Midwife Model of Care VS Hospital Model – Part 2

doula at work

Conclusions

The Medical model of care has been dominant for a century in the northern century. “By the 1920s the United States and Canada became the first societies in human history to do away with midwifery (186)”, only to learn decades later that women still wanted midwives and some would reinvent midwifery if necessary.

In the United States – our present times, only 10% of the babies delivered are born with the assistance of midwives. Whereas, in Western Europe and the rest of the world midwives attend the majority of the births. These nations have the lowest rates of maternal and newborn deaths.

There are some variances within the models of care. Some doctors now will practice according to the midwifery model of care. Some midwives, are employed by large hospital practices where the technological-medical model of care is the rule. They use the midwives for those women who desire midwifery care but the midwives in the medical model are pressured to work in the technological-medical model of care.
This information was taken from Ina May’s Guide to Childbirth. Ina May is an internationally known Midwife, who has delivered babies and written books on Midwifery and natural childbirth. She works at THE FARM, in Tennessee.

Midwife Model of Care VS Hospital Model – Part 1

doula at work

The Midwifery Model of Care

This ancient form of birthing care approaches the idea of birth as more holistic way of care-giving, recognizing the female power of creation. It also acknowledges the holistic view with a seamless unity of mind, body, and spirit; that mother and baby are inseparable units, birth is a normal healthy process.

Visits are much longer. The Midwife is attentive to the pregnant woman, answering her questions. Care-giving, education, counseling are all a part of the Midwife Model of care.

Nutrition is emphasized as the means for a healthy pregnancy, good birth, and strong thriving babies. Companionship during labor is considered important to minimize the use of technology to intervene in the process of birth.

The Midwifery Model has not time-constraint on the process of birth. Labor has its on rhythm, “…it can start and then stop, speed up or slow down and still be normal (Gaskin, 184)”. Midwives give continuous assistance throughout the duration of labor and delivery, and postpartum support after the baby is born. Women can move freely and eat freely throughout the process of labor.

Medical Hospital Model of Care

A product of the industrial revolution, and male derived, its basis is technology and medicine. It is assumed that the body is machine-like, full of short-comings or defects (some has stated child-birth as “pathological”). Pregnancy and labor are viewed as an illness, and that to prevent harm to the mother and baby, must be treated with drugs and/or medical equipment. Also, birth MUST take place within 24 hours.

Mind and body are separate entities. Women are consigned to the bed in a supine position, hooked up to electronic fetal monitors, intravenous tubes, and blood-pressure machines. Eating and drinking, after a certain point in the labor process, are not allowed. Analgesia is administered to ease labor pains since the Medical Model of Care deems pain as unacceptable.

Office visits during pregnancy are short, and questions are discouraged. The mother must take the back seat in her concerns during pregnancy, and passive role during labor. Women are treated homogeneously, with individuality considered unimportant.

Positions for Labor-Part 2

POSITIONS FOR LABOR – PART 2

Variations of the Squat

The Supported Squat

birthing• Your partner sits or squats behind you, toboggan-like style with back against the wall or bed, or using a chair for support
• Or your partner can be in front, doing a squat, and hold your hands for balance.
Standing Supported Squat
• As you relax down into the squat, take the weight off your feet and melt into the arms and against the body of your partner.
• In this position your body will tell your mind to relax
• You then surrender your mind and body to your labor
Dangle Support Squat
• Your partner supports from behind, or two people supporting you (one on each side) helping in supporting you in the squat position.

Kneeling

image004This position is a natural extension of the squat position when the labor is too intense.

• Kneel on the floor with a pillow
• Lean against a chair
• Or get on all fours
o especially good for back labor
o to try and turn a posterior positioned baby
o or if your labor is accelerating and seems unmanageable.

