Ethics in Midwifery ~ Midwifery Today

birth_microbiome

Ethics in Birth Care

We now know so much more about overall health and the seeding of a healthy microbiome at birth that it would be unethical not to have the mother and baby skin-to-skin and undisturbed unless there is a life-threatening emergency. We find in life that many of the things we used to believe are not true anymore. We can really only take responsibility for what is known. The benefits of a healthy microbiome are now well known, and birth practitioners fail mothers and babies when they do not facilitate the best foundation for a healthy life.

Michel Odent wrote a great article for our next issue of Midwifery Today magazine where he talks about all of this in detail. He concludes that the best place to have a baby is in the mother’s home where her microbes flourish. We homebirth midwives are at a great advantage here but it is also important that we facilitate what we know. Since most babies are born in hospital, it is of utmost importance that practitioners there figure out the best ways to help families facilitate this right to a healthy microbiome!

~ Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. 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, or join her online, as she works to transform birth practices around the world.

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The Voice of Reason

“Good luck with that cesarean section problem,” said my webmaster as he posted the beautiful home water birth photos of mother Kalista and baby Loki with father Trace and sister Sophie immersed in love, joy and newborn water. “It seems we were talking about that problem 30 years ago.” Yep, he’s right. We were.

By 2013, ACOG had released their new definitions for gestation, making 40 weeks term and paving the way for inductions at 39 weeks. California-licensed midwives received news of tighter restrictions for homebirth. National and world statistics worsened for infant and maternal mortality making it seem reasonable to move toward higher requirements for birth worker education and tighter control for standards in childbirth. ACOG seems to be the voice of reason.

I, however, am the voice of another reason. In all these rulings, standards, guidelines and laws, the voice of the mother is rarely seen as the expert. Her final knowing and final word ought to stand firm above the knowing of others about her; this is a human rights issue. As we midwives started to create a tiny space to serve mothers, serve our callings and serve ourselves without being thrown into prison, we thought the mother’s voice was heard through our midwifery voice; this was our initial mistake. The Cherokee made the same mistake in calling all men brothers as the foreign foot stepped onto this land. Another’s voice can never replace the one to whom actions are being taken or suggested, especially when the action is insisted upon with threats of death. This is why one must go deep and quietly into the presence of birth to see what miracles are possible.

In his latest book, Childbirth and the Future of Homo Sapiens, Michel Odent concludes, “Let us work as if it is not too late.” Some may work for legislation, others for research, some with colleagues and some with mothers, but may all work with heart and soul with little thought of self and much thought of the seventh generation. I have many passions, but intellectualizing and standardizing birth is not one of them. So I am the voice of undisturbed birth and I am saying, “Stop frightening birthing mothers.” May we learn how to speak our truths without frightening others and without frightening ourselves.

Meanwhile, I wonder, why can’t we see that the way we are handling birth and the very real correlating outcomes are making things increasingly worse? Who cares how much more qualified, educated, scientific, evidence-based, equal or superior we have all become if we as a collective motherhood and as a collective midwifehood are more afraid of birth and, therefore, act accordingly. I’m not sure anyone with any education or training is best suited to be with a birthing mother. If a mother can somehow escape the claws of a professional, she ranks in the numbers of those women who are birthing the last free human beings on our planet—the last human life free from needles, machines, drugs, plastic, spotlights and the coercion of fear.

The right to decline treatment, seek a second opinion, seek alternative therapies and change care providers is a human right available to all, including pregnant women. It is a bogus right if, when exercised, a woman is made to feel that she is stupid, irresponsible and dangerous to her own offspring. The use of threats, coercion, bullying, demeaning language and looks, withdrawal of care and downright meanness are used every day against the women who carry the future of their families and the future of our species inside their wombs under their heart near their instinctual nature. The right to humane treatment is more visibly applied to endangered species of zoo animals than to pregnant women.

Sister MorningStar
Excerpted from “The Voice of Reason,” Midwifery Today, Issue 110
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What is the purpose of midwifery education? What is your purpose for midwifery education?

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Has shifting it from the apprenticeship model to the formalized education model improved birth outcomes? Does making midwifery education stream through a formalized route create a profession and a professional that improves birth experiences for women? What does the effect of fear have on the birth outcome? Is there a causative effect of fear for safety that diminishes the goal of a positive outcome, as well as diminishing a mother’s perception of happiness in her birth experience? What long-lasting effects does a professional creation of fear for safety have on a woman’s happiness beyond the birth experience? Has safety become the yard stick by which midwifery education is researched and measured and globalized? Have we succeeded in creating a false sense of security in birth with the presence of a professional?

