Reflecting on Childbirth Practices: Will We See More Respect for Midwives?

In the introduction to the book, Modern Mothers in the Heartland, a speech by Dr. Caroline Hedger is referenced. In 1920 Dr. Caroline Hedger gave a speech entitled, “The Relation of Health to Progress”. Like reformers of the time she was calling attention to the health of women and children.

A broad coalition of public health practitioners, social welfare advocates, and women’s rights supporters argued that a sound and democratic future depended upon mothers’ ability to produce  and  maintain  a  robust  citizenry.1

It seems to me that this is still a valid concern.

In an autobiography, Dr. Bertha Van Hoosen wrote about her experience as an obstetrician.

Midwifery exacts a toll of the mental, physical, and emotional reserves of the physician that is comparable to no other specialty, and for this reason, in solving the problem of obstetrical anesthesia, the obstetrician should be considered along with the expectant mother and baby.   For  fifteen  years  after I began practice I delivered patients in their homes, and regardless of assistance it was I, the doctor, upon whom the morale of the patient and family rested. I was called when labor was evident, and I never left my patient until she had been delivered . . . Hospitalization of the obstetric patient decreases the time and inconvenience of the physician by seventy-five percent.2

Dr. Van Hoosen was a proponent of twilight sleep and devised methods to keep disoriented and combative patients in their beds: adult cribs, a patient gown that had one long sleeve that trapped both arms and delivery tables with restraints.

When I began working as a labor nurse at a hospital in Detroit twilight sleep was being phased out, but the labor room still had beds with high side rails that were like those of a crib. Delivery tables still had wrist restraints as well as stirrups with restraints for legs.

These female physicians in the early 1900s worked hard for women and children’s health. Yet, it is unfortunate that trained midwives were sidelined at this time. Midwives and doctors had different skills and perspectives; they could have benefited from working together. As the medical profession grew the gap between midwives and doctors expanded.

I subscribe to Midwifery Today. The summer issue has an article titled, “The Way of Birth”. The author wrote: My friend and assistant midwife in the 1970s, Deni and I would walk the concrete paths of Kansas City, Missouri, and point out who was under the care of a board-certified obstetrician . . . We predicted then what we are living today: that few babies would be born “under the stars”. We predicted that we would see conception become a medical procedure not unlike what we watched happen to birth. That the body of a woman and the making, growing, birthing, and feeding of a baby would be delivered into the hands of medicine and machines. And men. 3

My recent mail included a publication, Panacea, from the University of Michigan School of Nursing. I was pleased to see an article4about the accomplishment of midwives in Liberia. Inspired by midwife Jody Lori, Maternity Waiting Homes have been established in Liberia in an effort to reduce maternal and infant deaths. Expectant mothers come to the homes, which are located close to health clinics, in the last few weeks of pregnancy.

It is my hope that the midwife model of birth would gain greater respect in the United States. Have you given birth? What was your experience like?

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1Curry, Lynne, Modern Mothers in the Heartland: Gender Health, and Progress in Illinois, 1900 – 1930, Columbus, Ohio: Ohio State University Press, 1999, p.1

2Van Hoosen, Bertha, Petticoat Surgeon, New York: Pellegrini & Cudahy Publishers, 1947, p. 272 -273.

3Sister Morning Star, “The Way of Birth”, Midwifery Today, Summer 2018, Issue 126, p. 21

4Meyers, Jaime, “The Road to Maternal Health”, Panacea, School of Nursing University of Michigan, summer 2018, p. 8-11

Different Environments: New Perspectives

I am joining the writing community, Five Minute Friday, today. We write for five minutes (or sometimes a little more). The prompt today is: ADAPT

Family - Bouquet

 

It was a decision I came to after much thought, choosing to work with physicians and midwives that attended home birth. I had worked in the hospital for many years.

I continued to work in the hospital labor/delivery unit on a  per  diem   basis, while taking weekend call for the home birth group.   Nurse colleagues in the hospital who knew about my second job warned me to keep quiet. Don’t tell any of the doctors.

There is a big divide and limited communication between hospital based birth attendants and home birth attendants. Home birth practitioners are reluctant to transfer patients to the hospital until absolutely necessary. Hospital staff only see the home birth patients that are in crisis. They don’t see the healthy births that take place at home.

I learned so much attending labor patients in their home. I carried supplies that might be needed (IV fluids, oxygen), and arrived at the home when a woman was in early labor. I assessed her and encouraged her to rest in early labor. As labor progressed I helped her with positions changes, suggested a warm shower and offered massage. I made sure she stayed hydrated and nourished.