Kneel-Squat Position

• Kneel with one knee while squatting with the other leg.
• Alternate between legs, or you can do a rocking and swaying motion.
Knee-Chest Position
• Your knees are on the floor, while your head and arms are on a pillow
o Slows overly intense contractions
o Counteracts an urge to push when your cervix is not fully ripened.

Sitting

CHAIR STRADDLE• Sit straddled over a low stool, toilet seat, chair or birthing bed angled like a seat
• The best of these is the sit-squat over a low stool, for the same reasons as the plain old squat position

 

Side-Lying

SIDE-LYING• Does NOT use GRAVITY in the same manner as the SQUAT.
• Best on the left side, to prevent the uterus from compressing major blood vessels that run along the right side of the backbone
• It provides a way to labor without pressure of the uterus on the back, and allows for some sleep in a long labor.
• Use pillows for your head, and pillows under the knee of the right leg, and support pillows behind your back.
o It allows you to quickly roll into the kneel or up into a squat
o Once the contraction is done you can roll back into your nest of pillows.

 

*Images from The Birth Book, Sears & Sears (1994) and internet birthing images/stock photos*

REFERENCES:

Balaskas, Janet. Active Birth: the new approach to giving birth naturally, rev. (1992) Harvard Common Press.

Dick-Read, Grantly. Childbirth Without Fear: principles and practice of natural childbirth, 2nd ed. (2013) Pinter & Marition.

Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

Non-Professional Labor Support

NON-PROFESSIONAL LABOR SUPPORT

father in delivery room

 

 

 

 


By the baby’s Father or Partner of the woman:

• Can speak for her, to interpret her needs and desires to the staff.
• Assurances, relaxation, encourage her to drink and eat snacks.
• Assistance in walking during labor, assist in getting in and out of the shower or birth tub, etc.
• If knowledgeable, help with breathing and focus in the 2nd stage of labor

Note: to work effectively, the father needs to be well informed. He needs to know what to expect. If he gets panicky he should leave the room to regain composure and then re-enter. First-time fathers especially need to be informed and may still have need of assurance. This can be assisted by his attendance at the Childbirth Education classes.

By a female relative (Grandmother, mother, aunt or sister):

• [At the hospital] Can speak for her, interpret her needs and desires to the staff.
• If they have experienced a natural birth, their assurances are “gold”. They will know what and when to do things to support the process.  If not, they need to become informed about natural childbirth.
• Assurances, relaxation, encourage her to drink and eat snacks.
• They can assist in labor as well, by walking with and supporting the laboring mother; assist her getting into and out of the shower or birth tub, etc.
• Can help with breathing and focus in the 2nd stage of labor.

RECOMMENDED POSTS To READ:

Let Your Monkey Do It
Overdue Pregnancy


FUTURE POSTS YOU WILL NEED TO READ:

Hospital VS. Midwifery Model of Care
Pain in Childbirth
Normal Vaginal Birth
Optimal Fetal Positions
Positions for Labor
Water Birth
Premature Rupture of Membranes
Fetal Distress
C-Section
VBAC

Your Birth Stories

Share your birth story! I am asking for volunteer submissions of your birth story that you wish to share on my blog.

baby-loading-tshirt

My 3rd Birth:

I was going to county hospital for checkups. I was a week over-due and they put the monitor on me. It was way too tight when I had contractions [Braxton Hicks]…so I pulled it off.

The nurse came to check it and decided there was something wrong with the baby. “The heart beat dropped during contractions”, she said. I explained what had happened, she would not hear me. They began to talk C-Section.

I said “I have my daughter with me, and would need to go home and get her to a sitter. I need arrange for the older two children’s care, and find my husband…” (no cell phone).

I went home and called my mother. I told her I was NOT going back to that hospital. They were C-Section crazy! We discussed that it was too late for a midwife (obviously) and she suggested I go into the emergency room of another hospital.

