What does a midwife do?

The Art of the Midwife

Care with a modern midwife is truly an art form - combining the guiding, healing hands of one's most trusted advisor and nurturer with today's knowledge, science and medicine. This fusion is what sets midwives apart from most doctors.

A midwife's care is based on the idea that the woman is the central decision maker in matters regarding her birth and her child. Midwives respond to mothers as a caring and collaborative partner, highly trained to work with each unique situation individually. Her goal is the health and well being of mother and baby. She has the resources, wisdom, and professional training to safely guide the journey of pregnancy.

A qualified midwife will provide comprehensive prenatal care, guides labour and birth, and cares for newborns. However, her unique value is revealed as she connects with a woman and her family to offer a deeper level of care. During pre and postnatal visits that are three to ten times longer than standard doctor visits, the midwife listens to what is needed at each step of the process. She can then offer appropriate information, physical, emotional or clinical support, and options.

The safety and benefits of midwife care have been proven again and again in countries across the world. World Health Organization statistics show that births attended by midwives have lower infection rates, lower C-section rates, fewer complications, and healthier outcomes - thus, lower overall medical costs - than physician-attended hospital births. In addition, there is no difference in infant mortality between midwife-attended and physician-attended births for low-risk women. Countries such as the Netherlands, Sweden, and New Zealand, which have the best birth outcome statistics in the world, use midwives as their main maternity care providers.

Article courtesy of this link.

Waiting for Baby

WHAT YOU NEED TO KNOW
The body is doing a lot of inner work to grow a baby. One of the healthiest things to see is a woman pregnant with her first child who takes the time to enjoy the process. Usually it is women in their late thirties or early forties who have seen success in the outer world who are now willing to abdicate the "benefits" of the corporate world and reassess their lives through the lens of parenting.

SPIRITUAL AND HOLISTIC OPTION
The tenor of pregnancy contributes to a child’s constitution for the rest of his or her life. It is a crucial time in a child’s development. And because the baby is part of a woman's own body, positive inner communication between the two can translate into a woman’s deeper trust in herself that continues after birth.


COMMUNICATE WITH YOUR UNBORN CHILD
Once pregnant, you can regularly communicate with your baby. Visualize your child in a pink bubble (or another color of choice—I suggest pink because it is associated with love) and send the message that she is safe and loved. This is an especially useful exercise during times of stress or when you are scared or anxious. You can also read to your baby and talk to her regularly. Hearing begins to develop in the first trimester! And remember, pregnancy is a two-way street. If you tune in carefully, you may sense that your daughter is also communicating with you.
Teresa Robertson is a midwife and a birth intuitive who helps women enhance the health of their babies in utero and their own ability to carry a child to full-term. She does this by teaching pregnant women to tune into and connect with their unborn child. Since meeting her at the Omega Institute in Rhinebeck, New York in the’80s, I’ve referred many pregnant women to Teresa. I found her approach both empowering and effective—it’s the essence of what I call "yin" power, the power of waiting, of being open and receptive. Teresa helps encourage the fundamental nature of femininity, and that’s exactly what it takes to both conceive and carry a healthy baby—or any other creation.

GOOD VIBRATIONS 
Make listening to music, dancing, and singing a regular part of your pregnancy. It helps tune both of your bodies. Layne Redmond, an accomplished drummer and author of When the Drummers Were Women, points out that the original beat our bodies were exposed to was our mother’s heartbeat. And that’s why the beating of drums still stirs us right to the bone.

Music has been shown to reduce anxiety, heart rate, and respiratory rate. It also decreases stress hormone levels, boosts natural opiates, relaxes laboring women, and has beneficial effects on the physiology and behavior of the newborn, including contributing positively to weight gain in both normal-weight and premature babies.¹

DON'T WISH AWAY YOUR PREGNANCY
When she was diagnosed with breast cancer, comedian and writer Erma Bombeck wrote down some of the things she wished she had done while she still had the time. One of those was savoring her pregnancies. She wrote, "Instead of wishing away nine months of pregnancy, I’d have cherished every moment and realized that the wonderment growing inside me was the only chance in life to assist God in a miracle."²

USE THE POWER OF THE MIND-BODY CONNECTION
Take advantage of your emotional porousness. Use birth affirmations regularly during your entire pregnancy to help you program your body and mind for optimal birth. In her book Ina May’s Guide to Childbirth, midwife Ina May Gaskin points out the amazing power of the mind to influence the body during labor. She told one pregnant woman that during her labor her vagina, vulva, and cervix would become huge openings to allow her baby to pass through easily. When she gave birth, that is exactly what happened! Put affirmations all around your environment—your refrigerator, bathroom mirror, Palm Pilot, journal, and phone—to remind you of your birthing power. Say them out loud or in your head regularly. Write them down repeatedly. Let the power of your emotions and thoughts do its magic with your body.


