This release should give midwives all the more reason to submit their statistics--so we can continue to prove the safety of homebirth...
And I encourage everyone to watch the Business of Being Born, which addresses many of these issues and will be available via netflicks later this month.
And remember, there are more than 40 countries where it is safer to be born than in the USA and that is not because babies are being born at home--but because of hospital interventions. We have one of the highest infant and maternal mortality rates of industrialized countries, yet we spend more on equipment and procedures. Come on people, do your homework!
NEWS RELEASE
For Release: February 6, 2008
Contact: ACOG Office of Communications
(202) 484-3321
communications@acog.org
ACOG Statement on Home Births
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.
ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).
Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.
Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.
ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
Tuesday, February 12, 2008
Wednesday, December 12, 2007
SENEGAL CONT...
Senegal part 2
Delivering babies in Senegal is very different from birthing at home, and from being in an American hospital, even the crappy ones like Kaiser Sunnyside (I thought it seemed dirty. I had no idea). There were three different clinics that we worked at. One was far from Mboro, and I actually didn't catch any babies there. The delivery room was smaller than most master bath rooms. It had one of the "typical" delivery tables---they are short and sturdy, mainly metal, nothing moves or stretches, or is remotely comfortable about them, I imagine not even to a cadaver. For the most part women give birth on their backs, like we did in the 1950's (and honestly more recently than that) only they don't put their legs up in stirrups. At the main clinic, there were two delivery tables and one, slightly more comfortable table (I did sleep on it one night) that the women labor on when they are 8-9 cm and close to pushing. The room at the main clinic was not much bigger than my bedroom. And it was much, much filthier. The walls have all been painted with a cheap, blue-grey colored paint that is actually more of a brown because of the dirt. I doubt that the walls have ever been scrubbed or washed. Aimee and I spent one evening disinfecting the delivery room as best we could. I swear it was the first time in at least 10 years that the beds had been moved and the walls behind them cleaned. And the bars on the end of the delivery tables, where women hold on as they push, and the edges of the bed that they lean over to spit or vomit, I doubt they had ever been scrubbed either. There were lots of layers to the grime. It was beyond gross. Honestly it was heartbreaking. I was blown away--I am not sure the matrones or the health administration has a concept of germs. For example, there was a limited supply of gloves so the matrones would just keep washing the ones that they had. And although they had working autoclaves (we tested them out) they "sterilized" the instruments in a chemical solution similar to bleach, but the strength of a cleaning product you might use on your kitchen floor and counters. Not strong enough to kill much of anything. And the instruments that were used, that I had to use, weren't very well scrubbed before soaking in the solution. Basically the scissors for cutting umbilical cords, the catheters for urine, the instruments you might, God forbid, use to cut an episiotomy, or repair a tear, they soaked in these plastic green buckets of diluted bleach and floating particles. Yuk. And there weren't many instrument sets, so if three women came in within an hour or two of each other, those instruments were used again, without soaking in the unsanitary bleachy water for very long. The whole picture still blows my mind. The beds, and the instruments, and the curtain. Yes, the curtain. There is a curtain at one of the clinics, that separates the delivery tables from the labor tables and from the outside world. Its purpose I suppose is to provide some sort of privacy. It hangs very close to the main delivery table, so close that when you are standing on one side of the table to support a pushing mom's leg, or to hold her hand or wipe her brow, you brush up against it. Actually it just hangs against you. The curtain is very, very old. And it is very, very dirty. I am sure it, like the walls and beds, rarely, if ever, gets washed. It is decorated with brown blood stains and holes, and dust. I am sure it has had amniotic fluid splashed against it, not to mention vomit. Birth can be very, very messy. Women shit, pee, bleed, gush. If it can come out, it will come out. And if there is a curtain or a table or a towel (I won't even describe those) to splash against, to stain, believe me, it will happen. And there aren't any washers and dryers or big buckets of bleach or cleaning staff, to tidy it all up.