Downtown San Jose had a hospital, so I took the bus there. The doctor on call said, after I explained what happened, that he wanted to put a monitor on to be sure. I could understand his reasoning, so the monitor was placed on my abdomen. We had to wait awhile for a contraction and after four hours, he says “Baby looks fine. I will call the other hospital and explain that you will be here”…[taking off the monitor] he says “You can get up an walk around”.

At that point, I had been having regular contractions 20 minutes apart. My mom arrived just before that, so we walked the halls of the hospital.

My water broke, and the monitor was put back on. I was dilated 6 centimeters. Contractions were getting stronger, too. 2 contractions 9 minutes apart…I could feel the baby crowning.

The nurse was called in. I told her the baby was coming NOW.

“Oh no, sweetie, you couldn’t be having the baby now. Your contractions are too far apart!”

“The head is coming OUT!! I know what that feels like, I have had two babies previously…LOOK!!”

She looks under the sheet. Hits the buzzer, slaps the rails up, while saying “Oh shit, the baby IS coming!”

Not longer after, my youngest was born. No stitches, a couple tears, no complications. So much for needing a C-Section.

I am making a page that will feature birth stories. Look for it!

Issues part 1

The issues that affect Lakota Native women during pregnancy and childbirth in regards to:
Racism, Sexism, and Oppression

In this report, I will discuss the diminishment of access to information for native female populations of traditional cultural / spiritual values regarding reproduction, healthy pregnancies, and child-birth. As well as cutting the ties to cultural education for young native females (and males/but not discussed herein) directly addressing gender-related socio-cultural information.
Today young native females in Lakota country find they are alienated from the cultural concepts of reproduction and childbirth practices that once were available from the elder women within their family groups.

The path of traditional information is fractured, if not completely broken in Lakota country. Also access to traditional midwifery is not available in many areas.

Young women find themselves (by necessity) having to deal with doctors and hospitals that are a part of the system of oppression that conquered their people and that had forced assimilation practices upon their elders. They have also heard about Eugenics Policies to eradicate native populations, by means of the sterilization policies enacted in the 70s through Indian Health Services.

Due to historical trauma, these young women find themselves re-living much of post-traumatic effects during the pregnancy time-period and at birth. The trauma affects the decision-making process as well.

Historical Background

Initial contact with European colonists was tenuous at best. The European white settlers had asserted its dominance from the onset of settlement. Through the lens of the European settlers, these indigenous people were inferior, only due to the differences in cultural systems of governance. Almost immediately the settlers asserted dominance and control over tribes in which they had initially contacted. The tribes were left with two choices: to conform or to resist.

The colonists viewed the encountered indigenous people as an inferior / savage group. This view was based upon the fact the tribes were not Christian (hence “savages”) and technologically not as advanced as their own (incoming) settler populations. The lens of the white populace was Eurocentric/ethnocentric due differences in ideological concepts such as the differences in view, regarding ownership of land.

The indigenous people did not cultivate the land in the same manner as the Europeans settlers. The settlers could not understand the concept of joint stewardship of lands by the native populous. In their ethnocentric mental lens white settlers conceived this ideology as a waste of good farming land, and of course their ideals were superior in that the land would produce food. Land to the settler, was a resource a non-movable commodity.

From this mental idea of superiority, the desire for lands in which to cultivate both their crops and cattle, the European settlers began to broker deals with nearby tribes through treaties . If they could not gain the land through a treaty, they forcibly took what they desired.

Next week: Part 2 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression.

Culture Part II

Cultural Perspectives on Childbirth

Achomawi mother and childMulti-cultural Beliefs (Continued)

Last week I ended with discussion about the Lakota belief in a spiritual being who assists the souls of the unborn in their journey to human existence. It is thought she “marks” them before entry into this world.  This “mark” is what the medical field calls a “Mongolian” mark.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child. This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe. This is true whether they have a traditional spiritually based upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and spiritual in the birthing process.