CREATE AN OUTER PLACENTA
Pregnancy, labour, and birth are physically demanding events that require a large outpouring of life energy. Every woman who is going through the changes of pregnancy needs to replenish that energy, not just through proper nutrition but through the love and support of those around her—the nourishing environment I call the outer placenta. Just as the developing baby cocreates her own placenta in partnership with her mother, so too must the mother "implant" herself into her community to cocreate this outer placenta. The urge to reimplant yourself into your own mother is particularly strong at this time. Obviously a supportive mate is a major plus in a woman’s ability to care for herself optimally. A carefully chosen, committed health-care team can also make a big difference. In general, the more effective and diverse your community of support, the better.

Article courtesy of the following site.

LEARN MORE | RECOMMENDED READING OR RESOURCES

• Ina May Gaskin is one of the best-known pioneers of midwifery. Learn more about her work at www.inamay.com.

• To learn more about Teresa Robertston’s work, visit her atwww.BirthIntuitive.com.

Birth Stories

Do you have a Birth Story or two you'd like to share? 

Have you had a baby at Genesis Clinic recently? What was your baby's birth like? Did you have an easy or difficult time in labour? We all love to hear other people's birth experiences and also to share about our own experiences, no matter what the outcome of your birth, whether you had natural or you had a VBAC (Vaginal Birth After C-section), or you tried for natural but ended up with a C-section.

Story telling is an important part of moving into parenthood. You have probably told the story of your labour and the birth of your baby over and over many times to your friends, family and neighbours, maybe even to complete strangers on the bus or when you were at work!

Each woman's story is unique and each labour and birth is unique for every woman. So whether you have one child or ten, no two labours will be the same - at least it would be very rare if they were. Have you had 2 labours that were identical? If so please do tell us about them.

So take some time and write your story. When you're happy with it email it here for others to read. By sharing your experience you can help other people to learn by things you have gone through.

Whatever your childbirth journey is, we'd all love to hear it! 

Do You Have A Birth Story To Share?

Share it with us and we will post it on the Genesis Clinic website under our 'Birth Stories' section.

Please email all birth stories to birth@genesisclinic.co.za

Coping with labour naturally

• Choose a care provider and birth place that will allow you freedom in labour and plenty of support.
• Practice relaxation during pregnancy.
• Use affirmations and visualization during pregnancy.
• Choose labour companions who will support and encourage you - consider a Doula.
• Read inspiring birth stories during pregnancy.
• Labour at home as long as possible.
• Make your location as comfortable as possible.
• Keep your space warm and dark.
• Bring comforts of home to the birth center.
• Go about your daily routine during early labour - sleep if it's night.
• Eat and drink as you need to.
• Move. Walk inside or outside, use a birth ball, slow dance - movement helps.
• Surrender to the power of labour and the power of your body, embrace it.
• Play music that you love, that helps you move deeper into labour, or that soothes you.
• Stand and bear down on low support, or pull on a soft rope support if it helps.
• Be grateful that you'l be meeting your baby soon. Be grateful for your attendants.
• Vocalize -use deep, open moans. Relax your jaw. This relaxes your bottom.
• Know that you can do this.
• Visualize your body opening and your baby moving down.
• Keep peeing. This gets you moving and some women like labouring on the toilet.
• Try aromatherapy. Massage with essential oils in a carrier oil can be wonderful.
• Have an attendant use counter-pressure for strong back labor.
• Use a hot sock, rice sock, or aromatherapy stuffed animal to apply moist heat.
• Use cool washcloths or a frozen hot sock, rice sock, or aromatherapy animal for cold.
• Get in the shower.
• Get into warm water.
• Have an attendant give you a massage on your legs, or anywhere that feels good.
• Don't try to escape the pain - embrace it, go with it. Explore it, be curious about it, if it helps.
• Feel the love of those around you.
• Talk to your baby.
• Look in the eyes of your support team.
• Do what your body tells you to do. Breathe.
• Trust yourself.