But back to the birthing mothers. It was a big deal to try and get them to change positions. Women pushing on their backs don't have the help of gravity and in school we are taught that it is hard to push a baby's head under the pubic bone if the woman is flat on her back. I have to say that while it looks very uncomfortable, most of the Senegalese women had no trouble birthing their babes. There is more to birthing on the back than just discomfort and a lack of gravity, it can cause problems like decreased fetal heart rate. And at the clinics where I worked, if a mom pushed for more than an hour, the matrones were eager to cut an episiotomy. Not only are episiotomies something that midwives rarely, if ever do, but there is some form to how and when you do them. There was one birth where I literally had to push the matrone and her scissors away from me and the mom's perineum in order to keep her from cutting the episiotomy I had just refused to perform myself. The baby's head wasn't even crowning (meaning that it was still up near the pubic bone and I couldn't even see anything. Generally, if you do have to do the evil procedure, you do it when the head is trying to push past the last bits of tissue, when she is stretched wider than some of us would care to imagine). I thought that the matrone was going to push me back, or push me out of the delivery room, but she just shrugged and looked at me like I was out of my flippin' mind. Luckily we were able to get that particular mom off her back and onto her hands and knees. Getting a birthing mother to change positions, especially while pushing, is no easy thing, even when you can speak the language. We had the help of the matrones, some of whom thought we were nuts, and a beautifully constructed chart depicting a pregnant woman in hands and knees, on her side, in a squat, and being supported by her husband (the last option isn't an option in Senegal. Men are not allowed near the birth room). Hands and knees is a great position for pushing, and was our ideal, since there were no squat bars, and women who changed to their sides inevitably rolled back onto their backs. Some of the matrones were pleased to see that being in hands and knees brought the baby down faster. The sooner the women give birth, the sooner the matrones can return to their other duties (like helping patients who have come in for malaria treatments, premature labor, headaches, and the number one ailment "meti" which is pain). A couple of women upon realizing they could be in whatever position they wanted, grabbed onto that freedom for life. They labored on the floor (which was not as dirty as the clinic walls, it does get mopped most mornings), on various beds, on their sides, in a squat, in a supported squat, anything but their backs. Those births were great triumphs for us. One of my favorites though, was in the last week. A mom who was birthing her eighth or ninth baby was getting frustrated that the baby wasn't coming faster. I asked her if she would like to change positions. We pulled out the chart, pointed at the hands and knees woman, demonstrated the position ourselves. made grunting-pushing noises, told her in wolof/french that the baby would come faster this way. The mom looked at me like I was her worst nightmare. She basically told me that she'd given birth many times before and all of the babies came while she was on her back, and she wasn't going to change that now. And, the problem was that she had to pee and needed a catheter, and oh, where was her IV? Needless to say, she got her catheter and peed, and a long time later birthed the baby. I am sure she went home to her village and told the other women that she had been subjected to the midwifery ways of a white woman and that had caused her to have the longest push in all of her childbirthing history. And who knows, but she is probably right. While some women were very appreciate of our gentleness, I think other's probably thought they were part of something like a science experiment.
Delivering babies in Senegal is very different from birthing at home, and from being in an American hospital, even the crappy ones like Kaiser Sunnyside (I thought it seemed dirty. I had no idea). There were three different clinics that we worked at. One was far from Mboro, and I actually didn't catch any babies there. The delivery room was smaller than most master bath rooms. It had one of the "typical" delivery tables---they are short and sturdy, mainly metal, nothing moves or stretches, or is remotely comfortable about them, I imagine not even to a cadaver. For the most part women give birth on their backs, like we did in the 1950's (and honestly more recently than that) only they don't put their legs up in stirrups. At the main clinic, there were two delivery tables and one, slightly more comfortable table (I did sleep on it one night) that the women labor on when they are 8-9 cm and close to pushing. The room at the main clinic was not much bigger than my bedroom. And it was much, much filthier. The walls have all been painted with a cheap, blue-grey colored paint that is actually more of a brown because of the dirt. I doubt that the walls have ever been scrubbed or washed. Aimee and I spent one evening disinfecting the delivery room as best we could. I swear it was the first time in at least 10 years that the beds had been moved and the walls behind them cleaned. And the bars on the end of the delivery tables, where women hold on as they push, and the edges of the bed that they lean over to spit or vomit, I doubt they had ever been scrubbed either. There were lots of layers to the grime. It was beyond gross. Honestly it was heartbreaking. I was blown away--I am not sure the matrones or the health administration has a concept of germs. For example, there was a limited supply of gloves so the matrones would just keep washing the ones that they had. And although they had working autoclaves (we tested them out) they "sterilized" the instruments in a chemical solution similar to bleach, but the strength of a cleaning product you might use on your kitchen floor and counters. Not strong enough to kill much of anything. And the instruments that were used, that I had to use, weren't very well scrubbed before soaking in the solution. Basically the scissors for cutting umbilical cords, the catheters for urine, the instruments you might, God forbid, use to cut an episiotomy, or repair a tear, they soaked in these plastic green buckets of diluted bleach and floating particles. Yuk. And there weren't many instrument sets, so if three women came in within an hour or two of each other, those instruments were used again, without soaking in the unsanitary bleachy water for very long. The whole picture still blows my mind. The beds, and the instruments, and the curtain. Yes, the curtain. There is a curtain at one of the clinics, that separates the delivery tables from the labor tables and from the outside world. Its purpose I suppose is to provide some sort of privacy. It hangs very close to the main delivery table, so close that when you are standing on one side of the table to support a pushing mom's leg, or to hold her hand or wipe her brow, you brush up against it. Actually it just hangs against you. The curtain is very, very old. And it is very, very dirty. I am sure it, like the walls and beds, rarely, if ever, gets washed. It is decorated with brown blood stains and holes, and dust. I am sure it has had amniotic fluid splashed against it, not to mention vomit. Birth can be very, very messy. Women shit, pee, bleed, gush. If it can come out, it will come out. And if there is a curtain or a table or a towel (I won't even describe those) to splash against, to stain, believe me, it will happen. And there aren't any washers and dryers or big buckets of bleach or cleaning staff, to tidy it all up.
But back to the birthing mothers. It was a big deal to try and get them to change positions. Women pushing on their backs don't have the help of gravity and in school we are taught that it is hard to push a baby's head under the pubic bone if the woman is flat on her back. I have to say that while it looks very uncomfortable, most of the Senegalese women had no trouble birthing their babes. There is more to birthing on the back than just discomfort and a lack of gravity, it can cause problems like decreased fetal heart rate. And at the clinics where I worked, if a mom pushed for more than an hour, the matrones were eager to cut an episiotomy. Not only are episiotomies something that midwives rarely, if ever do, but there is some form to how and when you do them. There was one birth where I literally had to push the matrone and her scissors away from me and the mom's perineum in order to keep her from cutting the episiotomy I had just refused to perform myself. The baby's head wasn't even crowning (meaning that it was still up near the pubic bone and I couldn't even see anything. Generally, if you do have to do the evil procedure, you do it when the head is trying to push past the last bits of tissue, when she is stretched wider than some of us would care to imagine). I thought that the matrone was going to push me back, or push me out of the delivery room, but she just shrugged and looked at me like I was out of my flippin' mind. Luckily we were able to get that particular mom off her back and onto her hands and knees. Getting a birthing mother to change positions, especially while pushing, is no easy thing, even when you can speak the language. We had the help of the matrones, some of whom thought we were nuts, and a beautifully constructed chart depicting a pregnant woman in hands and knees, on her side, in a squat, and being supported by her husband (the last option isn't an option in Senegal. Men are not allowed near the birth room). Hands and knees is a great position for pushing, and was our ideal, since there were no squat bars, and women who changed to their sides inevitably rolled back onto their backs. Some of the matrones were pleased to see that being in hands and knees brought the baby down faster. The sooner the women give birth, the sooner the matrones can return to their other duties (like helping patients who have come in for malaria treatments, premature labor, headaches, and the number one ailment "meti" which is pain). A couple of women upon realizing they could be in whatever position they wanted, grabbed onto that freedom for life. They labored on the floor (which was not as dirty as the clinic walls, it does get mopped most mornings), on various beds, on their sides, in a squat, in a supported squat, anything but their backs. Those births were great triumphs for us. One of my favorites though, was in the last week. A mom who was birthing her eighth or ninth baby was getting frustrated that the baby wasn't coming faster. I asked her if she would like to change positions. We pulled out the chart, pointed at the hands and knees woman, demonstrated the position ourselves. made grunting-pushing noises, told her in wolof/french that the baby would come faster this way. The mom looked at me like I was her worst nightmare. She basically told me that she'd given birth many times before and all of the babies came while she was on her back, and she wasn't going to change that now. And, the problem was that she had to pee and needed a catheter, and oh, where was her IV? Needless to say, she got her catheter and peed, and a long time later birthed the baby. I am sure she went home to her village and told the other women that she had been subjected to the midwifery ways of a white woman and that had caused her to have the longest push in all of her childbirthing history. And who knows, but she is probably right. While some women were very appreciate of our gentleness, I think other's probably thought they were part of something like a science experiment.
