t you know it, a woman from the resettlement camp arrived in labor! Our amazingly dedicated and hard-working midwives cleared the mess aside enough for her to deliver a healthy baby girl. Amidst the chaos, life goes on.”

You can go online to donate to Mercy In Action at, or you can send a check to:
Mercy In Action
PO Box 2777
Paso Robles, CA 93447 USA

Mercy In Action Newsletter. 2012. “Devastating Flood at Mercy In Action Olongapo, Philippines.”

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Featured Article

Hospital Birth

Editor’s note: For this international edition of E-News, we asked Midwifery Today’s country contacts the following question: What does hospital birth in your country look like?


In Belize, private hospitals charge 1500–3000 Bz (750–1500 USD) for prenatal care and delivery. A c-section costs about 5000 Bz (2500 USD). Patients receive good, close-to-American care, plus extra benefits, such as the husband can attend the birth, they have access to private rooms, etc.

At public hospitals, women labor in a ward with 4–6 beds with curtains in between. The family can attend until late labor (7 cm or more) when the laboring woman is moved to a smaller room to prepare for delivery in a delivery room. Sometimes the family can accompany the birthing woman, but most often not.

Women deliver flat on their back on a small short bed with no pillow—since stirrups are used for all births, legroom is not needed on the bed.

For first-time moms, episiotomies occur 90% of the time, and the cord is clamped and cut in fewer than 30 seconds. Active management of third stage is the norm. Baby and mom room together at all times unless baby needs special care. The cost for public hospitals is 75 BZ up to 300 BZ if a c-section occurs.

The time involved to transport to a regional hospital (not all hospitals have an operating room) is usually around 1–3 hours. Patients bring their own supplies, such as a towel, a face cloth, diapers, pads, toothpaste, shampoo, toilet paper, soap and extra food.

— Gail Johnson


The rate of neonatal death in India is so high that the government has been encouraging hospital birth in recent years. They have also started a scheme called The Golden Hour, which is a country-wide project that trains anyone in the birthing world for free to do simple steps to promote good motherbaby-friendly care. This is an excellent initiative and I attended the course to update my knowledge and learn the current procedures here. Things taught included immediate skin-to-skin contact, no separation of motherbaby unless medically indicated, no routine suctioning and delayed cord-cutting. The majority of people on the course were pediatricians, although it was aimed at the grassroots crowd and was a simple but very good course with visual aids, role play and repetition of information.

Due to the overpopulation of urban cities, the government-run hospitals are swamped. That means:

  • Women are alone—no support person is allowed.
  • Routine care involves shaving, routine IV, augmentation, enema, etc.
  • Electronic fetal monitoring is standard if a machine available.
  • Women have to lie on small, thin platform beds and are not allowed to move; most give birth in the supine position.
  • No consent, nothing explained and internal exams are frequently done by doctors with no explanation.
  • Women are treated roughly (slapping, shouting) and are not allowed to make noise.
  • Episiotomies are given to all, including multips and women birthing tiny premature babies.
  • Fundal pressure is used if baby is not born immediately.
  • Baby is separated from mother while she waits to be sutured, etc. The separation is often for more than one hour.
  • Many women labor in one room. In a country where women are often modest and sometimes only have their eyes uncovered, at birth they feel very exposed and without dignity as their dresses are pulled up beyond their waist—a humiliating experience with no respect for privacy.
  • If complication or death occurs, women are blamed. I have witnessed repeatedly women being lied to and not told if her baby dies. She will not see her baby and therefore have no chance to say goodbye, making the experience even more traumatic.

The doctors are exhausted and the medical workers are overworked and overtired. When nurse midwives are at births, they do the same things: episiotomy, fundal pressure etc.

— Lina Duncan


In Portugal there are two systems: public and private. The number of cesareans in a private hospital is about two out of three births.

In the public system, you have to go to the hospital; there is no infrastructure that gives you any choice outside the hospital.

Things are changing a little bit, but still laboring women are given no food, no drinks, no company of their choice and the room is filled with bright lights. Sometimes women are shaved and receive enemas. The hospital is paid by the amount of interventions they do.

According to protocol, women will have a vaginal exam every two hours and will be in a room with other women until they reach 7 cm dilation. Fathers-to-be have hardly space to move; there is no privacy. When women reach 7 cm of dilation, they are wheeled into a birthing room and push with their legs in stirrups (this is with 10 cm of dilation, not with pushing contractions).

Breastfeeding is not on demand, and mother and babies are separated. Vitamin K is given by injection and so are some vaccinations, which are done in the very first days (tuberculosis and hepatitis B). After three days you are allowed to go home. If you want to go home sooner, the baby has to stay at the hospital. Informed consent is unheard of.

Mary Zwart


The hospitals that are meant for rich people are quite clean and even a little kind, but the birth process is nearly always on a high table, often with stirrups and surrounded by strangers. Episiotomies are given and the umbilical cord is usually cut immediately. Baby is then taken away from mother.

However, things are changing since the CNN Heroes event last December. I have had many appearances on Indonesian and Filipino TV—gentle birth is all the buzz. I met with more than 900 Filipino midwives and promoted gentle childbirth, loving birth and long, long delay of umbilical cord cutting on International Day of the Midwives in May. Usually more than twice a week I teach groups of graduating Indonesian midwives (called Bidan). These groups come 30 to 100 at a time by bus and airplane from many islands to learn about loving, gentle childbirth. Last week I taught a group of 1500 midwives in Jakarta. I am supposed to inspire them, but they inspire me with their potential for making birth better and gentler for the mother, baby and family. These are amazing times and the midwifery-to-mother model of care is just getting better and better in Indonesia.