It was so much easier for a woman to work with labor in her home. (I had taught Lamaze classes, but rarely saw such focus and ability to cope with labor in the hospital setting.)

It was my job to notify the doctor of any problems, and to update him on the progress of labor(so that he/she would arrive in time) . Of course, sometimes a woman needed the interventions available in the hospital. Sometimes I urged the doctor to transfer the patient. A couple of times I rode to the hospital with a labor patient needing intervention.

Hospital staff and home birth practitioners could benefit from switching places. They could learn skills from each other and develop better communication.

As I worked with a foot in both settings, I tried to adapt what I had learned in the home to the hospital setting. The home setting had given me new perspectives on birth.

Women’s Rights & Midwifery

Prayer and RestWomen today have more rights than our ancestors. As we have made progress it is odd that the loudest voice in the current women’s movement is for abortion. I would rather support the right of women to give birth in the setting that they choose. Across the world there is unresolved controversy over midwifery and home birth.

At the same time that suffragists were fighting for a woman’s right to vote, the medical system in the United States, was fighting against the practice of midwifery.

For the past few years I have been researching the life of Hanna Pörn and her court case. She was a Finnish midwife that received a certificate of midwifery from the Chicago Institute of Midwifery. She lived and worked in the Finnish/Swedish community of Gardner, Massachusetts. After eight years of practice, having better statistical outcomes than the local doctors, she was arrested for practicing medicine without a license. The case went to the district court, and was appealed several times. In 1909 she was found guilty and sentenced to two months in jail.

Other countries have had lawsuits against midwives. In recent years Agnes Gereb left her position as an obstetrician and trained as a home birth midwife in Hungary. After delivering many babies in the home setting, she was arrested because one baby died. She was placed in house arrest and the case has been moving through the courts. You can read about her case here.

Today my husband handed me the Wall Street Journal pointing out this article, Sweden Blacklists an Antiabortion Midwife. Ellinor Grimmark trained as a midwife in Sweden in response to the current shortage of midwives.

In spring 2013, with one term left in her studies, she asked supervisors at the hospital where she planned to work to accommodate her conscience rights. [She did not want to participate in abortion.]

She received a furious call from one manager. “How could you even think of becoming a midwife with these opinions?” *

It is a strange world if, in order to attend the birth of babies, you must be willing to kill babies. This brings to mind the Biblical account of two midwives.

The king of Egypt said to the Hebrew midwives, whose names were Shiprah and Puah, “ when you help the Hebrew women in childbirth and observe them on the delivery stool, if it is a boy, kill him; but if it is a girl let her live.” The midwives however feared God and did not do what the king of Egypt told them to do; they let the boys live. Exodus 1: 15-17

Ellinor Grimmark was unable to secure a position in Sweden and is now living and working in Norway. Swedish mothers are coming to Norway to give birth.

Many women are seeking a kinder, gentler way of birth.   Birth  has    physical, emotional and spiritual aspects. Midwives understand this.

So  much  emphasis  is  placed  on  the   physical aspect of birth alone—treating pregnancy like an illness. Frequently, aggressive management of labor takes place in the hospital—and there are consequences. We need to swing the pendulum back. Let labor and birth take place at a natural pace. Midwives have an important role in providing healthy birth care.

In Illinois the Home Birth Safety Act is up for debate in the senate.      Thirty-two states allow midwives to provide home birth care. Illinois should join these states and pass SB 1754. If you live in Illinois, call your state senator and ask him to support SB 1754.

*Sweden Blacklists an Antiabortion Midwife, The Wall Street Journal, April 10, 2017, A17.

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Is Birth a Human Rights Issue?

The first debate between Hilary Clinton and Donald Trump left me with a sense of incompleteness. Some of the questions posed by the moderator had little relevance to current issues in the United States. After the debate I wrote a letter that was published on the editorial page of our     local newspaper. Here is the text of my letter:

During the first presidential debate the topic of abortion did not come up. Neither candidate was asked about taxpayer funding for Planned Parenthood. I was thinking about this when I opened the current issue of Midwifery Today. The theme of the issue is: Birth Is A Human Rights Issue.

I wonder if we have lost sight of mothers and their infants in the attention that has been placed on the provision of contraception and abortion.

The article written by Jan Tritten quotes a point listed under Article 25 of the Universal Declaration of Human Rights (United Nations 1948):      Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

Some would like us to believe that the most important issue for women is the freedom to have an abortion.   Is anyone paying attention to        maternal/infant morbidity and mortality? Why is the United States one of the few countries where the maternal death rate is increasing?