Western culture encourages reading and the attendance of Childbirth Education classes, along with other strategies for birthing. In traditional cultures women “…prepare more symbolically. They avoid all actions and thoughts that have anything to do with ‘getting stuck’ or ‘closing up’ and ‘letting go’…  In traditional societies, women often go to midwives to confirm the pregnancy and then again only if there are special problems… (145)” prior to childbirth.

Another aspect is that most women within many traditional cultures would have been directly involved in the childbearing and child birthing aspects from a young age. Her mother or aunts and grandmother would have taught her about the processes of childbearing and childbirth during childhood and/or adolescent years. The concepts would have “…been integrated into her maturity into adulthood (Ibid.)”. It would have come from her experiential life and stories told to her instead of a class or books.

Unfortunately, much of this kind of experiential life and tradition has been lost or no longer practiced today by local tribal women. Some of the other women will talk about this or that grandma who was a midwife, and who may have been allowed at IHS for a birth. When I have asked women, they mostly talk about a more negative experience for their childbirth if they speak up at all.

Traditionally, the birth of a baby was in the home, not a hospital. Some cultures used “a special hut [that] is constructed for that purpose ;…(Ibid)”. But today in the local area, birthing mostly takes place in a hospital setting, here on the reservation. Locally, there is the IHS. There also is Winner Regional, in Winner South Dakota (45 minutes from Mission, SD) or Cherry County Hospital in Valentine, NE.

Due to past experiences with IHS (the “Eugenics Project” of the 60s and 70s, for one), many women may opt to not have their babies unless there is an emergency. Both Winner and Valentine have doctors that have demonstrated certain biases against native women. Without midwives to deliver locally, this is what women on the Rosebud (Sicangu Oyate) Reservation face today (with the exception of one community).

Each of these three hospitals has their own regulations as to who may attend the birth. They also decide on whether a woman can have assisted births (Nurse-midwives/doulas/etc.).  My attempts to discover these policies, and the reasons for them, have been futile.

– Next week will be “Part 1 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression”

 

OverduePregnancy

“Overdue” Pregnancy

silhouette of pregnant womanThe word “overdue” is not really a correct term to use. The concept of the length of a pregnancy being a 40-week period of time was just a random time-frame that was chosen.  A German obstetrician in the early 1800s announced strongly that pregnancy should last ten lunar months of four weeks each.

The timing is relative.

The current standard for determining due dates, ultrasonography, does not do so accurately. In the first trimester it can give a time frame of plus or minus 5 days, a ten-day window. Sonograms done later in pregnancy are even less accurate than early-on.

These types of tests have been proven to have “poor predictive outcomes ” or better said, false-positive/non-predictable results. Yet it is exactly what the doctor uses to determine if a woman or/ and her baby are in need of intervention.

The tests are run at the 42-week mark. Usually, these tests are not accurate, but the doctor rushes to “rescue” the baby. Ironically, when the baby turns out to be just fine, then it reinforces the doctor’s belief that the baby needed “saving”.

Babies come when they are supposed to be born.

Just as doctors use the “average” for determining the length of labor, the “average” is what determines whether or not your baby is late, or not. That average does not take into consideration your own cycles (for date determination) or whether you even kept track of your menstruation cycles.

Doctors become concerned about the well-being of your baby if you have hit the 40 week mark and you have not begun labor. Their concern is not always justified. Below you will find some tests used to determine if your baby is well.

TESTS OF FETAL WELL-BEING

The false positives of these tests have begun to shore-up the idea that it would be a dangerous thing to allow a pregnancy to continue. When induction is started, there is an increase of fetal distress and with that, increased cesarean sections.

A test you can do:

Fetal Movement Counts: Beginning a few weeks before the “due-date”, pick a time in the day when baby is awake. Then begin counting 10 movements, doing this several days in a row. If there is marked drop in movement, seeing the caregiver who will follow up with one of the next few tests.

Tests the hospital may do:

Non-stress test: Using an external fetal monitor to track the baby’s heart rate when baby moves or during pre-labor (Braxton-Hicks) contractions. The heart-rate of baby should increase. But, sometimes it will not, because baby is asleep.