Please, midwives, delay delay delay cutting that umbilical cord. Bumi Sehat delays by a minimum of three hours, and we are doing a lot of full lotus births.

Love from Bali, Indonesia,

Ibu Robin Lim

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Maternal Exam for the Student Midwife, Part I, is also available.

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What is Midwifery Today magazine?

Midwifery Today Magazine
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If you’re a doula, you need The Doula Business Guide

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Website Update

You may check out the table of contents for the newest issue of Midwifery Today magazine here. The theme is Shoulder Dystocia.

Read this editorial by Jan Tritten from the brand-new Autumn 2012 issue of Midwifery Today, Autumn 2012:

  • Never, Never, Never Give Up
    Excerpt: She tried to get the shoulders free, did several maneuvers to no avail and then was going to call 911 when she remembered the YouTube video and to never, never, never give up. She continued working on the shoulders and freed the baby!

Read these reviews from the Spring 2012 issue of Midwifery Today magazine now on our website:

  • The Belly Mapping Workbook—by Gail Tully, reviewed by Min Yi Su
    Excerpt: This workbook addresses such questions as, Where’s your baby’s head? Is it engaged? Is your baby facing backwards or forwards? Is your baby’s chin tucked? There is so much more to our baby’s position than “head down.” … When mothers and attendants know the baby’s position before labor, proactive steps can be taken to ensure an easier birth.
  • Paths to Becoming a Midwife: Getting an Education, 4th Edition—edited by Jan Tritten and Kelly Moyer, reviewed by Sunday Tortelli
    Excerpt: Composed of a compilation of articles, this book empowers the prospective midwife to find her own best educational path. This is not a “how to” book, which may be frustrating for those who only want to learn the most direct approach to reaching their goals. Birth is about self-reflection and personal discovery. Whether a woman is birthing her baby or birthing a new phase of her life, the best way is always going to be her way.
  • An Introduction to Biological Nurturing: New Angles on Breastfeeding—by Suzanne Colson, reviewed by Nancy Halseide
    Excerpt: So does BN look different from how we have known breastfeeding to be in recent years? Yes, somewhat. Colson explains that in BN, instead of being bolt upright in a chair or in a side-lying position in bed, the mother semi-reclines while putting her baby on top of her abdomen so that the entire front part of the baby’s body is touching his mother’s maternal contours.

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Wisdom from the Web

Perineal massage does not “lengthen” the tissues of the perineum. However, it does increase the stretch in two ways. First, perineal massage is done with cold-pressed oil, which lubricates the tissue making it softer, more supple and improves flexibility. This makes it easier for the tissues to stretch as the baby is born. Second, perineal massage familiarizes the mother with the stretching sensations she will feel as the baby is born. This helps her learn to keep her perineal area relaxed during the stretching of crowning which can help prevent tears.

— Birthing Naturally, a free source of information about pregnancy and birth

Unrefined, real sea salt is almost gray in color and slightly damp in feel. It contains trace elements and minerals that act as electrolytes and keep the correct balance of fluids in the bloodstream. “Good” salt actually attaches itself to water and pulls it back into the bloodstream, instead of letting it leak out into the extremities—the pathological swelling of pregnancy that is so typical and normal for so many pregnant women. Unfortunately for these women, the swelling only gets worse and worse and more painful as the pregnancy progresses and they follow the low-salt recommendations of their doctor.

— Indie Birth, a website dedicated to providing “intellectual fuel for free-thinking mommas”

The lactation system inside your breasts resembles a tree. The milk glands (the leaves) are grapelike clusters of cells high up in the breast that make milk. Milk travels from these glands down through the milk ducts (the branches). These ducts then widen beneath the areola (the dark area surrounding the nipple), forming milk sinuses (the tree trunk), which then empties into the approximately twenty openings in your nipple (like the channels going down to the roots of the tree). These milk sinuses are located beneath your areola.

— Ask Dr. Sears, a trusted resource for parents

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

Byron Bay, Australia

full moon photoWe found a great place for a conference—Byron Bay, Australia. As you know, we have wonderful, healing conferences around the world, and my hope is to strengthen Australian midwifery. This location is amazing and I thank my friend Sue Cookson for suggesting it and helping me find it. We are thinking of having a conference there November 3–9, 2014. We wanted to have a full moon party on the beach! This location is one of the top places to go in the world—a beautiful long beach is located right next to town. The time is perfect for excellent swimming weather. Don’t play too much hooky while you are there because the conference classes will be excellent with our roster of amazing teachers. The location of the conference has restaurants and shops all around. A grocery store and many great accommodations in all price ranges are within a few steps of the venue. This is a conference that has us really excited, and we hope you will mark the days to join us!

— Jan Tritten

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With my third baby, I called all my relatives to join us! When I got to the hospital, my labor absolutely stalled out. I signed a waiver to leave and went to the hotel across the street. My family all helped me to get labor going the next day—it was very funny and ridiculous. Finally, late the next night, I lay down with my exhausted husband to get some rest, when contractions gripped me like nobody’s business! I gave birth to my daughter unassisted in the Courtyard Marriott, across the street from the hospital. They named the suite after her.

— Angela Kirsch

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