Midwifery Today, Issue 102, Summer 2012

Issue 102: Fourth Stage
Theme: Fourth Stage
Cover photo by Lora Denton
Lora Denton Photography

The theme of Midwifery Today, Issue 102, is Fourth Stage. For many new parents, the postpartum period is a time of survival. The myriad changes that have just taken place emotionally, physically, mentally and financially can be difficult to transition into, but for many in our culture, this sensitive time is overlooked or under-supported. Some view this fourth stage of birth as a nesting time of 42 days, others see it as the first three months of a baby’s life and still others see it as only the first one or two hours after birth. In this issue of Midwifery Today, you will read how some of the rest of the world views this time, as well as gain some information on newborn procedures and practices. Enjoy!


Poetry: The Heart of a Midwife
Kristi Shawana, Aboriginal Midwife
Jan Tritten
Midwifery Today’s mother shares some thoughts not only on the fourth stage of labor, but also on what she calls the fourth stage of midwifery.
Tricks of the Trade
Marion’s Message: Teso Safe Motherhood Project and Soroti Regional Referral Hospital
Marion Toepke McLean
“The relations between a hospital and a transporting midwife can be difficult.” Marion shares of her recent experience in Uganda and her thoughts on hospital transfers. She emphasizes that cooperation is a key ingredient for a successful outcome.
Media Reviews
Classified Advertising
Photo Album


The Fourth Stage: Sharing the Asian Way
Ibu Robin Lim
From her experience as a midwife in Indonesia, CNN Hero of the Year, Robin Lim, shares with us the Asian way of taking care of women postpartum.
First Hours After Birth: Family Integration and Mutual Regulation
Penny Simkin
Benefits of a holistic approach to fourth stage are reviewed in this informative article by childbirth educator and doula, Penny Simkin.
Michel Odent
French pediatrician, Michel Odent, shares how interfering with the process of childbirth causes a baby to enter the world of microbes in a radically different way-one that is far less desirable in terms of the health of the baby.
Linda Louise Henry
A personal account of a mom who sought to preserve and honor the fourth stage of labor by creating a “nest” and arranging her life so she could be fully present and fully undisturbed for the first 42 days of her newborn’s life.
No Midwife Left Behind
Rea Bochner
Feelings of longing, frustration and patience are felt as a woman shares her desire to become a midwife even though she knows that now is not the right time for her to walk down that path.
Evidence-based Midwifery: The Case Against Newborn Suctioning
Melissa Marks
“Research and studies show that oro-naso-pharyngeal suctioning (with the bulb or DeLee) does not improve outcomes (Mercer 2007), and it can actually be harmful to the newborn infant (Velaphi and Vidyasagar 2008).”
Let Time Stand Still: Bonding with Your Baby
Nancy Halseide
Managing editor of Midwifery Today, Nancy Halseide, shares the stories of the births of her daughters. She reflects on the bonding time with each girl and how the different circumstances hindered or enhanced this special time.
The Fourth Trimester and the Calming Reflex: Novel Ideas for Nurturing Young Infants
Harvey Karp, MD, FAAP
Dr. Karp shares his techniques on how to trigger a newborn’s “calming reflex” by using what he calls the 5 S’s: swinging, shushing, side-lying, swaddling and sucking.
I Am Not God
The Midwife
An emotionally-charged depiction of the pain and trauma experienced by an anonymous midwife from two births, only six weeks apart, that ended in loss.
Stanislawa Leszczynska: The Midwife of Auschwitz
Jane Beal
The historical account of Stanislawa Leszczynska, who, through her midwifery skills, bravely sought to bring hope and life into the hellish circumstances of Auschwitz.
Postpartum Emotions
Sue Turner
An informative look at the different hormonal shifts that occur postpartum and a discussion on what midwives can do to aid in this transition.
A New Understanding: Relating to C-section Trauma via Abdominal Hernia Surgery
Aurore Adamkiewicz
After birthing a baby through a broken pelvis and then going on to have abdominal hernia surgery, author Adamkiewicz was able to relate to the experience of a c-section by way of the medical procedures and recovery she endured.
All That Matters Is a Healthy Husband
Molly Remer
A light-hearted allegory of a bride experiencing the parallels on her wedding day of what many mothers experience in birth.
Violence, the Human Experience and Midwifery
Sarah Proechel
Midwife International clinical director, Sarah Proechel, reflects on the state of violence in the world today including its presence in birth and explores its roots as deeply embedded in the human experiences of shame and vulnerability. She offers the role of the midwife as an opportunity to transform violence at the source, holding the space for a more peaceful world to be born.
Angie Evans
A research-based article demonstrating the benefits of keeping the umbilical cord intact, specifically in regards to situations when resuscitation is necessary.
Prodromal Labor: Terra’s Birth Story
Judi Windleharth
A mother shares her experience of prodromal labor with the birth of her second child.
Judy Slome Cohain
Author Judy Slome Cohain demonstrates how lifestyle changes do more to improve birth outcomes than prenatal screening tests.
Social Media and Midwives: What Is Appropriate?
Louana George
A call for midwives, doulas and childbirth educators to come up with appropriate guidelines with regards to Internet posting.
A Triumphant Homebirth Story
Heather W.
A mother shares her encouraging story of a homebirth after two seemingly unnecessary cesareans.
Compound Presentation: An HBAC Triumph!
Katie Findlay
A mom who tested GBS positive, whose water broke before contractions began and whose baby was coming out with his hand on top of his head, was able to have a truly empowering HBAC experience.

International Midwife

Pokot Tribe
Amy Towle
A midwife shares her experience of learning about village birth from a traditional midwife of the Pokot Tribe located in the “vast nothingness” of Central Kenya.
Kraamverzorgsters: Postpartum Aid in the Netherlands
Thea van Tuyl
A look into the Dutch system of postpartum care.
Homebirth in Puerto Rico: A Little-known Choice
Limari Colón
In a country where the cesarean rate is 49%, homebirths are few and far between. Author Limari Colón shares her experience of giving birth at home. She also provides information on a recent campaign aimed at bringing down the country’s cesarean rate called Unnecessary Cesarean.
Birth in Israel
Ilana Shemesh
A midwife in Israel compares birth in the country now to what it was like 30 years ago and notes the improvements that have taken place.
Cards & Letters