SENEGAL
Being back is really strange. I can't believe how clean it is! I spent part of a day in Manhattan on my leg home and felt like the streets and sidewalks were clean enough to eat from and the air clear and fresh. And then to arrive in Portland where it is less polluted! It's also strange to see cars parked neatly against sidewalks and I have to remind myself that in America we don't greet every person who glances at us, or walks by. In Senegal there is a long list of greetings that are said to even the random people you pass by and to not answer them is very rude. Its something I wish we did here. It feels good to acknowledge the presence of someone who is just a stranger in the market.
The trip was rewarding in many ways, and it is hard to decide on favorite moments. I caught 19 babies, 7 of which came in the last week on a 48 hour shift and 6 of those came in a space of 16 hours. That was a crazy evening. I never did make it to the twin deliveries (there were two, one of which was on my shift, but I had preceptors reluctant to go to the clinic, so we didn't go in) and I missed the one breech birth. I'm a bit disappointed about that, but the rewards of experiencing 19 other deliveries and one transport are far greater. The transport is probably one of the most rewarding experiences of life to date. I A mom came in with a placental abruption, essentially she was bleeding internally, filling her womb and the amniotic sac around the babe with blood. Its one of the scariest situations in midwifery, and handling it in Africa, with minimal supplies and ambulance rides that are not affordable and take hours is beyond that. t's amazing what 20 American dollars can get you. In this case, a ride to the closest hospital and a life saved. Not to negate the care that Aimee (one of the other students) and I were able to provide, but there is only so much you can do without modern technology and doctors who can perform Cesareans. There really aren't words to describe the experience of sitting next to someone as their spirit decides where to travel next. I have sat with babies as they make the transition from the other world to this, and I have it seems, witnessed them struggle with the choice to stay in this world or return to the spirit realm, and I have been there when the choice was made not to be born into a physical body, but there is something profoundly different in witnessing a mother make those choices as well. There was a moment where I thought she had slipped beyond our medical care, beyond our human understanding, and I thought the mother was going to join her baby and the angels, but she seemed to drift back just as the ambulance was arriving, a couple hours after we knew she would need one. Here, she would have been to the hospital and probably would have been in recovery by then. Time in Africa has its own category--no one is in a hurry, ever, even when its a life and death experience. Once Aimee and I got the mother on the ambulance we had to return to the duties of the clinic. We would have to wait to hear if this woman made it alive to hospital. Hurry up and wait as they say. The mother did indeed make it. And she wouldn't have made it if Aimee and I hadn't had the 10,000 CFA's to pay for the ride. It leaves me with an odd sense of power, disbelief, and gratitude. But the truth is that these choices are not in our hands. We can have the best hospitals and doctors at our fingertips and not make it, and we can be in a tiny African village where time moves at a snails pace; where it takes over two hours for the ambulance that is less than a mile away to get up and running; where ambulances stop to pick up hitchhikers during a transport, and there are no EMT's riding in the back, and we can make it. We truly are led by the divine and in the hands of the divine and we really have not other option than to surrender.
