Birth Wisdom, Volume Two
A Collection of Editorials from Midwifery Today Magazine
by
Jan Tritten
SMASHWORDS EDITION
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PUBLISHED BY
Midwifery Today, Inc.
Birth Wisdom, Volume Two
Copyright © 2011 by Midwifery Today, Inc.
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Table of Contents
Chapter 1: Business and Midwifery
Chapter 2: Education Priority Check
Chapter 4: One Birth, One Woman at a Time
Chapter 5: The Battle Is in the Mind
© 2006 Midwifery Today, Inc. All rights reserved.
Editor's note: This editorial first appeared in Midwifery Today Issue 79, Spring 2006.
Business is second nature to me; I really enjoy it. I have been making lemonade for 32 years now and have always known that if I wanted to be rich I could have franchised my successful lemonade stand, Family Homesteader. The calling of midwifery got in my way, though. It got lodged in my heart and I just had to follow that dream. We direct entry midwives do business by the very fact that we must. No hospitals or doctors have implored us to come to work. Seldom will anyone hire us, other than the moms who need our services!
For nurse-midwifery to survive as an authentic form of midwifery and not give in to the pressure to become medicalized, large numbers of its practitioners must go into business for themselves—I think their very survival depends on it. Unfortunately, a number of barriers are in the way.
The first barrier is that the medical system got things backwards: Nurse-midwives should be hiring the doctors, or at least consulting equally with them. They have the calling and often cellular knowledge; with training in normal birth only they can keep the profession from being co-opted. They are the experts in normal birth; most doctors have never even witnessed a normal birth!
Certified nurse-midwives (CNMs) need to rise up, take the reins of their calling and start businesses. Starting a business in the US is easy: You just need to choose and register an assumed business name, keep records and pay taxes. This will allow you to take back your profession from those who don't understand it, collaborating with rather than being under the thumb of doctors. You should also work to ensure that midwives are not required to have physician approval to practice. CNMs are trained professionals, not handmaidens.
The job satisfaction obtained from owning your own business, or working with a partner, will make you a better midwife. (Having said all of this, midwives are still badly needed in the mainstream until the mainstream becomes a humane, well-working system.) If you are entrepreneurial, feel free to become your own boss or find a partner in business. If you have questions, talk to the experts: the direct entry midwives who have had no choice but to make their work into independent businesses. Helping each other to succeed will also have the benefit of creating reciprocal relationships that will unify us and help us to work together in harmony.
Another barrier is the lack of unity within the profession. When I first started midwifery I believed that CNMs would be the first line for the complicated cases that required women to be transported to the hospital. In my innocence I saw us working together for a common goal. While I haven't lost that innocence, I think that we have a long way to go. However, I am optimistic that with Catharine Carr as ACNM president we will make some progress toward that common goal.
At the Midwifery Today conference in Eugene in 2005, Catherine and MANA's president, Diane Holzer, taught a session in which they discussed the ways that these organizations could work together. Failure to do so in the past has hurt the field of midwifery in many ways. In order to reverse this trend and strengthen the profession we need to put the past behind us and work together.
The third barrier we face is a deep flaw in the US higher education system. Most students come out of college owing huge student loans. This makes it difficult for new CNMs to make enough money to start a business and pay back loans. In contrast, students in the UK are paid a small stipend for attending school, in addition to having school fees covered.
Perhaps we need to analyze midwifery education to determine the minimum requirements for entry-level independent practice. Business may be an important part of the curriculum. Perhaps nurse-midwife trainers should look at the curriculum to ensure that it focuses on keeping birth normal by including non-medicalized ways of practicing. Homeopathy, herbs, alternative practices for complications and learning from traditional midwives around the world might replace some of the usual medical curricula. Lay midwives, direct entry midwives and nurse-midwives need to work together to make midwifery a profession not dominated by medicine but by using medical practice for only the truly complicated cases. Let's reclaim authentic midwifery.
The final barrier I want to mention is the separation of midwives in practice by their route of learning. Why not include CNMs, certified professional midwives (CPMs) and even lay midwives in the same practice? We had a practice like that in Oregon for many years. We all brought different strengths to our work, which was remarkably helpful to the families we served. Marion McLean, a CNM, enriched the knowledge of the other midwives and made our learning enjoyable. We were amazed when she said she learned as much from us as we did from her. Together we seemed to have a better practice than when we were in practices with only one route of entry. This unified us in ways that are now lacking in US midwifery.
