Are you a birth worker who is looking to expand your skill set, explore a new topic, or get new perspective? The Birth Mag team has compiled a list of upcoming classes, workshops, skillshares, and mentorship opportunities for kicking the new year off right. All courses listed are either live or have a live component, and are available virtually.
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by Raichal Reed A midwife, a patera, a “granny”, and sage-femme are all names for the same person. The name midwife means “with mother” in basic translation. Since before time was recorded there have been people or a person who had the very important job of caring for the pregnant person and their baby. Depending on what country and sometimes what area you research, there are different stories concerning their roles, abilities, and relationships with the community. Coming into current day in the US, these individuals now have roles that extend beyond pregnancy, labor, and postpartum. Before schools and universities, the midwife directly taught and trained their apprentices/assistants/etc. in order for them to work with them and hopefully in their place once they were no longer able. Skills were passed from family to family and generation to generation orally and through practice along with the more skilled midwives. The first registered midwife in the US was in NY in 1716 and now we have more than 11,000 according to the American Midwifery Certification Board in 2017. This only counts for how many are registered with NARM in regulated states, but some states still do not have regulation or approval and so those midwives work independently and sometimes illegally to make sure that healthy parents and babies survive. “A midwife does not have off days, and a midwife is always on call” was one of the first things I heard when I became a student midwife. I didn’t understand the heaviness of this statement until months later. During the time of being a student midwife, I am at the beck and call of not only the pregnant individuals but also my preceptor. We have clinic all throughout the week and if we have a birth that interferes then we must schedule them on days that we normally aren’t there for. I learned to keep my phone, my watch, my tablet, and any other device that could always make a noise on loud. Babies come when you are in the shower, they come when you are in church, and even when you are asleep. If you plan to be somewhere then they especially come those days because for some reason, when you are busy, they like to start trouble. Labor and delivery are a wonderful, magical process but it is also one that you have no control over, neither you nor the…
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by Sinéad Morgan The midwife and doula collaboration truly puts a new family in a fantastic position to have a healthy, happy, and satisfying outcome during pregnancy, childbirth and postpartum. With ample evidence from lower cesarean section rates, less inductions, shorter labors and even better Apgar scores for baby, when a birthing person is supported by a midwife or doula; this team is a powerhouse for any expecting family. Which is why the two of them working together seamlessly is absolutely imperative to positive, nurturing beginnings for the whole family. While a doula is specifically hired by the family or birthing person for non-medical, unbiased, evidence based, emotional and physical support. The midwife is hired for clinical support in addition to emotional and physical support, and more often than not is chosen over an obstetrician because of their ability to view pregnancy and childbirth as a natural process rather than an ailment to be intervened with. Here are 5 ways that doulas and midwives can work together to ensure a successful and flourishing relationship. Doulas must practice within their scope of practice. As with any collaboration, there is the risk of “stepping on each others toes”. In order to avoid this a well trained doula should always keep in mind the importance of practicing within their scope of practice. The doula is hired as nonmedical support, this should be specified to the client at the time of hire and reminded throughout the relationship when necessary. Not only is this imperative in order to maintain a positive relationship with the entire birth team, but also in order to support positive healthy outcomes for the birthing person and baby. Unfortunately there have been instances where hospitals, or obstetric practices have disallowed patients to utilize doula support for this reason. While a doula may have a basic understanding of certain pregnancy/childbirth issues and may be able to help a birthing person and their family understand some of those issues, it is the midwives responsibility to monitor, interpret and treat the health and safety of the baby. Fill in the gaps. Just as a doulas role is to fill in the gaps of the birthing persons partner when he or she is not present, the doulas role is to also fill in the gap when the midwife is not present. The midwife may not always be present throughout the entire labor process (especially during…
