Birth Wisdom, Volume One
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 One
Copyright © 2010 by Midwifery Today, Inc.
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Table of Contents
Chapter 2: Birth Is a Human Rights Issue
Chapter 3: Drugs in Labor—A New Hope
Birth Odyssey
© 2001 Midwifery Today, Inc. All rights reserved.
Editor's note: This editorial first appeared in Midwifery Today Issue 58, Summer 2001.
Nothing is more important than the motherbaby relationship. The experience of growing a little person inside of you, nourished and fed by your own body and blood, is precious. These days we realize that our baby is also nurtured by our heart, mind and spirit.
I love being a mom. Even though I have had the privilege of getting to do some really special things in my life, from a 35-year marriage, to being a homebirth midwife, to founding and working on Midwifery Today and even traveling for Midwifery Today-I still say the most wonderful role God allowed me was to be a mother. I have loved every stage. I loved when my children were being born, I loved when they were babies and teens, and now I love experiencing them as young adults. I enjoy my own changing role in their lives. The joy of mothering never goes away but deepens and grows as my children mature.
One of my other special loves is travel. I like visiting different parts of the world to compare and contrast midwifery while going to or setting up conferences. I also like encountering new ideas and discovering resource people to write and teach for Midwifery Today. Recently I had the privilege of going on a 25-day trip through Europe with Loren, my last-born child and only son, who is now 21 years old. When I was pregnant with him and he was a baby I had a busy homebirth practice. At one birth when he was about 36 weeks inside of me, he leaped around and seemed really in tune with the baby being born. Loren went with me to many births during 1979-1980, my constant companion, much like he was on this recent trip. I told him this is the closest we've been since we were pregnant and nursing.
This trip was a sweet blending of my roles as mother and midwife, as well as part vacation, part work. I found my son to be as comfortable with vacation as with meeting the midwives.
Going to five countries and meeting midwives from all over Europe was a treat. In Prague, Czech Republic, my first task was to lead a tricks session and do two poster sessions at the conference, "Bringing Babies into the World." Loren and I then went on to meet midwives in Rome and work on the next homebirth conference, which Midwifery Today is trying to co-coordinate there. In Florence, Italy, we met with my friend who is a midwife educator. We visited midwives in Germany and Switzerland and then went on to France to work on the Midwifery Today conference, "Birth Renaissance," which will be held in Paris, October 18-22.
As I made my way through Europe I found myself focusing on two questions: 1) Is there a perfect way to be born? 2) Is there a standard by which we can measure our work?
I used to think that homebirth was the standard of care. But now I find myself emphasizing ways of preserving the motherbaby relationship so that no harm is done to either mother or baby and relationships to the mother's family and friends are strengthened. I learned a lot from the women I met in different countries. I also observed a transition in some of the ways birth practitioners care for women. Birth is a part of culture, but birth is also a mystery that reveals universal truth. As my long-time midwife friend Valerie El Halta says, "Birth is truth."
I went to a home waterbirth in Rome with a midwife friend whose concern for the birth was that the mother bond with her family rather than us. She also noted that she finds labors to be longer when the midwife does too much "labor support." A woman can find her way into the needed primal state if the birth attendant does less emotional nurturing, according to my friend. Back when I was actively practicing midwifery, my partner Monika and I had a similar philosophy. We felt like the important people for mom to bond with were her own family and friends because we were in her life intensely for just a short while. But we would always do and be what the birthing mother needed and wanted.
The birth in Rome went very smoothly and lasted about eight hours. At one point mom seemed to need encouragement so I went up and gave her a hug. She thanked me. I realized that midwives all over the world really practice similarly. Though we are different person-to-person we take each birth as individual and practice in whatever way we figure will strengthen mamatoto bonds.
