September 27, 2006
Volume 8, Issue 20
Midwifery Today E-News
“Midwifery Apprenticeship”
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In This Week’s Issue:


Quote of the Week

"We need to find a way between the rock of medical model standard of care and the hard place of women's insistence on pain-free, rapid childbearing to meet the needs of both mother and baby."

Sharon Glass Jonquil


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The Art of Midwifery

A really neat trick for newborns who have transient tachypnea—rapid breathing because the baby has not gotten all the liquid out of its lungs with its first few breaths at birth: Rub lobelia tincture on baby's back and chest (about 5 drops per side), lay baby on her/his side for 15 minutes, and then turn her/him on the other side for 15 minutes. The tachypnea should resolve by then. This technique also works for any respiratory illness in which there is mucus or liquid in the lungs.

Kimberly Juroviesky
Midwifery Today Forums


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 mtensubmit@midwiferytoday.com.


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Midwifery Apprenticeship

I have developed an apprenticeship program of "trimesters" … Applicants for apprenticeships are required to be certified doulas, monitrices or childbirth educators.

First Trimester

  • Personal contact with me (study groups, prenatals, etc.) for six months before attending any births
  • Adult/infant CPR certification
  • Read "Becoming a Midwife" by Carolyn Steiger
  • Attend three births as an observer

During this trimester, either one of us is allowed to discontinue the apprenticeship for any reason. After the third birth, we discuss our expectations and whether we both want to continue.

Second Trimester

For births 4–15, skills are developed and assessed at prenatal and postpartum visits under supervision.

  • Take maternal vital signs, check fetal heart tones, placental and cord sounds
  • Participate in palpation, physical assessment of mother
  • Assist at births with setup, assessments (not necessarily vaginal exams), charting, clean up
  • Begin a birth record book

I require birth evaluation for each birth attended by six weeks postpartum. I also encourage the apprentice to begin a formal academic route of studies; for example, college anatomy and physiology courses or a distance learning program. At the end of this trimester, we discuss the progression of the apprentice, what her learning needs are and whether we want to continue at this level.

Third Trimester

This trimester encompasses births 16–30. At this level, I prepare the apprentice for becoming a primary [caregiver]. Her academic assignments are based upon the cases and the situations she moves through (one month is allowed for each assignment).

  • Begin to do four-handed catches with me
  • Follow several cases entirely, including prenatals, labor checks, calls, postpartum visits and birth (under my supervision)
  • Round out skills: perineum support, sterilization of instruments, assessment, midwifery charting

These all begin to be pulled together for her use in pursuit of her own midwifery practice.

After birth 30, we once again discuss where she should go from this point. Either one of us may feel it is appropriate for her to continue as an assistant for a season. She may feel ready to take on her own clients as the primary, with me as a consultant and assistant. (We call this phase the internship.)

… In the third trimester, I begin compensation depending upon the apprentice and her assistance to my clients and me. When we enter the internship phase, she pays me $300 to consult and assist (this is what I pay a midwife who backs me up).

Renata Hillman
excerpted from "Passing It On"
Midwifery Today Issue 69


Midwifery Today Issue 69 can be purchased.


In some cases, when a woman finds a mentor, she may adopt a style that is something just short of worship. A Bradley teacher I once knew explained it this way: "I observed Anne X's classes as part of my training. When I started teaching on my own, I just did everything she did—she was such a good midwife and teacher, I figured if I just did everything like her, I would be great too. As I gained more experience, I eventually found my own voice and my own opinions."

I meet apprentices and midwives all the time who swear they are learning or have learned from the *best* midwife ever. Such enthusiastic role modeling has positive value in the initial total-absorption phase of learning. Normally it is followed by individuation, when one separates the heroine from one's own sense of self.

The trouble comes when separation does not occur and you have a woman who cannot consider doing things any way but The Way that her mentor did. Sometimes it is a way for an apprentice to gain esteem or power: "*My* midwife was So and So," which doesn't necessarily mean she herself is as qualified and caring as her mentor, but implies as much. By seeing one's mentor as infallible or setting ourselves up as such, we are seeing neither her nor ourselves as whole. We also run the risk of giving our own or the birthing couple's power over to our Heroine's undeniable rightness.

