The Case for Midwives at Birth and Death

Episode Four of Call the Midwife (see reviews of the other episodes below) was among the saddest yet, with a mother dying of eclampsia, not knowing her headaches were a classic sign of the affliction. Eclampsia remains one of the most confounding mysteries in childbirth. No one really knows why it occurs or how to prevent it. But the only way to end it is through delivering the baby before the mother’s life is threatened.  Unfortunately in this case, the baby was delivered and the mom still died. The midwife who first met the mother – but never had a chance to care for her – sat by her bedside as the woman lay dying, a reminder that historically, midwives ushered in new life and ushered it out as well. They typically cared for the ill and dying – not just pregnant women.  There are “midwives of death” – hospice workers and others  who help people pass peacefully at home. I think we need more midwives at both ends of the spectrum of life.

                                  

The Two Most Important Things in Episode Three of 'Call the Midwife'

Episode Three of PBS’ 'Call the Midwife' was another great show, with two interesting points relevant to the history of childbirth. (You can read my takes on Episode One and Episode Two, as well.)

First, an exuberant expectant husband who is craving information about his wife’s pregnancy comes home with a book written by Grantly Dick-Read (below), a British doctor who, like the midwives in the show, rode around London’s poor neighborhoods on his bike in the fog to help deliver babies. This was after World War I. Having grown up in the country surrounded by farm animals, he watched many mammals give birth and approached a woman doing the same without the fear that many other first-time mothers – and even obstetricians – brought/bring to the process. He considered birth normal, not an accident waiting to happen.

His first book, Natural Childbirth, was published in 1933. His second book, commonly called Childbirth Without Fear, came out in 1942 – right at the time of America’s great migration of birth moving from the home to the hospital. Many women, however, were shocked by how they were treated in the maternity ward, and they embraced Dick-Read’s second book like a bible for how to have a natural birth.

He arguably set the stage for the natural childbirth movement in American in the 1960s and ‘70s, though doctors Bradley and Lamaze are more often associated with that time.

The second point of interest for me in the show was the midwife’s use of a Pinard horn (below), a low-tech but effective instrument for listening to the baby’s heartbeat. 

Even today, midwives like to use these – or the fetoscope (below) – because they don’t pester the baby with bothersome noise like that which ultrasounds make in-utero.

Breeches and rickets: Lessons from Episode Two of the PBS Series Call the Midwife

Episode Two of PBS’ Call the Midwife gave us two births that most contemporary pregnant women don’t have to deal with. (You can read my post on Episode One here.)

The show included a woman with rickets, which is a vitamin D deficiency that was common among poor women who did not have a proper diet. The affliction can cause bones to bend – often noticeable in bowed legs, as in below – but can cause the pelvis to be misshapen as well. Sometimes the deformity could be so bad that there was no way for a baby to be born vaginally.

The mom in Episode Two had had a fatal outcome with a previous pregnancy but was able to have as c-section this time around thanks to the National Health Service covering the costs. If there is ever a time for a c-section, that would be it.

The other interesting birth was a breech, shown coming out “ass first,” as nurse Chummy (below) deadpans during the delivery. 

The scene shows how breeches can be born safely if patience, wisdom, experience and the right birth positions are applied. Today, sadly, very few women with breech babies are allowed to give birth vaginally by their doctors – mostly due to a lack of experience in knowing how to gently guide the baby out. It’s an artful midwifery practice we are losing – and shouldn't.  I’ll leave it to the sage midwife Ina May Gaskin to explain why. 

Call the Midwife: A historical guide to outdated birth practices

Call the Midwife on PBS is not only a well-written show based on a real-life British midwife’s work in the years shortly after WWII in London’s East End. It is also an excellent way to understand the true nature of midwifery, how childbirth has changed, and how it has not. I’ll be posting several pieces about the series as it unfolds.

One thing that is fascinating to me is seeing birth anachronisms – methods and instruments that are no longer used (for good or bad). And Episode One contains a wealth of examples. First, the midwives give mothers enemas. This practice thankfully fell out of favor decades ago. The rationale behind them was that by cleaning out the mom, the baby would have more room to maneuver and help the labor progress more quickly (as well as prevent soiling during labor). The technique was called “high, hot and a hell of lot,” referring to where to hold the container of hot water and how much to use. But enemas can be painful during labor and they were found to be of no benefit.

Episode One also contains a scene with pubic hair shaving, which midwives and doctors used to do in an effort to make the area more antiseptic. However, many studies later revealed that small nicks from shaving actually introduced germs into the mom’s bloodstream and could cause infection, so it is no longer recommended, except sometimes in c-sections. Phew.

Finally, perhaps the most awful of all of the outdated interventions seen in Episode One is the episiotomy – a scene that will make anyone cringe! -- where a cut is made to make the birth opening larger. These were once routine, but again, many scientific studies have debunked the method, showing that introducing a cut could make a mother tear more deeply and have more pain later when she might not tear at all if left alone.

Understanding Pelvic Organ Prolapse and Its Treatment Options

Below is a guest post about pelvic organ prolapse, which recalled for me some historical case studies where uneducated birth attendants would, after the baby was born, yank on an umbilical cord to remove the placenta more quickly, and cause the uterus to come out as well. At the Mutter Museum in Philly, devoted to medical oddities, there were even some gruesome examples of what women had to use as pessaries (including potatoes)!

Anyway, good information and sound advice below, especially as it relates to "mother directed pushing," which means, you push -- or don't push -- as your body feels most comfortable; not when someone else tells you to.

