Midwife: Sage Femme, Hebamme, Comadrona, Partera

I’m sharing some of my older posts here - the ones that began some real shifting for me in terms of practice. I need to just tag these posts so they can all be contained and easy to find for me:

How the Baby is “delivered”

However, I wonder if the way the mothers respond to seeing their whole baby and picking up their baby when they’re ready actually benefits them hormonally. More so than having the baby placed on their belly. It almost appears as if there is a more serene transition from labor to seeing the baby. More peaceful. I would tend to think that this floods the body with oxytocin (the hormone that we all feel after having an orgasm, also responsible for uterine contractions during labor and expelling the placenta after birth, as well as stopping bleeding after birth) in a more efficient manner than if the baby is hastily placed on the mother’s belly only to be messed with by attendants.

The Tentative Pregnancy - how ambiguous prenatal testing offers little more than anxiety and more ambiguity

Unlearning the Midwife

Just because your preceptor did something doesn’t mean that it’s the RIGHT thing to do. I think we DO too much - and hardly any of it is evidence based (polyester or cotton hats on baby’s head right at birth, managment of third stage, perineal support, suctioning babies with or without meconium). We do it because we haven’t been told NOT to.

Challenging Ideas in Midwifery

What I wasn’t prepared for is how my assistant and I were affected by this change in practice. While we are aware of the condition of the baby and mother, we are also able to “see” the birth in a way that we never could before. No longer consumed with duties that required us to “do something”, we simply watched the birth of a new family. Both of us have looked at each other with tears in our eyes during this time. The benefit extended to us as well.

Traditional Midwife? In What Sense?

We know TOO much to say we’re traditional midwives. Two hundred years ago, midwives were much more hands on and directive than they ever needed to be. Just like current midwives. We need to recognize that we have more knowledge - which doesn’t mean we need to override the delicate flow of birth, but to feel comfortable in honoring it. The true challenge will be really listening to the research that claims women’s bodies innately know how to birth - without our help.

My First Breech Vaginal Birth - surprise!

Her water soon broke, and there was TONS of water the color of …. well, it looked like old meconium, more gold than green. She was instantly concerned and I told her that sometimes babies release meconium without stress. She sat on the birth stool and on the chux pad below I saw fresh meconium. Fresh as in from-the-butt meconium.

Criticisms of My Practice

The true art of midwifery comes in the words of one of my clients: “I’m paying you to NOT do those things!” In some ways, it is a shame that we would need to pay someone to hold our birth space and give us information to birth safely. Sure, I can bill insurance companies more if I suture, or break water, but should it be set up like that? Does that encourage undisturbed birth?

Immediate Newborn Care

My friend Linda has mentioned to me about the “birth bubble”. This is the protective “other world” that the birthing woman is in right before birth and right after birth. All those hormones, including adrenaline, flooding her body causing her to focus on her new baby are beneficial: they assist in a smooth, easy separation of the placenta from the uterus and the normal physiology that follows.

What is a “Hands-off” Midwife?

It also means that I hold the space for women in a way that feels good and supportive for them. I default to sitting in another room and I’m honest with families that I do this. This is to allow the couple to work on their own - in privacy. I explain that an unobserved labor is one that progresses smoothly, that allows a woman to labor in positions that might be embarrassing, etc. I also explain that my ears, eyes and intuition is on alert. I’m open and ready to hear what she is needing, saying or asking. I’m available to apply counterpressure to her back, to reassure her that what she’s feeling is normal, to encourage her when her strength is diminished. I’ve been known to sit right next to a woman throughout her entire labor because that is what SHE needed.

Why I don’t check with the birth of the head for nuchal cords (cords around the neck)

I feel like it’s not necessary. I don’t really buy the theory that a tight nuchal cord keeps a baby from being born completely (the uterus shrinks in size to follow the baby down the birth canal and if it “allowed” the baby to get that far, it’s not likely to inhibit the rest of the body). If the cord is very tight, simply holding baby close to the mother and somersaulting it through the cord can work, but this is a very rare occurrence - in seeing over 270 births I have yet to witness this.

Why I don’t use urinalysis strips

There have been many studies on the uselessness of routine urine dipsticks in asymptomatic low-risk women. While some of these studies have been published in US journals, it’s Europe that has started putting its money where its mouth is. With socialized medicine comes a definite need to know if various treatments, tests, etc., are financially sound. In the US, the rate of malpractice litigation leaves little evidence-based practice to be found.

The confusing topic of what is true anemia in pregnancy and what is normal and physiologically healthy

A Guide to Effective Care in Pregnancy & Childbirth by Enkin, Keirse, Renfrew and Neilson reports that a hemoglobin count of 9.5 is optimal for fetal growth and maternal well-being

My views on rising blood pressure in the last month of pregnancy

I’ve heard many providers, midwives included, refer to any gestational hypertension as pre-eclampsia. Usually because they also see trace amounts of protein and some swelling. Trace protein is not a sign of pre-eclampsia, but it could be a sign of a woman needing more protein or just having concentrated urine. In order for an accurate reading to be made re: proteinuria, a 24 hour urine collection MUST be done. Dipsticks are NOT reliable for this. Proteinuria is a late sign of pre-eclampsia…you’re not likely to see proteinuria as an indicator for pre-eclampsia in the early stages of rising blood pressure.

Important information about the moment of birth

A lifeguard at a pool observes, watches the entire picture. She is there in case there is a need for her skills/assistance. Even when she sees a person struggling a bit, she doesn’t jump right in to save them. She carefully watches them and if they do not take care of it themselves, she is there to help.

Then, I found this great article: Failure To Progress: What’s Wrong with Hospital Obstetrics….many of you won’t be surprised by anything in here, it’s just a nice article.

So, here’s YOUR challenge: go through your blog and pull out some old posts that might shed some light on your life, your challenges, your beliefs. Put them up front!

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