Alison Parra
excerpted from "Thoughts on the Apprentice's Path"
Paths to Becoming a Midwife: Getting Education, a Midwifery Today Book


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Research to Remember

In "Serologic Evidence of Prenatal Influenza in the Etiology of Schizophrenia" (Archives of General Psychiatry. 2004; 61:774-780), researchers at the College of Physicians and Surgeons of Columbia University reported the following: Compared to children of mothers who had not been exposed to influenza during pregnancy, "[t]he risk of schizophrenia was increased 7-fold for influenza exposure during the first trimester. There was no increased risk of schizophrenia with influenza during the second or third trimester. With the use of a broader gestational period of influenza exposure—early- to mid-pregnancy—the risk of schizophrenia was increased 3-fold. The findings persisted after adjustment for potential confounders." However, the researchers acknowledge that the latter conclusion, for exposure to influenza from approximately the midpoint of the first trimester to the midpoint of the second trimester, "fell slightly short of statistical significance."


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Love is a strategy for human survival.

Scientification of Love Read The Scientification of Love by Michel Odent to learn about the short yet critical period of time following birth that has long-term consequences in terms of the capacity to love. Has an undisturbed birth resulted in an expansive capacity to love, or have interventions of many kinds resulted in violent criminality, suicide, impaired sociability, schizophrenia? Order the book.

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Web Site Update

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Forum Talk

I just had my first child, at a time when I have 10 months left of my midwifery study. Having a child myself, and especially having gone through labour and birth, has given me what feels like a deeper look at my own function as a midwife. I am not saying that midwives who are mothers themselves are better midwives! I am saying that it has changed the way I view and analyze my own role as a midwife and perhaps understand things I didn't understand before. Are there any of you, who had your first child while being a student, who have felt a difference in yourself/your midwife role before and after becoming a mother/going through labour and birth?

Anna


Go to our forums to share your thoughts and experience.


Question of the Week

Q: How do you, a birth practitioner, act during a woman's third stage, the delivery of the placenta? What is your approach to/attitude about third stage?

— Midwifery Today E-News Editor


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message. Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


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Think about It

While shopping [one] day, I noticed hand-dipped chocolates, homegrown vegetables, hand-spun wool, homemade preserves, cottage-industry soaps—all at premium prices, since they were made with care, individually, by hand, at home. I reflected, too, on how "old-fashioned" doctors, famous for house calls and compassion, are remembered fondly as part of the "good old days" and praised for their one-on-one caring. I mused how our society honors unique, special, one-of-a-kind items and services.

Yet when it comes to maternity care, it seems the bigger and busier, the better: high-tech procedures, standardized treatment, massive patient loads, in-and-out, assembly-line-style facilities. We are urged to leave the clean peace and quiet of home and go, instead, to a large, centralized center and entrust ourselves to a system of detached and often distracted institutional workers whom we've never met and may never see again. I find it hard to believe that anyone would consider hospital care preferable, if they really thought about it.

High-tech or hands-on? The choice is not new. In many cases, of course, mechanical and technological advances have been just that: improvements. Other advances, as we all know too well, have resulted in lasting harm.

Judy Edmunds, excerpted from "A Grand Triumph," Midwifery Today Issue 37


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Feedback

To a degree, I agree with the writer who considers birth videos and photos to be an invasion of privacy [E-News Issue 8:17]. I don't think I could handle the taping of any of my births, though I would have liked a photo of crowning or partway through the actual birth. That said, watching gentle birth on video is the only way many women every find out about it. If you don't know anyone who has done it, someone who has made a tape is a godsend. A key part of my childbirth education group is watching videos of all sorts, even the brutal hospital ones, so that we can overcome the cultural void surrounding birth.

Lynn Carter

You are right, I wouldn't want an audience in my bedroom with me during conception of a baby, it's private. However I consider myself a "social birther." At my first birth I had a friend with me since my husband was deployed to Saudi Arabia and we lived in Germany. Along with the friend, the German nurse (a male) who spoke almost NO English got another mother/patient who was a German wife of an American soldier to come (with her baby) into the LDR to help translate for us. When the doctor arrived she stayed to see the birth and help in whatever way she could (she wiped my brow).

My second birth was with just my husband, the nurses and the doctor. Along with everything else that I didn't like about this birth in a typical American hospital, I look back at it as having been very lonely.

We did my third birth without assistance from a professional and stayed home—it was my very nervous husband, my three girlfriends and me. It was a wonderful experience other than knowing that no one really would have known what to do in the event of a bad outcome. For my next birth I hired a midwife and she and her apprentice and two friends as well as my husband and two of my three children were in attendance. It is one of my favorite birth experiences. I felt so supported!

The next birth I had all four of my children and an acquaintance (a Japanese gal from my husband's work) to help translate for us in the event I couldn't understand the Japanese midwife I had found at 38 weeks. The midwife had said family was fine, but no friends, so I didn't call any of the friends I wanted to share my birth with and still feel sad about not being able to have had them there six years ago.