I want to finish by quoting a line from the musical Oklahoma. It took place in the Old West when the farmers wanted to fence the land and the cowboys wanted to have free range for their cattle. "The farmer and the cowboy can be friends." And just maybe they should go into business together. Now don't start fist fighting like they did in the movie. I really believe we can work together. Indeed, I think it is the only way we will advance midwifery.
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Education Priority Check
© 2001 Midwifery Today, Inc. All rights reserved.
Editor's Note: This editorial originally appeared in Midwifery Today, Issue 60, Winter 2001.
We do midwifery to help families have good, healthy, and if possible, joyful pregnancies and births. Our greatest love should be for women and their babies. The bottom line for you as students and aspiring midwives is to keep your focus on motherbaby—not on getting your professional degree as a certified nurse midwife (CNM), or approval from the North American Registry of Midwives (NARM), etc. Your love of women, babies, families and each other needs to be your focus. You are answering a calling, one of service, not one that is self-serving. If you don't feel deep in your heart that you are called to be a midwife, please do something else. This is not work in which you will make a lot of money. In these times, it is one of the more uncertain jobs you can undertake.
When I was at the Midwives' Alliance of North America (MANA) conference, I realized that the focus of some students has moved away from serving women to serving themselves. My associate editor, Jill, mentioned the difficulty in getting dedicated apprentices, stating, "These days, everyone is looking for their 'numbers' so that they can fulfill their NARM requirements and quickly set up their own practice." There is nothing intrinsically wrong with NARM's requiring a certain number of births, prenatals, etc., in order to prove competency—it is a wonderful way to train and educate midwives. However, there is fallout we may not have expected.
I was having lunch with several early arrivals to the conference when one experienced midwife said, "I'm not going to take apprentices from schools anymore." Surprised, I asked why. She expressed that these "school midwives" were focused on their own experiences and numbers rather than on the pregnant women my friend was serving. A discussion followed that non-school students are looking for their numbers too. I found it an interesting contrast to the complaint that going to Jamaica was using women from poorer countries to learn our midwifery and get numbers. It seems we can stay home and do the same thing. It basically boils down to the spirit of the practitioner. Ask yourself, "Am I as a student of midwifery serving myself or the families I am involved with?" What is your motivation? This is an important question to ask throughout your whole career.
I think I just realized how much things have changed in the 25 years I have been doing this lifework called midwifery. When I started, we became midwives almost accidentally. (Isn't that a good name for a movie? The Accidental Midwife.) We set out to help women have homebirths, period. Our concern was whether we knew enough. We were afraid we would miss something important. The entire frame of our reference was women, babies, families, pregnancy and birth. We studied like crazy to make sure we knew enough, but the bottom line was not our license, profession, career or certification. The only bottom line we knew was the families we were "serving."
I truly believe when we are talking more about ourselves and our politics and profession that we have lost the true essence of midwifery. I don't care if I am at an ACNM (American College of Nurse-Midwives), MANA or Midwifery Today conference, we should be talking more about birth than ourselves. I exhort you to find a program that is centered on families, a program that also nurtures you as a student.
Another interesting fashion I noticed is that licensed midwives can get their license with 50 births, a certain number of prenatal visits, etc. This, in my opinion, sometimes leads to an arrogance in recently licensed or certified midwives: I have my credential and you don't. However, many who don't have credentials prefer it that way. They have done thousands of births over two or three decades of dedication to women. We have created a "license culture" within midwifery that does not always honor or learn from the wise women who have gone before. We have fallen straight into the paternalistic system so prevalent in Western culture.
My hope is that we, as enlightened, alternative thinkers and doers, can somehow do better. I had hoped there would be mutual respect and a sense of harmony, or better yet, unity with a lot of diversity.
It has always been Midwifery Today's role to encourage all kinds of midwives, doulas and childbirth educators. We still do. There is more than enough room for all kinds of practitioners. We need everyone working to change the way women are treated in childbirth. For 15 years, one of our main mottos has been, "Each one teach one." We need a great mentoring spirit in this field. And there must be respect in these mentoring relationships, respect flowing in both directions. I ask senior midwives: Please keep taking apprentices. It's a way in which we can work toward the ideal of one midwife for every mother.