The family was so appreciative---the families in general were very appreciative. I had a baby named after me, and a couple of moms that were happy to give me one of their children. Including the mother of the twins who's birth I missed. She would be happy to share one of her babies with the American. The people were easy to communicate with, despite the language barrier. Hand gestures and humor get you far. Bargaining in the market was lots of fun, as was having clothing made. Aimee and I had quite a time trying to communicate about dress style and size with the dressmaker who spoke only Wolof---we couldn't get by on Aimee's french this time around. Needless to say, we have Senegalese outfits that do actually fit and I received my second marriage proposal (this was early on in the trip, there were more proposals and refusals made). It's an honor to be the second wife, its actually the preferred marital spot, so I guess I should feel blessed that no one wanted me as a first wife (those wives are really only good for cleaning and cooking). Another highlight was having prayer ties made and relay race of communication that happened around that. It was a big deal that I was even asking to have prayer bags made, me being a non-muslim and an American. This man, probably in his 50's sat under a big neem tree just about every day making these medicine bags. The women and the men wear them around their arms or waists--they are considered powerfully protective and can bring many blessing. The women don't remove them during birth and the babies are given theirs in the first hours postpartum. The prayers are written on long strips of brown paper and then tightly folded and wrapped in colorful leather. The leather is sewn around the paper so that each pouch is sealed. A few of the pouches contain a piece of bone, often a horn. Of course I wanted a horn too, but that was lost in the translation. I am not sure if that was asking too much or if the man just didn't get the message. In any case it took a lot of work to have this piece made. It took my dramatic hand gestures and limited Wolof phrases (including one that translates to "slowly slowly the monkey comes out of the jungle" meaning "I'm sorry I am a foreigner who didn't bother to take the time to learn your language, but I am trying") Aimee's french, a man who translated some of english and some of our french into wolof, another man who translated some of Aimee's french into wolof, a handful of observes, a few children, our taxi driver, his friend (who offered me the last marriage proposal of the trip, once again as second wife) and of course the artist making the bag to get the job done. It was a priceless experience. And I am sure the man making bag was happy to get good payment for his efforts, and I am sure he was relieved that I had refused his marriage proposal (given a week earlier) as I think he realized American women are more trouble than they are worth and wouldn't be very useful wives. By the way, there is a group of men wandering the streets of Mboro waiting for some American women to arrive. Aimee and I promised them that we would send our single female friends their way.
Anyway, that's all I can process for now. It's a lot to filter through!
The trip was rewarding in many ways, and it is hard to decide on favorite moments. I caught 19 babies, 7 of which came in the last week on a 48 hour shift and 6 of those came in a space of 16 hours. That was a crazy evening. I never did make it to the twin deliveries (there were two, one of which was on my shift, but I had preceptors reluctant to go to the clinic, so we didn't go in) and I missed the one breech birth. I'm a bit disappointed about that, but the rewards of experiencing 19 other deliveries and one transport are far greater. The transport is probably one of the most rewarding experiences of life to date. I A mom came in with a placental abruption, essentially she was bleeding internally, filling her womb and the amniotic sac around the babe with blood. Its one of the scariest situations in midwifery, and handling it in Africa, with minimal supplies and ambulance rides that are not affordable and take hours is beyond that. t's amazing what 20 American dollars can get you. In this case, a ride to the closest hospital and a life saved. Not to negate the care that Aimee (one of the other students) and I were able to provide, but there is only so much you can do without modern technology and doctors who can perform Cesareans. There really aren't words to describe the experience of sitting next to someone as their spirit decides where to travel next. I have sat with babies as they make the transition from the other world to this, and I have it seems, witnessed them struggle with the choice to stay in this world or return to the spirit realm, and I have been there when the choice was made not to be born into a physical body, but there is something profoundly different in witnessing a mother make those choices as well. There was a moment where I thought she had slipped beyond our medical care, beyond our human understanding, and I thought the mother was going to join her baby and the angels, but she seemed to drift back just as the ambulance was arriving, a couple hours after we knew she would need one. Here, she would have been to the hospital and probably would have been in recovery by then. Time in Africa has its own category--no one is in a hurry, ever, even when its a life and death experience. Once Aimee and I got the mother on the ambulance we had to return to the duties of the clinic. We would have to wait to hear if this woman made it alive to hospital. Hurry up and wait as they say. The mother did indeed make it. And she wouldn't have made it if Aimee and I hadn't had the 10,000 CFA's to pay for the ride. It leaves me with an odd sense of power, disbelief, and gratitude. But the truth is that these choices are not in our hands. We can have the best hospitals and doctors at our fingertips and not make it, and we can be in a tiny African village where time moves at a snails pace; where it takes over two hours for the ambulance that is less than a mile away to get up and running; where ambulances stop to pick up hitchhikers during a transport, and there are no EMT's riding in the back, and we can make it. We truly are led by the divine and in the hands of the divine and we really have not other option than to surrender.