In Germany I spent time with Cornelia Enning, a brilliant midwife who has been doing homebirths for more than 25 years. I first met her at the summer 2000 waterbirth conference in Portland, Oregon and was so impressed with her work that I invited her to teach at both the Midwifery Today conference in Paris this fall and our Philadelphia conference March 21-25, 2002. Her observations in birth are so very subtle that she is seeing new neurological signs of well-being in mothers and babies. She has been doing "unassisted births" for her whole practice. In Europe "unassisted" doesn't refer to "no" midwife present at the birth as it does here, but really "mother assisted." In other words, the mother "delivers" or "catches" her own baby. Cornelia does this with twins and breeches as well. In fact with breeches she feels it is even more important. She shows in her videos the last cardinal sign the baby gives as she/he is emerging vertex, which is to turn to look toward her/his mother on the way out. When the practitioner's hands are there the baby swims more downwards.
Cornelia played video after video, absorbing me in these births. One video shows four mothers handling their babies as they are doing exercises to prepare for baby swim, which she also teaches. She said, "Tell me which one was a c-section, which an emergency vaginal birth, which the one where the baby swims out of its mother and which a pushed-out birth." I was amazed that she has discerned the difference between a baby "pushed" out and one that swims out. Watching both how the mothers handle their babies and how the babies react, you can distinguish what kind of birth motherbaby has experienced. This is subtle but obvious knowledge.
Cornelia really thinks outside the box. As I ponder what she taught me and the many other ideas I have encountered from different midwives around the world, I realize that we as midwives really do hold the future in our hands-because we possess and share more understanding of the motherbaby relationship than anyone, except for the mother and baby themselves. As birth attendants-whether midwife, doctor or doula-we have a huge responsibility for the well-being of our culture via the motherbaby relationship. Birth is truth and a very high calling indeed. I urge you in your calling to really ponder and practice what best facilitates the strongest motherbaby bond.
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Birth Is a Human Rights Issue
© 2009 Midwifery Today, Inc. All rights reserved.
Editor's Note: This editorial originally appeared in Midwifery Today, Issue 92, Winter 2009/2010
“We hold these truths to be self-evident, that all men [and women] are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”(US Declaration of Independence)
Every mother and baby has the right to be treated with reverence and respect during the birth process, including pregnancy and beyond.
When a woman becomes pregnant, she and her baby have unalienable rights. First, the right to life: In June of this year, the United Nations Human Rights Council adopted a landmark resolution acknowledging maternal mortality and morbidity as a human rights issue.(1) The adoption of this resolution prods governments to “change the way they view maternal death—that is, as a human rights issue no less serious than executions, arbitrary detentions, or torture.”(2)
Next, the right to liberty: The word “liberty” contains aspects of freedom, independence, autonomy, emancipation. These concepts are not usually considered in relation to the childbearing year. It is time to declare that mothers and babies have the right to liberty in pregnancy and birth.
Finally, the pursuit of happiness is of utmost importance to those of us who care for mothers and babies. Most births around the world lead to some varying degree of preventable trauma for the mother and baby. I say it is preventable because much of it is iatrogenic, caused by the doctor or midwife. In many cases, if the mother, baby and birthing process had been treated with respect, the trauma would possibly have never taken place. Instead, the mother likely would have had the most miraculous experience of her life. At the very least, she would have felt a part of the decision-making process if things still did not go as planned. Birth today is a doctor dictatorship in many practices and in many hospitals. Mothers and babies are missing the healthiest possible beginning, both physically and emotionally. Their human rights are being violated.
Pregnancy and birth are usually the most crucial and powerful passages in a woman’s life. This can be perceived by the mother as either a powerfully great experience or a traumatic ordeal. Mom will generally have one of these reactions and those feelings will last her entire life, even if they are buried in the busy job of mothering. She will either soar at the thought of her birth or be driven to the depths of sorrow, especially in this age of the cesarean cut. The same is true of the way the birth experience imprints on the baby. Though he or she may not consciously remember it, the experience will have many life-long effects on the child.