For those who are called to midwifery, there awaits a life that will take all the love you have to give. You have the awesome honor of being "with woman" on her most important life passage. You are there, often the first one to touch the new life sent directly by God to reside awhile on this planet. You are there when people become a family, when maidens become mothers. This is a powerfully spiritual experience and you are there. You are a key person in this life-changing passage. The deepest humility is a necessary characteristic of being a midwife. You will always be learning because the women you continue to serve are your most important teachers. Honor them and their babies by putting them first, before your numbers, before your license—even before yourself.
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Mollie and Mary
© 2008 Midwifery Today, Inc. All rights reserved.
Editor's note: This editorial first appeared in Midwifery Today Issue 88, Winter 2008.
Carol Gautschi took me to Amish country to meet the midwives the week before the Philadelphia conference. She especially wanted me to meet two midwives, Mollie and Mary. Mollie Petersheim is an Amish midwife who lives in Mifflintown, Pennsylvania. Mary Hostetler is a Mennonite midwife who lives in Mifflinburg, Pennsylvania.
Our visit to meet them was one of the most memorable of my life. I feel like I’ve met angels. Their love and hospitality truly must come straight from the Lord, because it seems supernatural. I haven’t felt that welcome since my grandmother, whom I also consider an angel, passed away just before I turned four years old.
Mollie: “Thirty-eight years ago in April, my first birth took place. I convinced a doctor to help me learn. Soon women didn’t want the doctor and asked for only me to come. Sometimes I went to homes. I had a six-month-old that I left with my husband.”
“My biggest surprise was twins—they were third and fourth babies and weighed 9.6 and 9.7 lb. The heads weren’t that large! The head of the first baby came out and only half of the mom’s belly went down! I clamped the cord really soon and fussed about how cute the baby was and she got another contraction. She and her four sisters had a contest about who had the biggest baby.
“For shoulder dystocia, pray. It’s important to wait for the next contraction. Don’t panic. If the head comes out and then turns black, I get it out! For late babies, I like to use a strong raspberry tea, blue cohosh and nipple stimulation for starting labor. A purple head after a fast labor can also be a nuchal cord. The longest cord I had was wrapped five times around the neck. The baby had been breech and turned on its own. When I had tried to turn it, it wouldn’t turn.”
About births, Mollie said, “If I didn’t do it, I’d miss it!”
I asked Mary how long she had been a midwife, and she responded, “Always, I guess. In the summer of 1960, with my daughter a week old, I got caught up in this thing! We got amniotic fluid in our shoes!”
Carol asked, “Why is every midwife such a character?”
Mary responded, “We have to be! It’s all in the word LOVE.”
Mollie added, “We couldn’t do this thing if we didn’t love mothers 24/7.”
Mary said, “It’s still awesome after all of these years.” She said that she doesn’t charge if they transport. She told of a ninth baby, where there was no progress. She had the mom walk and walk and do nipple stimulation, and it worked.
Mary’s biggest baby was 13 lb 6 oz and the woman didn’t sustain a tear. “I had to literally get hold of his body and pull him out.”
Mollie’s biggest was 13 lb 7 oz. “This baby was back to birth weight at six weeks. The baby had a lot of water weight.”
To stop premature labor, Mary likes to use cramp bark, calcium, false unicorn, and a little wine if the mom is not against it. Since it’s used medicinally, most don’t mind. She has the mother take a couple swallows of wine every three hours. She tells them to drink a lot of water to keep hydrated.
Mary states, “I listen to the moms. I transported a woman who said she was fainting. Once I had a birth with a hemorrhage and that baby needed resuscitation. The grandmother came in at each prenatal. At the birth she came, too. While I worked on the mother’s hemorrhage the grandmother wrapped the baby and went and opened the kitchen window and did a change of elevation with the baby and it worked. We all pondered how she knew to do this. Was it an old common knowledge idea that got lost?”