The benefits of using water in labour.

Extract from “Water Birth” by Janet BalaskasHow water can help you in labour“The water looked very inviting and I was delighted with it when I got in. I had a fire burning and the room was candle lit, with soft music and lavender oil in a burner.”

The change in how a woman feels and behaves soon after entering a birth pool in a quiet darkened room can be remarkable. It seems to alter her state of consciousness and her concentration – sometimes dramatically – so that she very soon relaxes and sinks more deeply into herself and is able to let herself surrender to the involuntary rhythms of her labour. It’s as if she becomes sleepy, even dreaming.

In the ‘Birth and the Family Journal (Vol 8)’ Michel Odent writes: ‘The reason why kneeling or immersion in water during labour is so helpful is mysterious. What is clear is that water is often the way to reduce inhibitions… we observe that during such immersion in warm water, semidarkness is the best way to reach a high level of relaxation. Water may be a good way to reduce adrenergic secretion. Immersion in warm water with semidarkness may also be a way to reach alpha brain wave rhythms.

Water may be a symbol of mother, of comfort, regression to childlike needs and behaviour. Whatever way we want to talk about the effect of water during labour, one thing is sure.

The contractions become more efficient and less painful at the same time, so that sometimes the labour is very quick. Many women do not want to leave the pool because it is so comfortable. As a result sometimes the baby comes while the mother is in the pool.’

The benefits of water immersion, or hydrotherapy, in labour have been studied and assessed by many experienced midwives, researchers and doctors all over the world.

It is clear from common findings that including a pool of warm water in the birthing room adds a whole new dimension to the experience of childbirth. A recent study of 1,300 water births found that the use of a birth pool is rated very highly by women, whether having their first or subsequent baby and their enthusiasm is shared by midwives.

This echoes the findings of thousands of women and their midwives all over the world. There are some women who have had several water labours or births and have had such satisfactory experiences that they cannot imagine giving birth in any other way.

But just as every labour is unique, no two women will use a birthing pool in quite the same way. Moreover, a minority of women who try the pool do not find it helpful.

Many women however, are very keen to get into the pool at the earliest possible moment (although we will see later that it is not wise to get in too early) and some are so comfortable that they want to stay in the water for the whole of the remaining labour and birth.

Others find the pool helpful for pain relief during labour, but feel the need to be on dry land for the birth itself. A further group may labour and give birth on land but use the pool for relaxation after the birth.

In a long slow labour, episodes in the pool can be useful for resting. The message is that water can be of benefit in a variety of ways.

“My labour was very short and intense. Near the end I wanted to get my head down to slow the pain down When I went into the pool I found that I couldn't get my head down lower than my hips as I had been doing out of the water, so I felt the contractions more strongly than ever. I got out because I missed the presence of my husband to cling to and overall felt very isolated in the pool.”


Privacy and non-intervention

One of the benefits of labouring in a pool is the sense of privacy that most women who use it experience. Enclosed in her private space, protected by the gentle barrier of the water, a woman can feel secure from unwanted contact and more in control of her body. She is free to turn her attention inwards and focus on the rhythms of her labour and what she needs to do to ride the powerful sensation of the contractions.

Although it is essential that regular fetal monitoring is carried out periodically while the mother remains in the pool, in practice there are fewer internal examinations and other procedures than in most labours on land.

And, significantly, this ‘hands-off’ approach seems to have no adverse effect on mother or baby as was noted in a study of 2,000 women in a hospital in Switzerland where water birth is offered as an option to every woman.

“I was glad not to need any stronger pain relief (I had an epidural for the birth of my first baby) and to give birth naturally feeling in total control in the pool and in my own home. I liked the fact that being in the pool meant that the midwives keep a hands-off approach and leave it up to you with no internal examinations and no breaking of the waters. It was so different from my first experience.”

Midwives who attend water births often have to develop different ways of assessing progress in labour. Instead of routine vaginal examinations to check dilation, the midwife relies on more subtle indicators, such as the woman’s breathing, vocalisations and movements.

In fact, many midwives feel that attending labours and births in water has added an extra dimension to their midwifery skills, including an extra sensitivity to changes in the mother without the need for manual confirmation.