Vibroacoustic stimulation: A slightly different method than the previously mention one. Basically, a buzzer is sounded against the belly, which is supposed to startle the baby. There should be a resulting heart-rate increase.

Oxytocin Challenge Test: You get hooked up to the fetal monitor, an IV is started with oxytocin to check the baby’s heart rate when contractions have been stimulated.

Biophysical profile: An ultrasound scan that is for the evaluation of the placenta, the movements of the baby, and how often the baby does a “practice breath”. When a baby is having problems, the baby slows-down his/her movements and will stop the “practice breath”. This test is done on a 0-10 scale (“0” being the worst).

Amniotic Fluid Volume measurement: Ultrasound is used to estimate the amount of amniotic fluid in the uterus. The idea is that too little amniotic fluid creates a probability of stress during labor.

Backache

The body undergoes physical changes in pregnancy in your balance, posture, and your mobility. Your center of gravity becomes thrown off due to abdominal protrusion in the front, enlargement of your breasts, and the anterior   (frontwards) rotation of the pelvis. In order to maintain stability, a pregnant woman tends to increase the strain on the back muscles and the vertebral column.

Another cause is the shortening of the hip flexor muscle group caused by the anterior rotation of the pelvis, as well as the increased size of the muscles of the abdomen. This is not helped when a pregnant woman leads a sedentary lifestyle.

Cross-legged Pregnant Woman

REASONS FOR BACKACHES

• Weight of the baby and the contents of the uterus
• Constipation
• Poor posture
• Standing for long lengths of time
• Urinary tract infections
• Over-working
• SCIATICA is a severe form of backache caused by the sciatic nerve being “pinched” or pressure placed on the nerve.
• The pain radiates to the legs
• Occurs due to growing baby and the womb that causes pressure on the nerve.
• The kidneys can also be affected, do the growing uterus causing pressure.

RECOMMENDATIONS

Good posture can assist sciatic nerve issues. When you improve the posture, not only will the backache be relieved but eating and breathing will improve. You find digestion is much easier as well.

Begin by keeping your head up, looking down throws your posture off. Keep your chin level. If you hold your head correctly your shoulders and back will automatically fall into place. Drop your shoulders to a position that is more natural, and avoid allowing the shoulder blades to be thrown back as it will cause a strain on your back.

Tuck your tailbone under to bring it into alignment. Pull inward the abdominal muscles and tucking the buttocks muscles…tilt your pelvis forward. This will act as a counter-balance to the tendency of arching the back.

• Wear flat comfortable shoes. Keep your knees relaxed, not locked
• Sit up straight in chairs and when you drive

Do stretching exercises, and / or exercise by walking briskly for 30 minutes a day, leg lifts and lunges, swimming, or Yoga. Avoid too many weight-bearing exercises . Doing exercise relieves muscle tension. It also Relieves emotional tension. Another thing you can do is to rock your hips, or make love passionately (no joke), the latter relieves pelvic congestion.

Relieve constipation:

• Constipation is directly connected to lower back pain and pelvic discomfort
• To keep from having constipation, drink more water and eat whole grains.
• Increase Calcium and magnesium (see: minerals hand-out).

Elevate your legs, preferably for 20 minutes a day (up on a chair or lying down with two pillows under them)

DIETARY RECOMMENDATIONS

Keep cold or raw foods to a minimum (these increase kidney strain). Eat grapes, pears, and apples as these are the least “watery” of the fruits and are less strain on the kidneys.

Minimalize fruit juices, and caffeine. (coffee, black tea, chocolate, cocoa, and soda). They act like adrenaline in the system due the chemicals they contain. Adrenaline aggravates the kidneys.

