|August 14, 2013|
Volume 15, Issue 17
|Midwifery Today E-News|
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In This Week’s Issue
Topics Gail Tully covers include: how to identify the posterior position, how to avoid the ROA/LOP mix-up, flexion vs. extension, and asynclitism. You will also be told about new strategies and traditional techniques to assist fetal rotation without invasive measures, and there will be a discussion of the difference between a lull in labor and actual cephalopelvic disproportion (CPD). Part of our conference in Belgium 30 October 30 – 3 November.
Plan now to attend our conference in Harrisburg, Pennsylvania, April 23–27, 2014. Planned teachers include Robbie Davis-Floyd (pictured), Carol Gautschi, Gail Hart, Sister MorningStar, Gail Tully, Debra Pascali-Bonaro and Diane Goslin.
Birth is as safe as life gets.
— Harriette Hartigan, a photographic artist, writer, producer and midwife
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For the new mother, the third stage is a time of reaping the rewards of labour. Mother Nature provides peak levels of oxytocin, the hormone of love, and endorphins, hormones of pleasure, for both mother and baby. Skin-to-skin contact and the baby’s first attempts to breastfeed further augment maternal oxytocin levels, strengthening the uterine contractions that will help the placenta to separate and the uterus to contract down. In this way, oxytocin acts to prevent haemorrhage, as well as to establish, in concert with the other hormones, the close bond that will ensure a mother’s care and protection, and thus her baby’s survival.
— Sarah Buckley
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 email@example.com.
Send submissions, inquiries, and responses to newsletter items to: firstname.lastname@example.org.
Choice in Birth
I am really sad that, in most countries in the world, mothers are not given a chance to birth the way they want if the pregnancy involves twins, a breech or a VBAC. (Actually little choice is given in most births!) We asked our country contacts whether midwives can do these births in their countries and found the answers disturbing. You can read them below. It is really as if the mother has no rights regarding her own birth. I know much research has come out on these births recently and with good training and skills they all should be in the scope of midwifery. Who else will do them? You can learn about twin, breech and VBAC births at Midwifery Today conferences. With the evidence against unnecessary cesareans, I think we as a tribe of midwives need to help make these needed changes. Doctors generally do not have the experience or the skills for these types of births.
I asked on my Facebook page, “Do you do breech births for mommas? Why or why not?” Many of the answers gave me so much hope for turning some of this abuse around. We need to find ways to help put birth where it belongs—in the mother’s hands and with choice belonging to her.
Kemi Johnson: Yes, because I’m a midwife! Why would we allow specialists in surgery and pathology and a faulty bit of research strip us of our skill set honed over the history of humanity where occasionally children choose to present other than head first. There are some presentations that won’t come at all, but we have surgery for that. Breech presentation is not in that category. We have no valid excuse for denying women the care for an unusual type of normal presentation.
Sherri Holley: Yes. I did a set of footling breeches a couple of months ago, as well as another single footling last week. I have done probably 45 of these types of births now. I do it because every woman needs a choice of when and how she gives birth.
Joy Horner: research shows no difference in long-term morbidity or mortality between vaginal- and caesarean-born breech babies and a whole lot of mortality and morbidity for the woman undergoing caesareans, including risk to subsequent pregnancies; therefore, routine caesarean for breech is unjustified. That said, I would very carefully counsel and screen for breech and now recommend birth in hospital due to a head entrapment I attended. I’ve had the privilege of working alongside Mary Cronk, learning the skills of all-fours breech birth and am pleased to say a team in Frankfurt is about to publish data on the safety of this. I have attended high-risk breeches at home with good outcomes, but I have also had two frank breeches die at home. The sad truth is that some breech babies are breech because they have a problem (like Downs or Hydrocephalus, etc.) so more of these babies will die than cephalic-presenting babies. We know this when we take these clients on—and they need good midwifery care even more than others.
Join us in Belgium or Harrisburg for a full-day class on breech. Whether or not you plan to do breech births, you will need to be prepared for anything either in hospital or out of hospital. Skilled help might not be near at a hand!
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: https://twitter.com/jantritten
Country Contact Reports
Editor’s Note: Midwifery Today is interested in promoting international networking among childbirth practitioners. Our goal is to strengthen the international community by establishing a country contact in every country of the world. If you would like to become a country contact, please e-mail Jan Tritten.