GUEST POST:

Pelvic Organ Prolapse (POP) is a common condition that affects women between the ages of 50 and 70. In fact, approximately 50 percent of women will be diagnosed with the condition during menopause, when decreasing estrogen levels cause pelvic tissues to become thinner and weaker. The symptoms of POP range from very mild to severe, as do the treatment options. It is important that women understand what POP is, how it can be prevented, and the variety of treatment options available.

Some treatments are significantly more risky than others, so women should become educated to understand the risks and benefits associated with each.

Pelvic Organ Prolapse

Although decreasing estrogen levels during menopause can be the final trigger for POP, there are additional contributing factors. The primary causes of POP are pregnancy and childbirth, although smoking, obesity and a genetic predisposition can also lead to a diagnosis of POP. The condition occurs when weakened pelvic tissues begin to sag, or drop, in the pelvic cavity. In mild cases of POP, a woman will not experience any symptoms. Her doctor usually diagnoses it during a routine pelvic exam.

In moderate to severe cases, connective tissues will begin to detach from the pelvic structure, causing pelvic organs to drop completely and begin to prolapse into the vaginal canal. The organs most commonly affected by POP include the bladder, uterus and rectum.

Some symptoms of POP include:

·        -- an inability to insert a tampon

·        --  a feeling of bulging, or sagging, in the pelvic cavity or vagina

·       --  difficulty beginning to urinate and/or weakened urine stream

·       --  unusual constipation

·        -- pain or discomfort during intercourse

·       --  spotting or light bleeding

Preventing Pelvic Organ Prolapse

There is evidence that POP can be prevented — or the symptoms can be significantly reduced — by maintaining a healthy weight, eating well, exercising and quitting unhealthy habits such as smoking. Women who are pregnant should discuss "Mother-Directed Pushing," as well as their options for delivery positions during their labor. Research has shown that working with a woman's natural birth physiology can reduce conditions like POP and incontinence.

Kegel exercises are also beneficial in promoting pelvic floor health. Women who do Kegel exercises on a daily basis during and after pregnancy have a lesser chance of developing incontinence and/or POP later on.

Treatment for Pelvic Organ Prolapse

Once POP has been diagnosed, women should discuss treatment options with their doctor. They should try non-invasive methods before opting for more risky surgical interventions. Non-invasive methods include:

·        --Physical therapy

      -Electrical stimulation of pelvic floor muscles

·        --Vaginal pessary

More invasive methods should only be used for moderate to severe cases of POP in which symptoms are uncomfortable and/or debilitating. One surgical method used to correct POP uses a material called transvaginal mesh. It has been linked to thousands of cases of severe health complications. The mesh product can erode into vaginal tissues, causing pain, infections and even organ punctures (organ perforation). These complications can be impossible to reverse.

There are alternatives to transvaginal mesh surgeries that can be successful in treating POP. Women should discuss their full range of surgical options before choosing the safest and most effective treatment for their symptoms.

Author Bio: Elizabeth Carrollton writes about defective medical devices and medication safety for Drugwatch.com.

Raw milk mania

There is an excellent article in the current issue of the New Yorker on raw milk, chronicling how the feds are cracking down on the sale of the unpasteurized variety.The story, focused on a "milk trafficking gang known as the Rawesome Three" in California, posits that raw milk is the new 'pot.'

As I wrote in my book -- and this piece points out -- pasteurization came about because of swill dairies in the mid-19th century; cows were fed the grain leftover from whiskey production. That milk was making children sick. Pasteurization was the cure. And the concept became embedded in our culture.

After reading how federal agents were dumping out thousands of gallons of raw milk in their raids, it made me think: Aren't soda, Twinkies and cigarettes all more dangerous in the long term? Why aren't they illegal? (Actually, raw milk IS LEGAL in California)...So, instead of ranting, I will just say this:

Here's my jug.


Come and get me.

Why becoming a doula is important now

Today, I present a guest post from Gina Forbes, the Workshop Coordinator at toLabor.

Becoming a doula is important now, more than ever.   With the current political climate and the recent attacks on women's health care and civil rights, it seems very clear that this is a precarious time in American culture.  Yet, I also feel that we are on the cusp of something bigger and better.  Every day, I learn about more individuals making greener, healthier choices for themselves and the planet.  People are beginning to rise up and live consciously.  This gives me hope.

As a birth advocate, doula, childbirth educator, and Workshop Coordinator for toLabor, I have thought long and hard about the role of a doula in this cultural and consciousness shift.  What is the greater significance of being a doula?

The answer is this: that EVERY person deserves to have autonomy over their bodies, their babies, their families, and their choices.  It is a human right, a civil right.  Every person who becomes pregnant, gives birth, and becomes a parent deserves to have high-quality, loving and compassionate care around this incredible time in their lives.  Doulas are people who are trained to respect that principle as the basis for all other work they do in their role as birth professionals.  Doulas ideally embody the role of empowered human being, facilitating a process of transformation and support for each and every client.  No matter what the birth experience looks like, doulas should be there to create the space for their clients to claim their choices, their autonomy, and their unique voice.  If done successfully, this paves the way for those individuals to become empowered, healthy, confident parents, which will have a direct impact on the quality of future generations' lives.  Birth matters!

I am an advocate for toLabor, the Organization of Labor Assistants for Birth Options and Resources, because toLabor exemplifies these beliefs in their doula training and certification program.   toLabor aims to return the focus of control to the laboring woman, to create the space and support for her to have her own voice, to be included and central in her birthing process.  toLabor understands the importance of empowering families, honoring birth, and changing lives.

Join the Community of Change.

toLabor will be having a doula training workshop in Jamaica Plain, MA on May 18-20.  For more information on that workshop, please contact local sponsor Catherine McKeown-Lindsey at catstamatos@yahoo.com or at 617-817-5397.  For other workshop listings and more information on toLabor, please visit the website at www.tolabor.com.