In most of the world, birth practices almost always lead to the traumatic side of birth. This is so unnecessary because women have within them the ability and the instinct to have a great childbearing experience. The importance of breastfeeding has finally been proven, yet traumatic birth experiences often add up to the inability to breastfeed long-term. A mother who has had the natural oxytocin high from her birth is much more likely to be successful in breastfeeding her child. I wonder if this oxytocin effect can last longer than we are able to record now. Midwives and doulas are key, because they spend the time making a crucial relationship with the family. Their nurturance is key to any system of health.
The right not to suffer from trauma in pregnancy and birth is a basic human right. That does not mean that trauma will not exist, but the concern of all of us should be to do everything we can to reduce it, and, if possible, substitute it with the birth high. We need practices that promote optimal birth. Read the International Motherbaby Childbirth Initiative.(3) We all have a responsibility to take on the role of protectors of normal birth. Why are we exposing babies prenatally to potentially dangerous and expensive tests that do not offer improved outcomes? Ultrasound not only has not been proven safe, it is potentially damaging. The unborn baby girl is carrying the eggs for her own babies from about two months in utero. What are we exposing these eggs to with repeated ultrasound? Our first guiding light is “First, do no harm.” We must take this seriously.
People walk around with scars, trying to lead normal lives. My oldest friend in life is Suz. We have been friends for 50 years—since we were 12. She says of people with great trials in life, “S/he didn’t get to start at Start,” as in a race. The race of life is difficult enough without depriving mothers and babies of the love and joy and natural oxytocin high of their birth. This massive human rights violation is reverberating throughout our world—the whole world, because these horrendous practices have gone out on a wave of medical imperialism. They have spread birth travesty around the world. Brazil is a sad example, with nearly 100% cesarean rates in some city hospitals.
We have caused incredible trauma in the birth room and in nearly every pregnancy. When I first started practicing homebirth 33 years ago we had not invaded the uterus. Moms at least made it through pregnancy without too much worry and trauma. Even our words now cause trauma and worry. A woman should come out of every prenatal visit with a renewed sense of well-being and confidence. Instead, our words are often swords that cut her down long before the cesarean knife, which will cut open one in three bellies. These are huge human rights violations.
At our conference in Strasbourg, France, which is the seat of the European Court of Human Rights as well as the European Parliament, we plan to take this issue apart and make plans for changing birth practices. The theme is “Birth Is a Human Rights Issue,” which is also the theme of our Summer 2010 magazine. I truly hope you can join us there for this pioneering event. It is time to start a revolution in birth. You are part of that revolution.
1. United Nations General Assembly; Human Rights Council. 2009. “Preventable maternal mortality and morbidity and human rights.” http://www.who.int/pmnch/topics/maternal/20090617_hrcresolution.pdf. Accessed 26 Oct 2009.
2. Stoffregen, Morgan. 2009. “UN Resolution Recognizes Maternal Mortality as a Human Rights Issue.” International Budget Partnership e-newsletter, No. 49, Jul-Aug. http://www.internationalbudget.org/resources/newsletter49.htm#IIMMHR. Accessed 3 Nov 2009.
3. International Motherbaby Childbirth Organization. 2008. “The International Motherbaby Childbirth Initiative: 10 Steps to Optimal Motherbaby Maternity Services.” http://www.imbci.org/USERIMAGES/File/IMBCI 04-05-08.pdf. Accessed 18 Oct 2009.
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Drugs in Labor—A New Hope
© 2004 Midwifery Today, Inc. All rights reserved.
Editor's note: This editorial first appeared in Midwifery Today Issue 71, Autumn 2004.