More attention needs to be directed at healthy choices that support life. Countries that have a greater percentage of midwives have better outcomes. Many states in the U.S. have limited the practice of midwives. In Illinois midwives have been fighting for legislation that would license them to attend homebirths.

Healthy women want to have the option of giving birth at home with a midwife.

Recently a law that requires pregnancy care centers to offer referrals to abortion clinics (SB 1564) was signed into law in Illinois. This law strips away the conscience rights of health care workers. I hope this law is challenged. In the meantime I think abortion clinics should have the same standard. They [clinics like Planned Parenthood] should be legally required to offer referrals to pregnancy care centers.

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Passion of The Suffragettes: What About Today?

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We went to see The Suffragettes. It was tough to watch the daily life of women who worked long hours in a laundry. The setting in this movie was the early 1900s in London. The main character was gradually drawn into the suffragette movement and became willing to fight for the women’s right to vote, at great personal cost.

I understand the passion of the women that were portrayed on the screen. They were fighting for respect and a voice. I was saddened that they felt compelled to use violence to make their voices heard. They wanted the right to vote and it was a long fight.

Are there issues worth fighting for today? I have been pleased to see that women and parents are coming together to have their voices heard.

The need for improvement in maternity care has been documented. Countries that have a higher percentage of midwives have better outcomes than the United States.

This is from an article published by  the  Global Health Work Force  Alliance:

When midwives were the main providers of care during pregnancy, women were less likely to give birth prematurely or lose their babies before 24 weeks of gestation. Women were reported to be happier with the care they received, had fewer epidurals, fewer assisted births, and fewer episiotomies – or surgical incisions to reduce the risk of a tear. Finally, in midwife-led settings, women were no more likely to have caesarean births, but they tended to be in labour for about half an hour longer on average.

In Illinois the Home Birth Safety Act is going to be introduced in the state House of Representatives. Research has shown that healthy women attended by a certified midwife have births that are as safe as hospital births, with less interventions. The midwives in Illinois have been working hard to promote this bill. You can see the petition that they have posted on change.org here.

In Indiana, parents pushed back against the aggressive promotion of the HPV vaccine for girls. The state health department had entered the vaccination records of children in a state registry and then sent letters out to parents that had not had their daughters vaccinated with the HPV vaccine.  Yikes, when I worked in the hospital the health records of every patient was private, and any violation of privacy was punishable. The following is an excerpt from an article by Jefferey Jaxen about this practice in Indiana.

It took exactly one month to the day for an activated Indiana population to turn back efforts by their state’s health department to coerce and pressure parents, outside of law, into having their children receive the potentially dangerous human papillomavirus vaccine (HPV). Independent health journalist, Jefferey Jaxen, was contacted by two separate families telling of letters they received by their state’s health departments regarding their child’s HPV vaccine status. An article chronicling the incidents was immediately published to raise awareness on October 5th, 2015.

 I am encouraged by these positive actions.  We can use some of the passion that the early suffragettes demonstrated.

The definition of suffrage is: 1 an intercessory prayer, supplication      2a vote given in deciding a controverted question or in the choice of a person for an office or trust.

The definition of a suffragette is:  one who advocates extension of     suffrage especially to women.

How can you participate?

  1. Stay informed—even when the news is unpleasant. The issues that may impact our religious freedom may be uncomfortable. But it is wise to become educated on new policies and laws that affect our families. Then pray with an informed mind, seeking guidance from God.
  2. Write letters to people of influence and to representatives in congress. Change in the Indiana policy came with people writing letters.
  3. Use social media to express opinions with clarity and civility.
  4. Ask questions about health care: medications, treatments and vaccines. Medical history demonstrates that we don’t often realize the negative impact of medication until years down the road.   After a   national study the common practice of hormone replacement therapy (HRT) has been reduced  because of links to heart disease and cancer. Read about the risks and benefits of HRT here.The birth control pill is also getting more scrutiny. Read this article that explains why one woman stopped using the pill. Science and medicine have provided cures, but they are human institutions. We shouldn’t just follow medical trends. An educated public that asks questions may bring problems to light sooner.
  5. Be an advocate for each member of your family.   We can’t  simply  accept that one type of birth, one medical protocol, one type of treatment, is good for all people.   We have a right to be informed  and  participate in decisions about health care.

Update: the flu vaccine is just 18% effective this year. Click here for link.

Linking with Tuesdays with a TwistA Little R & R,  Friendship Friday,  WholeHearted Home,  Titus 2sdayHope in Every Season, and the Art of Homemaking