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by Jessi Vining In 2013, the planned homebirth of my daughter became an unexpected hospital birth fraught with complications. I had been working as a doula and midwife’s assistant for 3 years, and I felt pretty confident and prepared going into my first birth experience. I had done everything “right” in order to have the peaceful homebirth that I wanted and that I felt was best for my baby and my body. I had eaten well, exercised, taken Hypnobirthing classes, and had trusted midwives who were committed to supporting me. I had also professionally supported dozens of people in achieving their birth goals as a doula, and had even facilitated several transfers from community birth to the hospital as a midwife’s assistant. I thought I was ready. But I wasn’t. Childbearing brings everyone to their knees in some way or another, and the transfer into the hospital caught me completely off guard. I wasn’t going to be one of those people, I thought. My daughter was born into my arms following a long labor resulting in a transfer to the hospital and filled with interventions I had never even considered being needed or used during my birth. She was healthy and well, and I was bruised and surprised. In the wake of my experience I wondered how in the world I could have missed the memo: sometimes transfer to the hospital happens, and we can’t always see it coming. I started reflecting on my prenatal care, the childbirth class, discussions with my midwives and even the conversations I had initiated as a birth worker with my clients. The general theme was that we didn’t seem to want to talk about transfer from community birth to the hospital. It was a subject tap-danced around and almost discouraged within the culture of the “natural” birthing community. How often does transfer actually happen? I’m often surprised by how midwives downplay the possibility of transfer to prospective or current clients. My experience is that many midwives lead the conversation by saying, “The most common reason for transfer is a very long labor that isn’t progressing. This isn’t an emergency, and we are usually going in for pitocin or an epidural.” Then, they might go on to list several other indictions for transfer of care. Rarely, they might then list their own transfer rates from previous years. This approach does very little to help clients gauge the actual risk…
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by Jessi Vining I was nineteen the first time I saw a woman cut without her consent. As a wide-eyed baby doula I watched, my mouth hanging open, while the doctor sliced into my client’s flesh without using any anesthesia. She cried out in pain and surprise, and looked up at me in shock. This wasn’t supposed to be happening anymore, I thought. I had just finished reading Episiotomy and the Second Stage of Labor by Sheila Kitzinger and Penny Simkin – a small book summarizing the research and evidence showing routine episiotomy to be harmful, rather than beneficial for parent or infant. That book had been published in 1984, and so I had assumed that by 2011 most (if not all) doctors would have abandoned the surgical procedure altogether. Sadly, no.The last eight years of birth work have shown me that the practice of routine episiotomy still hasn’t been eradicated like I once assumed, or even truly restricted to the “emergency-only” status many care providers like to claim. The History of Episiotomy An episiotomy is a surgical cut to the perineum with scissors or scalpel to increase the size of the birth canal and hasten the birth of the baby. The procedure is done during the second stage of labor. Though first described by a Scottish midwife in the 1740’s, episiotomy didn’t become a routine procedure in the U.S. until the 1920s. It should be noted that this was long before it was considered necessary to have research or evidence that a procedure was beneficial before adopting its widespread use. Despite the lack of evidence, episiotomy would remain a routine practice in the United States for the remainder of the century and by 1979, the overall rate of episiotomy in birth was 60%. Finally, in the 1980s and 1990s the first research papers on the effects of a procedure that had been used for decades were published and made available to practicing physicians. There have historically been two primary reasons used to justify episiotomy: 1. To prevent severe tearing and promote better healing by creating a clean, controlled cut and 2. To reduce trauma to the fetal head or reduce the length of time the head is in the birth canal (such as in cases of fetal distress). It was immediately clear from the research that routine episiotomy did not carry the benefits many physicians believed, and in fact resulted in MORE severe tearing, increased pain and serious complications with healing postpartum. There were no clear benefits of routine episiotomy for the…