In the late 1970s and early 1980s in Missouri, you could have your baby at home but you couldn’t have anyone help you who knew what they were doing. By law, physicians (trained or not in birthing babies) could have helped you, but they wouldn’t. Truthfully, that difficult situation helped those of us who chose homebirth to be clear and strong and mutually supportive. Gandhi said, “If someone can lead you out of the forest, someone else can lead you back in.” There wasn’t anyone else to trust but ourselves, and that served us very well.

The same instincts that guided our ancestors and the animals in the woods around us became our guideposts. My daughters and the children of my friends birthed powerfully at home and those births included the modern-day terms of postdates, small for gestational age, large for gestational age, gestational hypertension, gestational diabetes, premature and prolonged rupture of membranes and meconium-stained fluids. When I was having babies, we didn’t know the names of those conditions, and I believe that lack of professional or official education was to our advantage. We watched for things like general well-being, general happiness, capacity for handling stress and presence of fear. We watched to see if the pregnant mother was feeling better or feeling worse, and we circled close when her time came near. She knew us by name and we knew how she slept, pooped and what she ate. We knew if she had made peace with people and circumstances that surrounded her birth and her baby. It never occurred to us that her body couldn’t do something that her mind was clear about. We didn’t have a point to prove; we had a baby to birth. Many of those stories are in a book I wrote about my nearly 30 years of experiences with instinctual birth, called The Power of Women.

My drive and purpose and intention when I began to seek out midwifery education in the late 1970s was to find a midwife with whom I could apprentice. I wanted to learn how to get to know a mother in seven or so short months so that her honesty, love and power would be comfortable revealing itself in my presence. I followed my mentor everywhere, including the grocery store. After every prenatal appointment and after every birth we would sip tea as I asked questions and she asked me questions. I would ask, “Why?” and “What if?” She would answer straightforwardly and then ask me deeper questions about what I would do and what I was thinking.

Sister MorningStar
Excerpted from “Midwifery Education?” Midwifery Today, Issue 105
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Midwifery Today ~ The Medicine of the Ukhu Pacha: Andean Sacred Teachings around Pregnancy, Birth and Postpartum

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Editor’s Corner

[Editor’s note: This issue’s guest editorial is by Sister MorningStar.]

I am very aware at present of the need for a paradigm shift toward our community involvement with birthing mothers. People are afraid of birth. Even ER docs and paramedics are afraid of birth. They would rather handle a gunshot wound. Grandmothers have become silent. Friends and family feel ignorant and helpless. We have lost the joy and wonder and celebration of birth that allows a mother to move through pregnancy and labor surrounded by calm loved ones and familiar environments. Indigenous people’s rites, rituals and prayers often don’t work when exposed to unbelievers. The natural mystery of life and birth is often undermined to breed fear rather than curiosity and trust. What to do? Learning more has not helped. Science proves and disproves on a daily basis and keeps everyone reading and confused. Meanwhile, mothers are growing another baby. Maybe the Cherokee can help. Maybe simplicity and sacredness can help. Maybe returning birth to community by way of village prenatals can help. [See MorningStar’s article on village prenatals.] Together, we can circle the earth and start a new wave of hope and joy.

~ Sister MorningStar

Sister MorningStar has dedicated a lifetime to the preservation of instinctual birth. She birthed her own daughters at home and has helped thousands of other women find empowerment through instinctual birth. She is the founder of a spiritual retreat center and author of books related to instinctual and spiritual living. She lives as a Cherokee hermitess and Catholic mystic in the Ozark Mountains of Missouri. Visit her at her website.

 

The Medicine of the Ukhu Pacha: Andean Sacred Teachings around Pregnancy, Birth and Postpartum

Andean culture and wisdom offer a deep and honoring approach to women’s bodies and their reproductive health, including the time/space around birth and becoming mothers. Birth is considered a rite of passage in itself, where one will no longer be the same. The time of pregnancy and birth is considered to be a chakana (bridge) into maternity and an entrance to another reality: the Ukhu Pacha, where one enters her darkness, her inner world, and finds her strength and her medicine. The Ukhu Pacha is associated with the world of the ancestors, with the dark (from which everything is born), with the feminine generative force, with the periphery and with the unknown. The wisdom present in this can help women understand the different emotions we experience throughout pregnancy, birth and postpartum, which are not only emotional or mental states on the “bright side” but can include also sadness, grief, doubt, deep fears and confusion as we dwell in the waters of the Ukhu Pacha. As we will see, Andean cosmovision doesn’t understand these emotions as negative but as opportunities to better know ourselves, heal in deeper levels and strengthen our personal medicine.