The family was so appreciative---the families in general were very appreciative. I had a baby named after me, and a couple of moms that were happy to give me one of their children. Including the mother of the twins who's birth I missed. She would be happy to share one of her babies with the American. The people were easy to communicate with, despite the language barrier. Hand gestures and humor get you far. Bargaining in the market was lots of fun, as was having clothing made. Aimee and I had quite a time trying to communicate about dress style and size with the dressmaker who spoke only Wolof---we couldn't get by on Aimee's french this time around. Needless to say, we have Senegalese outfits that do actually fit and I received my second marriage proposal (this was early on in the trip, there were more proposals and refusals made). It's an honor to be the second wife, its actually the preferred marital spot, so I guess I should feel blessed that no one wanted me as a first wife (those wives are really only good for cleaning and cooking). Another highlight was having prayer ties made and relay race of communication that happened around that. It was a big deal that I was even asking to have prayer bags made, me being a non-muslim and an American. This man, probably in his 50's sat under a big neem tree just about every day making these medicine bags. The women and the men wear them around their arms or waists--they are considered powerfully protective and can bring many blessing. The women don't remove them during birth and the babies are given theirs in the first hours postpartum. The prayers are written on long strips of brown paper and then tightly folded and wrapped in colorful leather. The leather is sewn around the paper so that each pouch is sealed. A few of the pouches contain a piece of bone, often a horn. Of course I wanted a horn too, but that was lost in the translation. I am not sure if that was asking too much or if the man just didn't get the message. In any case it took a lot of work to have this piece made. It took my dramatic hand gestures and limited Wolof phrases (including one that translates to "slowly slowly the monkey comes out of the jungle" meaning "I'm sorry I am a foreigner who didn't bother to take the time to learn your language, but I am trying") Aimee's french, a man who translated some of english and some of our french into wolof, another man who translated some of Aimee's french into wolof, a handful of observes, a few children, our taxi driver, his friend (who offered me the last marriage proposal of the trip, once again as second wife) and of course the artist making the bag to get the job done. It was a priceless experience. And I am sure the man making bag was happy to get good payment for his efforts, and I am sure he was relieved that I had refused his marriage proposal (given a week earlier) as I think he realized American women are more trouble than they are worth and wouldn't be very useful wives. By the way, there is a group of men wandering the streets of Mboro waiting for some American women to arrive. Aimee and I promised them that we would send our single female friends their way.
Anyway, that's all I can process for now. It's a lot to filter through!
Monday, October 15, 2007
African Birth Collective
I am in my final days of packing for a journey to Senegal. I am getting prepared to spend three weeks working in three birth centers where I will deliver an average of 30 babies. Not the kind of midwifery I am accustom to! A woman, Kaya Skye, started a program in Senegal a while back, where midwives and midwives in training can go and teach and learn.
Here is some information about the program and how you can help!
It is our experience that there is a real crisis of education among the matrons in Sénégal, who deliver the vast majority of babies. They spend six months in practical training in a local clinic and are then often posted to more rural outposts. During this time they follow and learn from the other matrons and sage-femmes, but they have no academic component to their education. The result is generally an unclear understanding of the anatomy and physiology involved in birth. They are taught “protocol”, which is based on outdated Western medical practices such as extreme fundal pressure, supine delivery positions with stirrups, standard pitocin drips, placental extractions and routine postpartum methergine shots. They are not taught problem solving techniques that facilitate good management decisions or allowed to incorporate traditional methods or alternative positions. There is currently no system of peer review in place, and they do not use charts to document the woman’s labor progress or communicate with other matrons. The sage-femme who heads the clinic is responsible for all the women who come in and is on call 24 hours a day for complications. She has very little time to train the new matrons in special skills or theory. The cumulative effect is that Senegal has one of the highest infant mortality rates in the world: 79 deaths per 1000 live births (World Bank 2002).
African Birth Collective has been able to counter the Western obstetric model that has been handed down through post-colonial education with an alternative view. We support women to walk around during labor, deliver in non-supine positions, and support the perineum to allow for slow restitution of the head and prevent tears. We have also been able to learn effective techniques commonly practiced in Sénégal, such as the “milking” of the cord and inverted resuscitation methods.
Together we are able to understand a wider perspective with which midwifery knowledge can be seen as something always growing and changing, drawing on traditions as well as new experiences. In this light, “protocol” must always be reevaluated to determine if it is both useful and appropriate.