The story of Mary’s entry into midwifery is interesting. Her first birth was July 18, 1960. Her friend decided to do her own birth. “I went in the room and the water bag came first. I had never seen a birth. I just went and tore the bag and out came the baby. Another couple wanted to do it on their own and the same thing happened. The water bag came, but they didn’t know what to do and hadn’t thought to break the bag. The 9+ lb baby didn’t make it. She never tried to do it by herself again.”
“When we go in the hospital they think we’re ignorant. One time we went in with a woman who had a 5.5 hemoglobin, with a partially retained placenta. She lost a lot of blood but didn’t want blood with AIDS in it. The hospital staff was surprised that she knew what AIDS was!”
Mary had her first baby at home in 1958 with just her husband. “In my day they tied your legs and arms down and gave scopolamine, so there was no way I was going to do that!”
Carol said, “I think they are making a big deal about mother’s age.” Carol’s oldest mother was 48 and Mary’s oldest was 46, having her 14th baby.
Mary said, “I am a CCM; that’s a ‘Community Created Midwife’.”
We had a lively discussion of what it means to be a midwife and how we were called to become one. In the 70s we were all Community Created Midwives.
Mary said, “The Lord will teach you. I still keep the image of that first birth and of tearing the bag of waters; I just felt the Lord’s hand pushing me to do it.”
Mollie and Mary each received the MANA (Midwives Alliance of North America) Sage Femme award. The award is for midwives who have shown excellence over a lifetime, and Mollie and Mary certainly have!
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One Birth, One Woman at a Time
© 2003 Midwifery Today, Inc. All rights reserved.
Editor's Note: This editorial originally appeared in Midwifery Today, Issue 65, Spring 2003.
Do you ever have this haunting thought: “Why am I working so hard for change and to improve conditions for motherbaby when things keep getting worse?” When I look at birth around the world I realize that the changing of medicalized, technological and interfered-with birth is the most important plan we can make. We think of the motherbaby—their experience, their lives and their physical, emotional and spiritual health—and we go on. We reflect on the lovely families we have served and we go on. A spiritual stirring deep in our soul moves us on. We have been given a special love for what we do. We are like the little girl who saw thousands of starfish washed up on the sand and started throwing them into the sea, one by one. Someone said, “You can’t make a difference for all these dying starfish. There are so many and you are so small.” She picked up another, threw it in the ocean and said, “But I can make a difference for this one.” We are that little girl. We are making a difference for this family, one birth and one woman at a time. In the face of these frustrations, we fight for mothers and their babies.
I know things can be rough for us as midwives, childbirth educators, doulas and activists, but we must change things. We are the only ones who know about instinctive birth and authentic, women-centered midwifery. Our charge now is to make the changes we know are necessary. Let’s get our allies together, make plans and carry those out. Someone in the profession with the title “midwife” may or may not be an ally. The title “doctor” does not automatically eliminate those from the ally category either.
Most importantly, look at yourself. Take account of what you do well. Which of your attributes and strengths can you enlist for this most important struggle? How much time can you carve out of your already busy life? If you only have one hour per month besides your practice, it is still needed.
There are little things we can do each day, just by being who we are. Wear a shirt or earrings—or carry a bag—with a birth saying or image on it that leads to dialog about midwifery or birth. Start conversations in which you can teach informally. Let women know they are beautifully designed for birth and what a miracle it is. Help quell their fears and get them thinking. We are like birth ambassadors wherever we are: in line at the supermarket, waiting at the airport or in schools. It is our calling to help our society, especially women, understand birth and its far-reaching consequences. When I was gathering my thoughts for this editorial, I saw a bumper sticker with the message, “Be the change you wish to see in the world.” How appropriate for us.
Whenever you are asked what you do, claim “midwife” as part of your identity in all situations. Those who have gone before you have helped this country know that midwives exist. When I used to say, “I am a midwife,” people would say, “A mid- what? I thought they disappeared.” We must normalize the concept of who we are and what we do as a forerunner to normalizing birth.
For these impromptu situations, keep in mind important sound bites of information for quick, but life-changing conversations. Know well the most important concepts to help women when you have only two, five or 10 minutes with someone. I know each of you have had conversations when you go away knowing you have made a difference. You help people, especially women, break the life-damaging myths that are particularly rampant now.