It is starting with conception that the pregnant woman slowly enters this Ukhu Pacha as her pregnancy progresses, reaching its greatest depth at birth. She then slowly emerges from the Ukhu Pacha together with her baby. When we cross the threshold at the time of birth, diving in the deepest waters of the Ukhu Pacha, we experience a paramount transformation and are reborn at different levels of experience. When we cross the threshold of birth, we not only give life to a new being but we give birth to ourselves. We birth ourselves as new women, as we will not be the same again. Thus, according to Andean practices, to incorporate within the world of culture or the Kay Pacha (the here and now reality), the woman and her baby, as beings in transition, make a trance from one state to another, from one world to another, and must enter in the cultural world of norms (Lingán 1995). Thus, special care is given to the new mother by female community members in this rite of passage, as this is understood to be a very vulnerable state, not only physical, but emotional, mental and spiritual, where so much of her experience in the world as a woman is transforming. In a way, a woman in her state as a new mother after birth is weaving again, little by little, her new identity/identities and her place in the world. This personal transformation into becoming a mother must not be taken lightly (by herself and by her community).

The mother and baby during the pacha, or time-space after birth, are still dwelling in the Ukhu Pacha and going out little by little (and incorporating themselves) back to the Kay Pacha, or time-space as we know it, and they sense it normally. Thus, in the Andes, the common cultural practice is to have a one-moon or one-month retreat after the wawa (baby’s birth) to support this transitioning. The new mother stays in her house during the first days after birth just in her room, and she is cared for by close family and female community members. Her husband is a key part of this support circle, and he helps with household chores, as the new mother has to be in absolute repose and isn’t supposed to cook, wash laundry or dishes or clean the house. Although she is “on retreat” and has to follow some cultural norms during her time of seclusion (e.g., a special diet, minimum contact with water), she is not alone and she feels supported in this process. Certain cultural practices are followed by mother and baby to support the containment needed in this vulnerable pacha, such as the Andean practice of walta or walteado (swaddling). It is also advised that the household’s physical environment remains dark, and this is easy to attain as typical Andean houses aren’t illuminated; they resemble dark little wombs.

Reference:

  • Lingán, M. 1995. “El ritual del parto en los Andes.” Dissertation. University of Nijmegen.

Cynthia Ingar
Excerpted from “The Medicine of the Ukhu Pacha: Andean Sacred Teachings around Pregnancy, Birth and Postpartum,” Midwifery Today, Issue 118
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The Voice of Reason by Midwifery Today

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“Good luck with that cesarean section problem,” said my webmaster as he posted the beautiful home water birth photos of mother Kalista and baby Loki with father Trace and sister Sophie immersed in love, joy and newborn water. “It seems we were talking about that problem 30 years ago.” Yep, he’s right. We were.

By 2013, ACOG had released their new definitions for gestation, making 40 weeks term and paving the way for inductions at 39 weeks. California-licensed midwives received news of tighter restrictions for homebirth. National and world statistics worsened for infant and maternal mortality making it seem reasonable to move toward higher requirements for birth worker education and tighter control for standards in childbirth. ACOG seems to be the voice of reason.

I, however, am the voice of another reason. In all these rulings, standards, guidelines and laws, the voice of the mother is rarely seen as the expert. Her final knowing and final word ought to stand firm above the knowing of others about her; this is a human rights issue. As we midwives started to create a tiny space to serve mothers, serve our callings and serve ourselves without being thrown into prison, we thought the mother’s voice was heard through our midwifery voice; this was our initial mistake. The Cherokee made the same mistake in calling all men brothers as the foreign foot stepped onto this land. Another’s voice can never replace the one to whom actions are being taken or suggested, especially when the action is insisted upon with threats of death. This is why one must go deep and quietly into the presence of birth to see what miracles are possible.

In his latest book, Childbirth and the Future of Homo Sapiens, Michel Odent concludes, “Let us work as if it is not too late.” Some may work for legislation, others for research, some with colleagues and some with mothers, but may all work with heart and soul with little thought of self and much thought of the seventh generation. I have many passions, but intellectualizing and standardizing birth is not one of them. So I am the voice of undisturbed birth and I am saying, “Stop frightening birthing mothers.” May we learn how to speak our truths without frightening others and without frightening ourselves.

Meanwhile, I wonder, why can’t we see that the way we are handling birth and the very real correlating outcomes are making things increasingly worse? Who cares how much more qualified, educated, scientific, evidence-based, equal or superior we have all become if we as a collective motherhood and as a collective midwifehood are more afraid of birth and, therefore, act accordingly. I’m not sure anyone with any education or training is best suited to be with a birthing mother. If a mother can somehow escape the claws of a professional, she ranks in the numbers of those women who are birthing the last free human beings on our planet—the last human life free from needles, machines, drugs, plastic, spotlights and the coercion of fear.

~ Sister MorningStar
Excerpted from “Voice of Reason,” Midwifery Today, Issue 110
View table of contents / Order the back issue