To address the need for a larger transformation of the matrones’ education, African Birth Collective is seeking funding for ENDA Santé to translate “A Book for Midwives” (Hesperian Foundation) into French to use as a teaching tool and reference. We are seeking to develop a closer relationship with the Association des Sages-Femmes Senegalaises, to work together to provide resources and opportunities for rural matrons to expand their knowledge, understanding and respect for birth. We sincerely encourage the appropriate use of both traditional and modern knowledge within this model.
We welcome all midwives, midwifery students and those interested in supporting safe birth in Africa! Your support and love makes all of this possible. Please contact us to find out how you can help. Donations of baby blankets, hats, socks and newborn “onesies” [I think onsies might be a trade name so I would use the quotation marks, at least] are put together in ziplocs for new mothers. Any amount of financial donations will be put toward the purchase of needed supplies or go into our ambulance fund. Local birth centers and hospitals often have expired meds and other supplies that might get thrown away. These will be gladly taken to Sénégal and shared with rural clinics that often have no latex gloves or suture, lidocaine or basic instruments. African Birth Collective has 501(c)(3) status and tax deductions can be taken for all donations. Thank you!
African Birth Collective (a Not for Profit Corp.)
Kaya Skye
595 Weller Ln.
Ashland, OR 97520
541.488.6424
kaya.skye@africanbirthcollective.org
Here is some information about the program and how you can help!
It is our experience that there is a real crisis of education among the matrons in Sénégal, who deliver the vast majority of babies. They spend six months in practical training in a local clinic and are then often posted to more rural outposts. During this time they follow and learn from the other matrons and sage-femmes, but they have no academic component to their education. The result is generally an unclear understanding of the anatomy and physiology involved in birth. They are taught “protocol”, which is based on outdated Western medical practices such as extreme fundal pressure, supine delivery positions with stirrups, standard pitocin drips, placental extractions and routine postpartum methergine shots. They are not taught problem solving techniques that facilitate good management decisions or allowed to incorporate traditional methods or alternative positions. There is currently no system of peer review in place, and they do not use charts to document the woman’s labor progress or communicate with other matrons. The sage-femme who heads the clinic is responsible for all the women who come in and is on call 24 hours a day for complications. She has very little time to train the new matrons in special skills or theory. The cumulative effect is that Senegal has one of the highest infant mortality rates in the world: 79 deaths per 1000 live births (World Bank 2002).
African Birth Collective has been able to counter the Western obstetric model that has been handed down through post-colonial education with an alternative view. We support women to walk around during labor, deliver in non-supine positions, and support the perineum to allow for slow restitution of the head and prevent tears. We have also been able to learn effective techniques commonly practiced in Sénégal, such as the “milking” of the cord and inverted resuscitation methods.
Together we are able to understand a wider perspective with which midwifery knowledge can be seen as something always growing and changing, drawing on traditions as well as new experiences. In this light, “protocol” must always be reevaluated to determine if it is both useful and appropriate.
To address the need for a larger transformation of the matrones’ education, African Birth Collective is seeking funding for ENDA Santé to translate “A Book for Midwives” (Hesperian Foundation) into French to use as a teaching tool and reference. We are seeking to develop a closer relationship with the Association des Sages-Femmes Senegalaises, to work together to provide resources and opportunities for rural matrons to expand their knowledge, understanding and respect for birth. We sincerely encourage the appropriate use of both traditional and modern knowledge within this model.
We welcome all midwives, midwifery students and those interested in supporting safe birth in Africa! Your support and love makes all of this possible. Please contact us to find out how you can help. Donations of baby blankets, hats, socks and newborn “onesies” [I think onsies might be a trade name so I would use the quotation marks, at least] are put together in ziplocs for new mothers. Any amount of financial donations will be put toward the purchase of needed supplies or go into our ambulance fund. Local birth centers and hospitals often have expired meds and other supplies that might get thrown away. These will be gladly taken to Sénégal and shared with rural clinics that often have no latex gloves or suture, lidocaine or basic instruments. African Birth Collective has 501(c)(3) status and tax deductions can be taken for all donations. Thank you!
African Birth Collective (a Not for Profit Corp.)