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Are you in need of continuing education units this year? Do you also want to do better in caring for LGBTQ+ clients as a birthworker? We have some ideas for you. Midwifery Care for Every Body: Integrating Gender Inclusive Practices for the Benefit of All Clients You have to act fast for this one! This introductory level course from queer midwife Ray Rachlin will be held this Saturday (October 19th, 2019) in Philadelphia, PA. Topics include vocabulary related to care for transgender clients, approaches to informed consent, inclusive infant feeding, and more. Space is limited, but still available, at $70 for those needing CEUs. A sliding scale is available for birthworkers of color. 2 Contact Hours (ACNM) Contraception Care for Transmasculine Individuals on Testosterone Therapy This course focuses very specifically on a single topic that is exactly as the title suggests: contraception for people who were assigned female at birth and currently on testosterone therapy. Course content is available online through Wiley Health Learning, with content pulled from the Journal of Midwifery & Women’s Health (the official journal of the ACNM). Access requires a membership or subscription that may result in additional costs, but the CEU granting course itself is $20 for members and $25 for nonmembers. 2 Contact Hours (ACNM) Providing Culturally Sensitive Care for LGBTQ Families This online course from Seattle, WA based MAIA Midwifery & Fertility covers a broad range of topics relating to caring for LGBTQ+ clients, starting from planning and conception, all he way up to the postpartum period and infant feeding. This course discusses both common situations for non-heterosexual parents, and information specific to gender identity and expression, and a section fully dedicated to approaching care with cultural humility. It is notably longer than any other on this list. The course is $225. 7 Contact Hours (MEAC and ACNM) Clinical Care for Transgender and Gender Nonconforming Patients This course is not birthworker specific, but it does specifically address reproductive health. It’s overall focus is on providing better informed consent, evidence based practice, and culturally appropriate care for those who are gender nonconforming or transgender. Course is available online with a $12 fee for CEU certificates. 1.5 Contact Hours (CNE or CME)
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A new study out of Nepal has found what many a midwife already knows: babies can be resuscitated with their cords intact, and often fare better when they remain connected to their placentas during resuscitation. You can find the full study here. Of note in this study, while both groups had comparable rates of NICU admissions, the mortality rate was 0% in the group where cords were left intact and newborns were resuscitated at bedside, versus a 3.1% mortality rate among newborns where the cord was cut immediately and baby moved to a resuscitation station.
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by Jen Marlow LM, CPM With the increasing accessibility of electronic pressure cookers has also come an increase in questions about their viability for sterilization of instruments. In meeting with World Health Organization and United States Food and Drug Administration standards, sterilization in at autoclave at 121°C and 15 PSI for at least 30 minutes is generally recommended. Many out of hospital midwives already successfully use pressure cookers intended for canning, or oven sterilization techniques, so it does not seem like a huge leap to consider using an electronic pressure cooker that needs little more than a button push after being loaded with cleaned and packaged instruments. The simplicity of use is not the only appeal. Most autoclaves are at least 10 times more expensive than a typical electronic pressure cooker. There are several electronic pressure cookers currently available that reach the necessary pressure and temperature. It is entirely possible to see color change on sterilization package indicators that show these conditions have been achieved. The primary concern, however, is that indicators on packaging only show that those conditions were reached at some point during the sterilization process. To meet sterilization standards, that level of heat and pressure needs to be reached and maintained. Until recently, there hasn’t been any clear evidence as to if any of these pressure cookers are consistently maintaining the necessary pressure and heat for the entire time. A 2018 study conducted at Dakota State University suggests that, yes, it is possible to substitute an electronic pressure cooker for an autoclave. Their results came with one big caveat though. Only one of the pressure cookers they tested met the criteria they were looking for. A variety of fungal and bacterial cultures were packaged and run through Instant Pot, GoWISE, COSORI, and Gourmia pressure cookers then cultures were incubated for one week before being checked for growth. Most notably, they were tested with Geobacillus stearothermophilus spores, a culture known to be heat resistant and commonly used to test that sterilization devices are functioning as intended. An Instant Pot with a sterilization setting was the only electronic pressure cooker that was able to successfully pass the spore test. The Instant Pot required a sterilization time of 150 minutes or more before the spores were inactivated, but the other pressure cookers tested were unable to inactivate the spores even at 300 minutes of sterilization time. This longer sterilization time…
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