My soul is flooded with grief. My frustration overwhelms me. I cry for countless mothers and babies—for the births that could be. I am overwhelmed because I have felt the strong light of a powerful birth. This beacon of joy took place four years after my first birth, in which the critical hour after birth was filled with only loneliness and the numbness of separation from my baby. This is the time that should have overflowed with joy of the highest order. These are the hours for which there are no second chances. It is too late to change that birth, but for the billions of women who will become mothers, it is not too late. Or is it? Have we gone too far down the road of devastation to call back the miracle? Is there a Berlin Wall of birth that can be torn down?
Drugs in labor are the core of this destruction. It is hard to change something that makes so much money. We have come to the point in childbirth that almost no one escapes this war that is waged against motherbaby. Nearly everyone succumbs to some kind of drugs in labor, whether through induction, pain relief or routine use of drugs for hemorrhage prevention (see IM editorial).
The cost of medicalization is both monetary and emotional, depriving mothers of a powerful and miraculous birth experience. An experience that sets the foundation for motherhood. The baby's house is now totally invaded, unless the mother flatly refuses to step into the medical culture. Where is there an island of light?
Why does the newspaper have an article about a baby who died during a midwife-attended birth? Doctors routinely induce, drug and numb motherbaby—where are the headlines for the deaths they directly cause? Why are they not held to a standard—a simple one, like don't damage mothers or babies iatrogenically? My niece just stomped out of an obstetrician's office because when she told him she was talking to her aunt, a midwife, he said, "You mean, baby killer?" What ever gave doctors the right to take over our birth culture and rob us of our miracle? What ever gave them the right to steal a woman's experience and her power and cause no end of health sequelae for mothers and babies? Where are their standards? Where are their ethics? Why this war against motherbaby and midwives? Why do we ask kids to just say no to drugs, when we flood them with drugs at birth? Why do we have to keep fighting this battle? Why are we losing?
God has given me this call as surely as He gave me the call to be a midwife. Every cell in my body knows and screams, "Don't let this happen to other women and their babies! Help them attain their miracle, because the joy lasts a lifetime—so does the devastation." So I keep fighting, as do you, sometimes wondering why, at other times knowing—for that occasional mother who sees the light. That gives us the resolve to go on. It is like the girl on the beach strewn with thousands of starfish. She is throwing them back into the ocean one at a time, when a man comes along and says, "What does it matter? You can't save all these starfish." She picks up another one, and as she throws it back into the ocean, she replies, "It matters to this one!" So for this woman and this baby, we will keep up the good work, screaming in our souls, "It matters to this one!"
I just finished the Oregon Country Fair. As many of you know I have made most of my living selling lemonade at craft fairs for the past 30 years. OCF is one of the last holdouts of alternative culture. There are hundreds of booths out in the country. Alternative energy, culture, entertainment, crafts and food are highlighted. Each booth is like an extended family reunion. The land on which the fair is held was a huge summertime gathering place of Native Americans. Now we all come back each year to meet old friends as the Native Americans did. I watch many of the babies I have midwifed grow. Most are in their 20s now.
While at the fair last weekend, I pondered my anger and frustration, sharing it with my dear midwife friend Penni Harmon, who usually helps me pull my head out of the negative places. This time she agrees with me. Birth seems doomed. We talk about what we can do to help women—a 25-year calling for both of us. We focus on the younger generation, those who are still children, because, except for a few starfish, childbearing-age women are essentially lost to their bundles of fear taught by doctors, the media and possibly even their own mothers. Realizing that it is mostly the media that teaches them, several of us have decided to start our own TV station. My German midwife friend Cornelia told me the story of two nuns who started a popular TV station in Europe. They woke up one morning to a dream that God had told them to start a TV station.
The interesting thing is that many of the 20-year-olds in my lemonade booth have the skills to plan, shoot and edit film, and they are really into the idea. If you have any connection to media or money that could help us with this solution, please e-mail me at jan@midwiferytoday.com or call me at 1-800-743-0974. This new world calls for new solutions, and this world is taught by the media. Let's use it. Maybe we can solve the fear, intervention and drug problems around birth in this way. New hope usually breaks through my frustration—maybe this is it.