There are many things you can do besides use your identity as a seed to be planted. Have an empowering bumper sticker on your car. Teach in the schools, present at meetings, adopt a doctor, congressmember or nurse, write articles. We love to publish your knowledge and insights for everyone’s improved learning. Encourage the next generation by leading a study group. Your knowledge is important to share with both pregnant women and the upcoming generation of midwives. I think of how Marion Toepke McLean mentored so many of us. I am sure you have your mentors, too. They are an important part of our tradition. Be a mentor. Always fight the competitive spirit within you, and fight instead to make midwifery the norm throughout the world.
Look at the structure of your birth community and make plans for spreading the word within it. Put flyers in the library and birth bookmarks in library books. Canvas your community with ideas and work with others. Pick up the awe and miracle of instinctive birth. Let others feel this through your heart and see it through your eyes. Revel in the glory of a baby flowing in health and happiness out of the mother’s body and into her waiting arms. Bask in a new life coming to the planet in love and in a woman’s own time, held joyfully, without disturbance, chatter or other more severe intervention. Let others see and feel the miracle—the deep spirituality—through your soul.
One birth at a time, you rescue the starfish. Making change in our society is going to take the loving, concerted, planned effort of all of us. The boat is sinking; nothing else will save it. We need you as one of the few on the planet who have received birth wisdom to use it as the important gift God has given you. The gift is given to be passed on.
Start changing the world…one birth, one woman at a time.
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The Battle Is in the Mind
© 2005 Midwifery Today, Inc. All rights reserved.
Editor's note: This editorial first appeared in Midwifery Today Issue 74, Summer 2005.
We are mammals. Most mammals birth fine. So what happened to us? We used to birth fine. Women in "primitive" cultures birth fine. What happened to modern women?
In 1896, Alice B. Stockham said, "I know of no country, no tribe, no class, where childbirth is attended with so much pain and trouble as in this country." (Tokology. Chicago IL: Alice B. Stockham and Co.)
This statement holds true to this day. At birth we are unblessed with a thinking mind. As adults, our minds become one of our biggest obstacles in pregnancy and birth. We listen to others, watch "Baby Story" on television, hear of cesarean rates and the ease of epidurals and completely lose our ability to do the task for which our bodies were supernaturally designed.
This system of fear has been exported on a grand scale on the wave of medicalization throughout the whole world. Western childbirth ways are literally a huge plague.
How many complications are caused by the mind? If we were birthing in past times and places, labor would be shorter and less complicated. Complications go MUCH deeper today than just those around birth. We have increased autism, breast cancer and detachment of our culture to children and babies. Most are related to the childbearing year.
Most complications are preventable with good nutrition and good midwifery care prenatally and in birth. Midwives play a key role in combatting this dominant birth culture. The fact that few mothers were born naturally themselves must also have an effect.
Midwifery can move the world individually, with continuity of care. It cannot be accomplished in 10-minute visits. There is too much damage to nullify and dilute. The midwives' own trust and knowledge of birth needs to be transmitted to the mom. After counseling and imparting our trust to her we need to keep her, if possible, out of dangerous environments. With drugs available and an environment that interrupts labor, everything she has learned disappears.
So how do we avoid iatrogenic complications? Stay home or in a birth center. Have a well-trained midwife, who honors physiology, not medicine. Keep out of the proximity of drugs, distractions and unnecessary procedures. First, do no harm.
Often in today's oppressive birth culture the battle is in the minds of the "care" givers. Most doctors have never seen a normal birth. Even when a woman has a good birth attitude, she goes unsuspectingly into the hospital, thinking this is the safest place to have her baby. She runs right into the trap of modern medicine, which is bent on making a lot of money from her and exerting POWER over her. She is subject to a cascade of interventions done unceremoniously to her and her baby, still thinking she is in a safe environment. Somehow her mind, though, has learned to believe this place and these people caring for her are safe practitioners. The hospital is a good back-up system for true emergencies, which are the cases where hospitals become safety nets.
Sadly the Western world has imperialistically pushed its "safe" medical practices on all other countries. For example, Western medicine teaches the dangerous birth practices that cause problems and then teaches more unsafe practices to supposedly fix the first problems (cord cutting, deliveries on the back, pulling the placenta out, etc.).
