That pesky meta-analysis

Posted by Tatiana

I don't know about you, but that meta-analysis that has been all over the news has made me uneasy.  I hear the criticisms of it, but it still makes me uneasy.  If it is true that there is this large increase of neonatal mortality in home birth, would I really want to be a home birth midwife?  I kinda don't think so.  I want to think the study is just wrong, but it doesn't satisfy to say, "Oh well, people I respect have dismissed the study, so... that should be cool."  I want to be a bit more clear than that.  If a client or, say, a policy maker happens to ask me "What about that study published in 2010 about the threefold increased risk to babies in home birth?" I'd like to answer coherently, and in a way that's grounded in real science.  Not convenience science.

I've alluded before that I really want a stronger understanding of how studies are conducted so that I can be a better judge of their quality, and I'm not there yet.  (Pan camera across floor riddled with toys and clothes to baby cheerfully pinching my arm and erupting with a river of spit-up.)  In time.  In the meanwhile, I've read a bunch of articles about this study over the last few weeks, and I came accross this reponse today which does well with specifics and left me curious to see what better studies in the future would show:

Planned home birth and neonatal death: Who do we believe? - posted by Amy Romano of Science and Sensiblity

I look forward to the results of the de Jonge and Buitendijk analysis she mentions.

Online traditional midwifery education

Posted by Tatiana

Seems a little conflicted, doesn't it? Traditional midwifery education - online.  But perhaps it isn't so outlandish.  Why not utilize this crazy virtual platform to bring together women from anywhere with internet access to learn lessons about traditional midwifery that have stood the test of time?

Quoting Clare Loprinzi from the Mamma Primativa's website:

"I am a traditional midwife and have never used ultrasound or drugs... as Onnie Lee Logan, a southern granny midwife said, 'What I know about deliverin babies came from motherwit, common sense.' 

...I realize that few will be traditional midwives but most of this knowledge will still become incorporated into your life and help you on this journey of empowering yourself and other women to birth with respect and grace."  

Opening at the end of September is Mamma Primitiva, an online traditional midwifery education program started by Clare Loprinzi.  Clare is a traditional midwife who lives and practices in Hawaii, and is called "mammana" - the name for midwife of her Sicilian ancestors. She is also on the board of directors and the medical advisory board of Mother Health International and has chosen to funnel the funds from the school in direct support of MHI's efforts.

MHI birth clinic in Jacmel, Haiti.  Mamma Primativa tuition directly funds MHI.

Photo reposted with permission - © 2010, Mother Health International

I learned of the program because I've been following MHI as the midwife for my April babe has been involved in starting their clinic in Haiti. They caught their 100th baby at the end of July (they've been operating since January.) They're building a more permanent structure for the clinic, but this dome is where they're working for now.  (I think dome birthing can catch on!)  I also suggest you check out the MHI blog, it features beautifully written birth stories written by volunteer midwives.

Back to the school; Mamma Primativa is beginning its first session September 27, 2010.  The program runs for three years and new sessions start every six months.

Mamma Primativa welcomes both students seeking a primary midwifery education, as well as people who want to complement a different educational choice. You can throw yourself in full force, or "listen to the lessons, read the questions and look at the answers."

The tuition is a sliding scale donation of $35-50 per month going directly to Mother Health International.

Clare Loprinzi, CPM with Dr. Jade Patti McGaff, MD (OB/GYN)
Both teaching staff at Mamma Primativa, pictured here in Clare's garden.

Photo reposted with permission - © 2010, Mamma Primitiva

Their teaching staff features an obstetritian, an emergency MD, a naturopathic doctor, two midwives, and a cultural practitioner.

The class format is four weeks of the month:

Week 1: Audio, video, or written lesson
Week 2: Birth story demonstrating the previous lesson
Week 3: Questions relating to the lesson
Week 4: Student discussion

I'm always excited when I see people setting up infrastructures that will be in the reach of many.  I'm more than a little tempted with this program myself!