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Baby's Choice
© 2008 Midwifery Today, Inc. All rights reserved.
Editor's Note: This editorial originally appeared in Midwifery Today, Issue 86, Summer 2008.
Imagine you are a baby in utero. Set yourself a stage in there. You are surrounded by warm water, a loving mother and the wonderful sounds of her heartbeat. (In the Mauritius Islands, this first home, the uterus, is called the baby's house, according to English midwife Huguette Comerasamy.) Your baby's house is tight. Soon you will be nearing your time to come to the earth through birth. What position are you in? How does it feel? What do you want for your birth?
Carla Hartley says, "More babies prefer homebirth." Is that what you want? Are you in a breech position or are you head down? Are you by yourself or is another baby in there with you? What would you personally choose for your birth? (No one usually considers your choices, but I think it is time that we as a culture consider what you may want.)
You probably want your parents to communicate with you from the time they know you're in your warm, beautiful water womb. Do you like the visits to the midwife? She massages and talks to you as she explains to your mom about how you are positioned and how to feed the two of you.
How do you feel about ultrasound? Are you telling us something when you move away from the vibrations? Can you feel an effect on your brain?
What do you feel during labor? Do you feel what your mom feels? How do drugs given to your mom feel to you? How do you feel coming out; do you prefer one position over another? Do bright lights and shouting affect your entrance into the world? Do you prefer homebirth? Do you prefer waterbirth?
What do babies want?
Mabel Dzata believes we need more RESPECT, whether for each other as birth practitioners or as practitioners for mothers and babies. Just think how birth would change if the motherbaby were respected. When I look at some of the stories of birth we report in Midwifery Today, I read of no respect in most hospital births.
Why would a midwife or doctor take a tool like a bulb syringe and go after the baby as if attacking an alligator? Bulb-syringing babies' nasal passages damages the mucus membranes and seems to always make them cry. Healthy babies do not need to cry at birth. Crying is the baby's way of saying "I am distressed."
"Birth is safe; interference is risky," is another one of Carla Hartley's "Trust Birth" sayings. We as midwives need to reconsider everything we do in prenatal care, birth and postpartum and eliminate all unnecessary and potentially dangerous interventions. We need to learn and to practice noninterference and respect.
Fredrick LeBoyer, in his book Birth Without Violence, encouraged respectfulness through lowering the lights, speaking softly and using a warm bath. Do you, as a baby, want that, too?
LeBoyer didn't go far enough with respectfulness, though. He took the baby from his mother for a bath and separated him from the only person he knew, just as the oxytocin was priming them to bond to each other. LeBoyer took a step in the right direction, but then made a huge mistake by taking the baby out of her mother's arms.
We need to do better by doing less. Waterbirth has certainly helped. For one thing unless we really try, we can't interfere as easily. What baby wouldn't choose to have her mother receive her if there were no complications or other valid reasons to separate them.
Mothers need to be educated by their midwives, but babies instinctively know about the importance of the first hour after birth. They want to be with their mothers. If they have to be bathed for cultural or other reasons (although recent evidence shows that vernix is protective) they may want to do it with their mother.
The baby's whole body, breath, soul, mind and hormones are geared to being with her mom. That's why the word "motherbaby" was born. For nine months the baby counted on her completely. Our medicalized culture has disturbed that reality. Babies can live this way, but not optimally.
We need to respect the baby's need to stay with mom and dad. Wouldn't you, as a baby, choose as warm and loving place as possible?
Midwives and doulas have a huge responsibility to help nourish and protect motherbaby. Midwives can help to ensure a loving home for the baby, even if his folks don't get along. We are given a sacred trust that is the most important part of our calling. Because of our roles we have influence; that influence can be used to educate. Several of my midwife educator friends have told me that if we do what we need to in prenatal care the birth will go as smoothly as possible. So step up to your calling and don't forget the importance of respecting the baby.