Pain relief through water

“The pool helped the labour to progress rapidly… I was very eager to get in the water and found it a huge relief when I entered… the pool was very useful in coping with the pain, helping to focus me so I could concentrate on making the pain useful and positive.”

One of the main reasons that women choose to use water during their labour is for the relief of pain. There is no doubt among midwives experienced in its use, that immersion in water can provide dramatic relief of discomfort for a high proportion of women.

Various studies have confirmed this finding. For example a clinical audit of water births carried out in five birthing units in England, ‘supported the proposition that water birth is effective as a method of pain relief.’

In hospital birthing units that have a long-standing commitment to the provision of pool facilities and support from birth attendants who feel at ease with using water in this way, there has been a dramatic reduction in the use of analgesic drugs such as pethidine (meperidine in the US).

The study cited above found that only 3 per cent of women who used water in labour used pethidine as well, compared to 60 per cent of women who laboured on land. A reduction in the use of such narcotic drugs is welcomed by all concerned, as its is now widely recognised that they can have a depressive effect on both mother and baby’s central nervous system, especially in repeated or large doses

A systematic review of three randomised control trials exploring immersion in water in labour only (not birth) found that there was a significant decrease in the use of medical pain relief in the women who used a birth pool in labour – indicating that for some women the use of a birth pool provides an effective alternative route to epidural anaesthesia.

Epidurals have become very sophisticated and generally provide effective relief from pain and can be used very positively in some circumstances. You need to be aware that using a birth pool will not eradicate the pain in the same way as an epidural – but works indirectly by helping significantly through the benefits listed below, to make it easier for you to tolerate and manage the pain yourself.


Summary of benefits of labouring or giving birth in water

Increases privacy
Provides significant pain relief
Reduces the need for drugs and interventions
Encourages a woman’s sense of control in labour
Facilitates mobility and enables the woman to adopt optimal positions for an active birth
Speeds up labour
Promotes relaxation and conserves energy
Helps to reduce tears
Is rated highly by mothers and midwives
Encourages an easier birth for the mother and a gentler welcome for the baby

Midwives: Starting a Trend & Saving the Birth Industry

06.22.12 My wish list to revolutionize the way we have babies here in the US, making it safer, more affordable and more available to all women

A recent article in the New York Times claims midwives have become increasingly popular healthcare providers because they’re a status symbol.  Apparently, upper middle class women are no longer too posh to push.  Instead, they’re posh enough to take over the childbirth market with demands for personalized, family centered and wellness oriented prenatal, labor and delivery care.  Hallelujah!  If midwifery care has become the hottest trend, I say there’s hope for the American birth industry yet.

Here’s a newsflash though.  Americans aren’t out in front on this trend.  Midwives rule the market in lots of countries including those where maternal health outcomes are the best in the world (and way ahead of the US), like Norway, Holland,  Ireland and Australia.  In other parts of the world where obstetricians are scarce (including developing countries like rural Africa, India and South America) and there are very few midwives, it’s the midwives who are saving women’s lives.

Not just certified nurse midwives either, but also certified practical midwives and trained birth attendants (AKA lay midwives).  They’re providing prenatal care and family health care, delivering babies and following up with postpartum and family planning care.  In countries like Uganda, for instance, there are obstetricians, but not very many and most women can’t get to where they practice and they don’t provide most of the routine, normal, healthy-mother services.  They focus on emergencies and complications.  Midwives are more readily available, though there aren’t enough by any means.

The Times article quotes Christy Turlington Burns, model, film maker, CARE advocate, entrepreneur and founder of Every Mother Counts, (a non-profit advocacy and awareness organization working to improve global maternal health conditions). Turlington Burns says, “I knew I wanted a natural childbirth.  When I met my midwife, her whole approach felt closer to home.”

That’s what a lot of women are looking for, partly in response to the backlash created by ever-increasing C-section rates and not-so-hot American maternal health statistics.  They aren’t necessarily looking for home births (and neither was Turlington Burns. She delivered in a birth center located within a hospital), however, or even all-natural births. Instead, they’re looking for alternatives to the cookie-cutter, baby factory, high-intervention model of care that’s been prevalent for much of the last couple decades.