Check out their website: Mamma Primativa - Traditional Midwifery Education.

More free learning resources

Posted by Tatiana

Just made two new additions to the Free Resources for Midwifery Study post:

Midwife's Abdominal Examination in the Antenatal Period from The University of Nottingham.  Interactive lesson from the UK nurse midwifery angle.

Free online learning resources for midwifery from WikiEducator.  A long list of learning resources including midwifery specific biology, suturing, breastfeeding and featuring stuff like pharmacology for the more medically inclined.

Enjoy!

"Selfish" moms and I liked it better when they didn't say vagina on tv. *warning I use anatomically correct terms in this post*

Posted by Le

I read an article from a fb link for midwifery today about how home birth moms are reckless and selfish. I am used to the hype about women who just want a spa like birth experience at home even though it increases the risks for their baby. So most of this article was the normal stuff I just ignore until I got to this part.  "The other selfish aspect of a home birth is that it requires a fully-trained midwife to leave the hospital and give one woman her undivided attention for the duration of her labour, which can be 24 hours or even much longer. Websites supporting home births, including the National Childbirth Trust, strongly encourage women to 'stand your ground' if a local authority declines a request for a home birth. There is no mention of all the other women in hospital who might need the midwife's care during that time. Thought is given only to the right of the woman to choose to give birth wherever she likes."

That really really bothered me and made me sad. It also showed that the author doesn't understand some of the fundamental differences between ob/gyns and midwives. While she is in England and things work a bit differently over there I would guess that home birth midwives there, like home birth midwives here, tend to have less clients due at the same so they can accommodate for spending a whole 24 hours (or more) with just one client. I think it is sad that she doesn't think she (or anyone else) is important enough to request special attention when giving birth. I for one think all women are special enough to have the complete attention of a midwife (plus whoever else comes with her) at their birth. That is part of why I want to be a midwife - to give women the attention and support that they need and deserve.

And on a different note I like it better when they didn't say vagina on tv because I can't stand it when people use the word improperly. I saw a clip on tv last night where a guy was complaining that a girl's vagina was showing. She was blurred but apparently the woman was naked and she was standing up with her legs together. If her vagina was actually showing then she needs to be rushed to an emergency room because there is a serious problem! I guess I should be happy they are attempting to use anatomically correct words but I'd be more impressed if they could add a few like labia or vulva because that is what they actually mean 99% of the time when they say vagina...

Birth Stories in India

Posted by Katy
August means a much needed vacation from school and the toil of New York City. I'm spending the month with my boyfriend in the Himachal Pradesh region of India (that is very north). I decided to let this be a true vacation and not do any nursing or midwifery work, but I still have run across some interesting stories:

Mountaineering Mama- We went to the mountain institute outside of Manali for trekking information and met the nicest woman who gave us a map, directions, and advice. She is a mountaineer, guide, and teacher at the institute and was clearly incredibly knowledgeable about mountains. She asked what I did and when I explained midwifery she launched into her birth story (it seems to be a cross-cultural response)! She explained that she had a c-section for her first baby because the cord was wrapped around his neck. She tried to have a natural birth with the second baby, but when the labor pains started, they were so painful that she requested another c-section.

Disappearing midwifery students

Posted by Tatiana

Did we all get sucked into our studies?  Just to liven things up, I'm making a more casual post.

A few lessons my childbearing and childrearing is giving me to take along into midwifery work:

• When a mother says she'd like to throw her baby out the window and nervously giggles, don't assume she's joking.
• Same mama can have pain free and ecstatic birth, and a bitterly disappointing and painful birth in the same set of (controllable) conditions.  Lesson: Avoid drawing conclusions about a woman based on the way you see her birthing!
• If I can remember that adults are like overgrown children and practice NVC and other presence-based communication with them half as willingly as I do with my kids, things are a lot more clear.
• If I feel the well of my patience is absolutely dry and life presents me with yet another challenge, I must be wrong about that well being dry.
• Vaginal exams during labor can be flippin' painful.
• A birthing woman can pull back her own swollen cervical lip, thank you very much.
• When giving nutritional counseling to a woman who already has children or is otherwise excessively busy, be very creative about how she can meet the nutritional needs of herself and her baby with minimal money and minimal time.