For this international edition of E-News, we asked Midwifery Today’s country contacts the following question:
Are VBAC, twin and breech births considered under the scope of midwifery practice in your country? Please explain how these births are handled.
Regarding the scope of midwives in India, VBACs are considered part of the normal birth process, but twins and breech births are done by obstetricians. Most of the time in these cases a cesarean is performed. Clients are not interested in taking the risk of normal delivery. Thus, we can say that these cases (twins and breech births) are not really in the scope of a midwife.
— Dr. Manju Chhugani
In Kenya, VBAC, twin and breech births are considered high-risk cases. They are not managed in a facility without theatre services. The cases must be seen by an obstetrician. For VBAC, a vaginal birth can be attempted if there is only one previous scar. The care shall be under a midwife, but with a standby obstetrician. Twin and breech pregnancies are given cesareans as the first option. Midwives are now losing the skill to manage such cases since cesareans are becoming the trend for management of twins and breech births.
— Benson Milimo
Unfortunately, in Iran most of the normal deliveries are cesareans. So it is obvious that VBAC, breech and twin are not considered under the scope of midwifery practice. They must be done under cesarean by obstetricians.
— Elham Shirvani
VBACs are considered while keeping in mind the reasons for the previous cesarean—a trial of labor is considered in most of the cases, but only in an urban setup. Breeches and twins are usually cesareans in urban areas. But in rural areas where facilities are not available, normal labor is undertaken in all the above situations or the case is transferred to a facility where a cesarean can be done.
— Uma Handa
In Ecuador, twin and breech births end in cesarean in 98% of the cases. Usually gynecologists attend these births. I attended a breech homebirth last year. When I arrived, the baby’s foot appeared first. It was amazing. The baby and mother were okay.
Most doctors and women are very afraid when the baby does not come head first. The medical protocols do not allow for normal delivery.
— Obst. Elbia Martinez C.
In Slovakia, twin, breech and VBAC births are not considered under the scope of midwifery practice (as specified in the Health Department Bill 364, latest revision in 2005). Midwives are only allowed to attend normal physiological births without known complications. Even these they rarely attend on their own because, with very few exceptions, there is always an obstetrician in charge. This is the primary issue we are trying to address.
— Iveta Jancigova
The full workshop schedule for Harrisburg, Pennsylvania, 2014 conference is now available online.
Midwifery Fun in Russia
We returned a couple of weeks ago from our third conference in Moscow, Russia. It was an amazing event with so much love and energy. Katerina Perkhova, who organizes these events, is so enthusiastic, loving and desirous of making birth changes in her country. As always, the international teachers did such an amazing job of teaching. We also got to learn from some wonderful and brave Russian speakers, including midwives and “good guy and gal” physicians from all over the world—they are brave beyond words. The threat of doing out-of-hospital births in Russia might even be greater than in the US.
Katerina has a gift of hospitality. When we got to Moscow, we went to a preconference class for mothers at a nearby spa and were treated to the most amazing massage, hot water treatments and other traditional Russian techniques. It was heavenly. We were mostly housed together in a big apartment and were treated to groceries to cook with. We were a 20 minute slow walk from Red Square and found so many places, people and things to photograph.
At Red Square, we teachers put our hands on top of one another and made proclamations and prayers for changing birth globally. We had done this before and it was a very hopeful gesture! I took a video of the whole proclamation. I do love those little iPhones that give you such ability to make record or your important times and events.
When we finished the conference, we took a night train to St. Petersburg and went to the Hermitage and the Church of the Spilled Blood. In the evening Katerina bought us all tickets to the opera, which was in a gorgeous, huge art-filled mansion. In a whirlwind trip we were able to try to help make birth change and enjoy some sightseeing! I guess trying to make birth change happen has lots of ups as well as downs, but Russia was certainly an up! Blankenberge, Belgium, is home to our next conference and being on the coast and 12 km from Bruges will also have its adventures. Please join us for them!
One of my client’s biggest fears was that she would poop during pushing. I assured her it was completely normal, probably wouldn’t even know it happened and a sign of great pushing! Well, during her pushing another doula was invited into the birthing room and, not knowing the client’s biggest fear, she said, “Oh look, you had corn for dinner last night!”
— Teri Saah Ayoub
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