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Hands-On Care
© 2004 Midwifery Today, Inc. All rights reserved.
Editor's note: This editorial first appeared in Midwifery Today Issue 70, Summer 2004.
Look at your hands. These hands are holy-ordained by God to receive babies. What is the substance of this divine trust? What is the responsibility? Midwife, partera is a high calling. (All practitioners are midwives if "with woman." I am talking about the calling, not the profession.) How do you carry out your role? First, do no harm. If possible, do some good.
Relationship is the essence of hands-on midwifery care. How would you know without relationship that a birthing mother does not want her mother-in-law in the birth room or the myriad of other details she shares with you? Hands-on prenatal care ensures that by the time birth arrives, you are prepared to do this dance with her. Some studies have indicated that we do not need as many prenatal visits to get the same outcome. This might be so with drugged labors and cesareans, but we hold a higher standard. We strive for optimum outcomes, in terms of both overall health and maternal satisfaction. We want the mother to fall in love with her birth. Loving her birth will give her more understanding and patience with her baby.
In practice, hands-on care takes many forms. Cornelia Enning offers what she calls "mother-led care." That is, she asks the mother to tell her how much guidance she wants from the midwife. Does she want to receive her own baby? Does she want coaching?
Some midwives use varieties of massage. (See the great article in this issue on massage.) Our Mexican midwife sisters have taught us many massage techniques. Their hands, hearts and very beings exude kind and caring "hands-on midwifery."
Ideally, hands-on care involves continuity, as it is difficult to truly protect families without this element. With hands-on care you teach and counsel during pregnancy how to prepare for a healthy birth. A woman doesn't intuitively know that good nutrition protects her and her baby from many complications. Midwifery must teach these things. Often you have to impart your trust in birth to women made afraid by their culture. We need to teach them their bodies are wonderfully made for this holy task.
For this reason, the most important elements we need to impart to motherbaby and family during prenatal care are faith and trust. To do this, we must have it ourselves. How can we impart trust if we do not have it? Where do we get it? We must guard our hearts and minds. If, as a student midwife or doula, you find that your education program is instilling fear rather than faith in you, consider changing programs. Our culture and society are counting on us to impart the sense of the miraculous, the trust and faith we find in birth, to the mothers we serve.
One midwife who faithfully carries out this holy calling is Mabel Dzata. She is originally from Ghana, Africa, but has blessed our community in Oregon for 25 years. When she came here she had already attended over 2,000 births. She immediately became, and still is, one of our treasured mentors. She teaches at many of our conferences and will be with us in Germany this October. She maintained a homebirth practice for years. Then she went through nursing school and then midwifery school and became a CNM. Mabel imparts to birthing women her faith both in them and in birth. As a nurse, she earned a reputation for getting the babies to be born just by being in the room with the laboring woman, often for less than an hour. How did she do this? She says, "Respect." Respect for the birthing woman and the sacredness of birth.
If we have the time in prenatal care, we can impart so much. This time we get with the woman is key to the birth experience. I tell you of Mabel because many of you do not have the luxury of time spent together, the essence of hands-on care. Our birth system is extremely dysfunctional. We must often work in the medical system while trying to change it. You midwives who work in it are much needed; your hands are just as ordained. The pressures on you are great. Often you do not have the chance through authentic, hands-on midwifery care during pregnancy to prepare for birth. You establish a relationship right in labor, but your respect for laboring women can heal a great deal. You still have much at your disposal with which to help them. You know what laboring women need—a quiet, dark, undisturbed place. You can establish a fantastic, protective relationship.
We must slice through the weirdness of our birthing culture and its myths and build our faith and trust. However, we cannot give from an empty well. We must fill up the well, because give we must. Few are we who understand this elemental process of bringing forth babies in love and peace, honoring the sacredness of birth. This knowledge gives us the responsibility to pass it on whenever and wherever we can. Please do it, because the world needs you more than ever.
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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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