Rather than being viewed through the lens that many obstetricians use that evaluates women as potentially risky,midwives tend to see women as probably normal.  Pregnancy and birth aren’t usually rife with complications.  Most of the time, for most women they’re, well, normal. That’s what midwives do.  They take care of normal women.  Can you use a midwife if you want an epidural?  Sure.  Certified Nurse Midwives that work in hospitals have easy-access to epidurals and if you need one, you can get one and still continue as a midwife patient.

In many parts of the world (including areas with the very best maternal outcomes) labor and delivery units are staffed with certified professional Midwife (CPMs), not certified nurse midwives (CNMs).  Here in the US, there’s a strong preference and bias towards CNMs.

What’s the difference?  Certified professional midwives go through an intensive training program usually via a university program and take a test that certifies their education and skills meet all the same requirements as certified nurse midwives. The difference is, their course of study doesn’t include nursing school.  Instead, they become the specialists in out-of-hospital birth settings like birth centers and home births. In a few states here in the US, CPMs also do hospital births).

There are some advantages to having a nursing background as CNMs do, but it isn’t always a mandatory element when it comes to choosing an excellent midwife.  In fact, in many nurse midwifery programs, the nursing piece is covered by only a one-year boot camp nursing education that prepares them to function in a hospital setting. CNMs are generally considered the experts at providing hospital births though many also deliver in birth centers and at home.  The biggest advantage of having that CNM versus CPM title is that CNMs are generally more accepted and respected by obstetricians and hospital administrators and they can practice legally in all 50 states.

Last year, I fundraised for an organization called Shanti Uganda, which was opening a birth center staffed by midwives in a rural area of Uganda.  They’ve been providing high-quality care for over a year now and just celebrated the birth of their first twins last month.  In addition to providing patient care, they also provide ongoing education to Ugandan women and children and healthcare providers who want to work with pregnant women.  In fact, this fall they’re doing a ten-day intensive doula training workshop that’s open to anyone with a passion for pregnant women.  If you or someone you know wants in on this, click the link and go for it.  It could be the adventure of the lifetime and the beginning of a great career.

So back to that New York Times article - if what it takes to put normal childbirth in high demand is for it to become a status symbol, well then, so be it.  Here are a couple other items on my wish list that I think could revolutionize the way we have babies here in the US, making it safer, more affordable and more available to all women, not just status-seekers:

·      Open more birth centers focused on normal childbirth located in or near hospitals.

·      Respect that midwives are really, really good at what they do and that includes CPMs, CNMs and     even some non-certified midwives.  They deserve the support and respect of the OB community.

·      Provide more pain relief options to American women, including Nitrous oxide (AKA laughing gas which is available to women all over the world except here in the US), so we have more to choose from than just going all natural or going for an epidural.

·      Add a safety net for women and midwives who want to try home birth by making it easier, friendlier and less adversarial to transfer to a hospital if an emergency arises.

·      Make it easier for all women to get good quality prenatal care whether they live here in the US or somewhere else in the world.

 

Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and five children. Got a question for Jeanne? Email it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.

Yoga Mama

Kristy Nel and Claire Stephenson, both Prenatal Yoga teachers, have many years of experience in teaching Yoga and currently offer Prenatal Yoga classes at Genesis Clinic on Thursday evenings from 17h00 to 18h30.

They have this to say about the benefits of Yoga for pregnant women.

“Recommended by most doctors and midwives, prenatal yoga offers a multitude of benefits to both mother and baby throughout pregnancy, 

during birth and beyond: 

• Joint exercises - perfect for poor circulation, swelling/water retention and excellent to improve mobility. Also enhances squatting and other birthing positions.

• Gentle Stretching - maintains supple and toned muscles, stabilizes blood pressure levels and alleviates heartburn and lower back ache.

• Breathing - balances the autonomic nervous system which regulates the major systems of the body and controls hormonal secretions. Deep breathing increases the intake of oxygen to both mother and baby. 'Birthing breaths' aid in the preparation for a calm birthing.

• Yoga Nidra - during this relaxation technique and one gains the equivalent of 4 hours deep sleep. Yoga Nidra also promotes inner communication with your child and assists in releasing any impressions associated with the fear of birthing.

• In addition, by developing a deeper awareness of your body, a powerful connection between a mother and her child is established.”

Yoga Mama will be at the Genesis Clinic Open Day 

on the 1st of September.

www.prenatalyoga.co.za