These imperialistically driven complications go even further, as certain U.S. aid-driven organizations have decided there are too many children being born to poor people in poor countries. Midwives from Mexico have told me that in hospitals in Mexico, IUDs are placed in women, without their knowledge or permission, just after birth, as soon as the placenta is "pulled" out. Many of these victims of Western imperialism then go to the midwife because they are hemorrhaging. The midwife takes the IUD out because it has fallen out of place. One of the midwives knew this firsthand, because she was sent to the hospital to learn to insert IUDs as soon as the placenta is out.
Reportedly they have gone into South America and Africa doing the same thing. It is a crime against humanity. It is a crime against culture and it is a crime against individual women and their families, who suffer most. Then FIGO and ICM have the audacity to tell us that we need to "offer" all women in the world "active management of the third stage of labor." That is, to disturb the body's own natural physiology and the bonding process, to give pharmacological oxytocin or cytotec, just when the body's own supply of oxytocin is at its highest for the purposes of bonding and hemorrhage control. Of course, nearly every birth is so disrupted by medical routines that medical personnel have already disturbed the process and the oxytocin levels. This, because we have already exported our distressing methodology for birth.
The entire birth situation in the hands of these overseeing organizations is absolutely ludicrous and criminal. We are mammals. As Michel Odent says, "We need to dehumanize birth." We have messed it up enough.
We need to follow the mother's lead in labor. If empowered, she will birth. We need to tell her she can do it, to help counter the cultural garbage that has accumulated in her mind. Birth works. Authentic midwifery care is there to help. Good midwifery care encourages or allows the unfolding of the birth. Good midwifery care empowers the woman in her pregnancy, helping her clear out the obstacles that culture has put in her brain.
Meddlesome midwifery and medicine need to stop now. Cultural and medical imperialism need to stop now. In their arrogance Western medicine and culture have imposed themselves in the world by ease of travel, community systems and economic dominance. Michel Odent questions, "Can society survive?"
It can survive and thrive, if we institute authentic midwifery care around the world. It can survive if we use our resources appropriately. With advancing medical understanding and techniques that, appropriately applied, can save lives, we can indeed survive. Authentic midwives and doulas know and understand more about birth and how it works than ever before. If we as a world can apply what we know and come up with a system of referral, we can have the best birthing the world has ever known. The tearing down of the Berlin Wall of medical culture will not be easy, but it is possible. We all need to work hard at birth change, doing everything we can to teach women that they can birth and to teach medical personnel that women can birth.
*****
Jan Tritten
Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine. She became a midwife in 1977 after the wonderful homebirth of one of her daughters. 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!\
Curriculum Vitae
1947 Born in Los Angeles, California.
1965 Graduated from Placer High School in Auburn, California.
1966 Trained for one year as a psychiatric technician. Courses included basic nursing, pharmacology, microbiology, anatomy and physiology, psychology.
1966–1971 Worked at DeWitt State Hospital in Auburn, California as a psychiatric technician.
1968 Graduated from Sierra College with an Associate of Arts degree.
1970 Graduated with honors from Sacramento State College with a Bachelor of Arts degree in Social Science.
1971 Earned Lifetime California teaching credential with fifth-year program from Sacramento State College.
1972 First daughter born in a hospital. It changed my life forever. It was an unsatisfactory birth experience, but I had a wonderful postpartum experience with 2-1/2 years of breastfeeding.
1976 Second daughter born. She was born at home with a doctor who talked me into a homebirth. The difference between the two births sent me on a path to do something to help women have positive birth experiences.
1976 Began training as a midwife. Because I was raising young children and running a business, and because there were no CNM schools in my area, becoming a CNM was not within my reach.
1977 Began attending births with the Birth Co-op in Eugene while organizing courses in our community taught by CNMs, physicians, nutritionists, etc.
1978 Began a midwifery practice, New Life Care, with a partner, Chris Howard, and apprentice Monika Dunsmore.
1979 Son born at home.
1980 Did a one-year program with Marion Toepke McLean, CNM. Four of us completed the program, which was modeled after CNM curriculum at that time. She took a year off from her practice to teach us and to go to our births with us.
1982 First group of midwives certified by the Oregon Midwives Council. Our board was composed of CNMs and physicians.
1986 Slowed down practice and started Midwifery Today magazine.
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