And just in case you also need a little extra oxytocin...

And yes, this baby came out of my vagina.

Standing on the Precipice...

Posted by D

This is it. The last big hurdle, outside of taking the NARM exam next year. This is what I have been waiting for and wanting, for many many months. I feel like I am standing on the precipice, waiting to jump off and either land on my face, or find out I can fly. Sure, I have 6 more weeks at Casa, but Casa right now feels easy and familiar, and much like a vacation to me now.

So, what is it that I am referring to with such trepidation? Last week the midwife I have been hoping to apprentice with called me and asked me if i was interested in working for her doing postpartums and birth assisting as a paid "nurse." Apparently, her most recent nurse quit after 2 months. She was hired when the previous nurse quit after 3 months, and she was hired when the previous quit after... Yes, I've heard stories. Stories about being yelled at, stories about how wonderful she is, stories from doctors about the "crazy" things this midwife does. And it all intrigued me until recently. Until she asked me to come work for her until she is able to hire a "real" nurse. So, today I went and met her and spoke at length with her one long term nurse. We talked aboutthe schedule and expectations and we also talked about the practical side of surviving working with this midwife. I've been warned. It will be rough. She will yell. But...she is also a great teacher and I will learn a lot.

Aside from the anxiety of workign with this midwife, I also have questions in my mind as to how this will actually work since I will actually be working with TWO midwives. This new one and the one who I've been going with for the last two months. I've logged a good 30 births in the last two months with the other one. She's VERY laid back and is so easy to get along with. She trusts me (for as much as she knows me) and she is very open to a student finding their way and figuring out what works for them. In other words, she's easy and comfortable for me now.

So, we worked on the schedule, which will be four days with one and probably two to 3 days with the other. There is some flexiblity in that, but it will be a lot of time on call. And though I remind myself that it is temporary, it is pretty clear that for the next year, or at least a good six months, my entire life will revolve around birth. It basically has been for some time, but it hasn't been with the commitment that it comes with now. Scheduled=paid=commitment.

The other thing that gives me pause is the fact that this population (Plain- Amish and Mennonite) is so different from the typical homebirth population that I would generally plan on serving. The general population is basically healthy, well-educated about health and hygeine, and they have doctors and the Internet readily at their fingertips. They take a huge responsibility to know their options and exercise choices in decision making. Many people (myself included) refer to these families as higher maintenance with their birth plans and ideas for the perfect experience. but at the same time the level of responsiblity they take on themselves is freeing to their care provider. The Plain population is easy in terms of birthing and choices, but they also rely on their midwives for information and care outside of the general scope of practice of a midwife. For example, this new midwife typically gives the MMR vaccine to the babies. Already I have seen families call the midwife when the baby is in the car seat and is pushed off the woodstove (cold woodstove) by the older sibling. Or a 2 year old who falls 8 ft from a barn ledge and hits her head, fracturing her skull. They call the midwife (who tells them to go to the ER). And I know of midwives who suture children after accidents that require repair. All of this makes me so nervous. In this practice that sees 18-20 babies a month...so much can and WILL happen. And will I miss something that I should have found. Will I miss a blood clot or a heart murmur? Genetic anomalies are common...will I miss a clue to a lethal something that could have been prevented. I've already been told that they typically attend 2 to 3 funerals a year. WHAT??? That definitely is not your typical homebirth population. And just as I had to rephrase my assumption that babies will choose breathing over eating , I am going to have to remember that much of the assumptions that we take for granted aobut birth being safe, really need to be balanced with the idea that things can and sometimes will go wrong.

For the time being, I am holding my anxiety in check. I know thiat this journey has been anything but boring to this point, and that there is a reason for everything. I'm confident that I can come out of this experience a better midwife and a better person, even if parts of it may be quite painful,