HERBAL RECOMMENDATIONS

If you are tired, feel overworked, or stressed you may be experiencing adrenal gland deficiency. The best herb to nourish the adrenals is nettle leaf, in a strong infusion (steeping for at least ½ hour). Nettle Leaf is one of the herbs found in your “Pregnancy Tea”.

Take St. John’s Wort and skullcap in a tincture form. About 20 to 30 drops in water or juice a couple of times a day. You can also apply the combination of Arnica and St. John’s Wort oils externally to relieve tension and promote the healing of the muscles of the back. It’s also helpful to use a warm water bottle on the area that has been treated with Arnica and / or St. John’s Wort.

Recipes – Part 3

LUNCH

Carrot and Lentil Soup

carrot n lentil soup

 

 

 

 

 

 

 

 

Ingredients:

2 tsp cumin seeds or 1 tsp cumin (ground)
pinch of chili flakes
1 cup vegetable broth
1 cup split red lentils (rinsed and drained)
carrots, 6-8 large or package of baby carrots / chopped
yogurt  /or cilantro (fresh)Naan or Pita bread

Instructions:

Heat a large saucepan and dry-fry the cumin seeds and chilli flakes for 1 min, or until they start to jump around the pan and release their aromas. Scoop out about half of the seeds with a spoon and set aside. Add the oil, carrot, lentils, stock and milk to the pan and bring to the boil. Simmer for 15 mins until the lentils have swollen and softened.

Whizz the soup with a stick blender or in a food processor until smooth (or leave it chunky if you prefer). Season to taste and finish with a dollop of yogurt/ or chopped cilantro, and a sprinkling of the reserved toasted spices. Serve with warmed naan / or pita breads.


Crepes

Use Krusteaz Buckwheat pancake mix to make the batter for crepes, but a bit thinner.

FILLING

2 lb young spinach leaves
2 tbs. water
1 bunch spring onions/ chop both white and green parts
2 tsp oil
1 egg beaten
1 egg yolk
1 cup cottage cheese
½ tsp nutmeg
¼ cup grated sharp cheddar cheese (or regular)
¼ cup walnut pieces
salt and pepper.

Instructions:

Make the batter for pancakes

Then:

wash and pack spinach into a pan with water, 5-6 minutes until soft
Drain well and let cool.
Gently fry the spring onions I oil until just soft, drain and set aside
Brush a small fry pan with oil, pour enough batter to fill the base, let cook 1-2 minutes (until set),
flip ver and cook one minute, until golden on underside. Turn onto a warmed plate. Repeat to make 8-10 crepes layering with baking parchment.
Chop and dry spinach and then mix with spring onions, beaten egg, egg yolk, cottafe cheese, nutmeg, and season with salt and pepper to taste.

Line cookie sheet with baking parchment
Layer crepes and spinach mixture / ending with a crepe. Sprinkle with cheddar cheese and bake in PREHEATED oven, 375 degrees F. for 20-25 minutes until firm and golden.
Sprinkle with walnuts and serve immediately.

Nutritional Information: 467 cal., 29g protein, 10g sugars, 31g carb, 26g Fat


SUPPER

Italian Soup

Ingredients:

Kale (1/2 to one bunch / depending on how much vegetables you would like)
Potatoes (6-8)
Italian Sausage (a pound of)
1 chopped RED Onion
2 cloves garlic
1 cup coconut milk
1 TSP Thyme / 1 TSP Basil

Instructions:

Chop sausage, onion, and garlic then fry on low temperature with a teeny bit of Olive oil in a large pot. While it is cooking, chop potatoes. When sausage is golden browned, add 6-8 cups of water to the pot. Let it come to a boil, then turn down to allow it to simmer. After 10 minutes, add chopped potatoes. Now rinse and chop kale (strip green parts from center white “vein”). After 5 minutes of potatoes cooking, add the milk, one tsp. thyme and kale to the soup. If you want the juice thicker, add some corn starch*.

You can make sourdough bread as a side, or biscuits

Serves 4-6 people

*Next topic coming up: Morning Sickness