I recently had another baby, and along with my own five children (all daughters, ranging in age from 6 to 15 years), I had with me a friend of my oldest who helped with my youngest, and also had my husband, two friends, (former doula clients of mine), a photographer and two midwives. It was a houseful and the cameras were rolling, both still and video, and yet I really didn't think about them other than I wanted to have a record/witness of this birth for myself! I loved that everyone was involved either quietly sitting across the room reading or actively rubbing my back/shoulders, holding me up in the water, getting me drinks or wiping my brow. My husband caught the baby and everyone was just there to share in our joy! It was wonderful, and I can't imagine it another way. Did the people or the cameras hold up my birth progress? No! Now, that might not be the case for everyone, but for me I knew what I wanted and what was right for me and my birth. I loved having the supportive network of friends and loved ones around me supporting quietly or actively.

As a doula I am usually very actively supporting the mom (and dad) at a birth and, as an apprentice, the midwives who generally aspire to the Michel Odent style of birth where mom labors best when left alone with her husband for the most part. I have a hard time trying to mesh the two styles and knowing what is best. How do I best help a mom who wants support, and how/when do I know if a mom needs to be left mostly to herself? I hope that this distinction will come with practice and experience. I know that my birth with all the people is not what usually is comfortable for my midwives, and yet they did allow me to do what felt right for me.

I don't think it is fair to say that sex is a private act and therefore birth should be just as private for all moms. I am so grateful that my daughters (and now their friend, and my friends as well), have seen birth in its normal natural wonder and will have so much more of an appreciation of that for themselves. One of the complaints about taking birth out of the home and hiding it away in the hospital is that our daughters (and sons) growing up don't get to see birth as a normal natural life event anymore and have a much greater fear of the unknown.

Wendy Robertson
Huntsville, Alabama

I strongly feel that it is completely up to the mother whether or not she allows anyone or anything in the room with her. I don't think a recording of her intimate experience will take away from anything she is feeling with her child. I personally have never given birth, but I have attended births with and without a partner/friends/family/support and have found the smoothest, highest energy (in all the right ways) productive births are those with lots of love and support. I think it depends on how comfortable the woman is with herself and how much she has already connected with her unborn baby. Each woman will make her own decision, and I want to be there to support each and every one of those decisions.

Emily

Nina Plank wrote about birth being a sexual event and then went on to say it was between mother and baby and questioned whether the father should be present (but the birth attendant is expected to be there). I agree that it is a sexual event, but very much disagree that it is a sexual event between the mother and child. The intimacy of the couple is what brought that child into the picture, and the birth is the completion of that sexual event. I believe it is very important for the mother and father of that child to be present together and that they need the privacy to bring forth their baby. The birth attendants need to be very sensitive to and supportive of that relationship. It is that relationship and the bond there that makes for a safe and nurturing place for that child to grow and mature. If there are real problems in the couple relationship and they can't be resolved during the labor to the point where there is peace, then it is more important for the mother to have a safe and peaceful place to give birth. I think the couple should be encouraged to seek help to work through their relationship problems afterward in that case so that the child will have an optimal environment in which to grow to maturity.

Serena Lazear


Thank you for excerpting my article [E-News Issue 8:17, about discharging adrenaline during labor]. I am still surprised that 25 years have passed since I discovered this simple answer to the pain and distress experienced by many birthing mothers.

When I was living in the States I belonged to a newsgroup for midwives and I pressed for some kind of answer as to why there was resistance to my discovery. Was it found to be wanting in some way? Was I wrong? Had my observations been flawed in some way? The only replies apart from support and agreement from a few midwives were suggestions that as I was a man, I could not be aware of anything to do with birth! This is like suggesting that a woman surgeon who had made a significant discovery in regard to prostate surgery must be mistaken as she didn't possess a prostate, a ridiculous suggestion.

What is it about this discovery that occasions such silence? I would have thought that such an observation would have been eagerly followed by some testing by midwives everywhere, to see whether or not it was true.

Once the adrenaline has been discharged by exercise, the birthing mother is able to tolerate the presence of relative strangers with ease and no negative reaction. I would have thought that all midwives would have welcomed such a discovery, as it diminishes any negative reactions that the newborn may suffer as a result of a traumatic and painful birth.

In my experience, most birthing mothers I have been in contact with have ample reserves of anger that they find relatively easy to tap into. What am I missing?

Rayner Garner


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