Kaya Skye
595 Weller Ln.
Ashland, OR 97520
541.488.6424
kaya.skye@africanbirthcollective.org
Wednesday, October 10, 2007
Sterile Water Papules for Back Labor Relief
I have seen this method of pain relief work at births where the baby was in a posterior position. It can be safe and effective alternative for women wanting to avoid an epidural. It has been reported that the pain relief lasts for 2-3 hours and it can be repeated. The sterile water is injected just unde the skin surface, near the spine, in four places.
History
In 1965, Melzack and Wall introduced what is now known as the "Gate Control Theory" which suggests that nerve cells from touch fibers can actually close the gate on pain signals to the brain, thus giving the perception of minimized pain. Therefore, for a woman in labor, the brain has the ability to influence the course of her labor and her perception of pain.
In 1975, Melzack and Fox determined that the perception of pain could be altered by introducing a brief period of pain. This, in turn, would alleviate the chronic back pain. An example of this theory is the use of a TENS (transcutaneous electrical nerve stimulation) unit. The TENS unit sends pulses which interrupts the brain's awareness of pain and may also cause a release of endorphins which is the body's natural pain coping mechanism.
Then in 1989, Lytzen, Cederberg, and Moller-Nielsen presented their study on "Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules" in a medical journal. This study included 83 women with lower back pain during the first stage of labor. These women were given injections of sterile water intracutaneously over the sacrum. All but six of the women noticed instant and complete pain relief which lasted up to three hours. The procedure could then be repeated. Sixty-seven of the eighty-three were pleased with the results.
Trolle, Moller, Kronborg and Thomsen introduced their study of "The effect of sterile water blocks on low back labor pain" in the American Journal of Obstetrics and Gynecology in 1991. This study contained 272 women complaining of severe low back pain. The women were randomly assigned to receive either a sterile water injection or a saline solution block. There was a significantly higher degree of analgesic relief for those in the sterile water group (89.4%) than those in the saline group (45%). No adverse effects were noted and the patient satisfaction was high.
The Procedure
The woman's back is cleansed. Then 0.1-0.15cc of sterile water is injected intradermally into four places on the women's sacrum. Preferably, the procedure should be done with two people doing the injections simultaneously. The injections cause an intense burning sensation which lasts 30-90 seconds. Relief from the procedure should be noticed in 2-3 minutes. Because of the intensity of the pain, the woman should have constant support and encouragement during the time of the injections.
Conclusion
Sterile water injections is an excellent alternative for pain relief due to back labor. Even though it may not provide relief from contraction pain, often once the back pain is alleviated, the laboring women can cope better with her labor. Likewise, often the relaxation of the back can assist in the proper decent and positioning of the baby, leading to a shorter labor. With no known side effects and no medications entering the body, sterile water injections may become the choice for the relief of back labor for many laboring women.
History
In 1965, Melzack and Wall introduced what is now known as the "Gate Control Theory" which suggests that nerve cells from touch fibers can actually close the gate on pain signals to the brain, thus giving the perception of minimized pain. Therefore, for a woman in labor, the brain has the ability to influence the course of her labor and her perception of pain.
In 1975, Melzack and Fox determined that the perception of pain could be altered by introducing a brief period of pain. This, in turn, would alleviate the chronic back pain. An example of this theory is the use of a TENS (transcutaneous electrical nerve stimulation) unit. The TENS unit sends pulses which interrupts the brain's awareness of pain and may also cause a release of endorphins which is the body's natural pain coping mechanism.
Then in 1989, Lytzen, Cederberg, and Moller-Nielsen presented their study on "Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules" in a medical journal. This study included 83 women with lower back pain during the first stage of labor. These women were given injections of sterile water intracutaneously over the sacrum. All but six of the women noticed instant and complete pain relief which lasted up to three hours. The procedure could then be repeated. Sixty-seven of the eighty-three were pleased with the results.
Trolle, Moller, Kronborg and Thomsen introduced their study of "The effect of sterile water blocks on low back labor pain" in the American Journal of Obstetrics and Gynecology in 1991. This study contained 272 women complaining of severe low back pain. The women were randomly assigned to receive either a sterile water injection or a saline solution block. There was a significantly higher degree of analgesic relief for those in the sterile water group (89.4%) than those in the saline group (45%). No adverse effects were noted and the patient satisfaction was high.
The Procedure
The woman's back is cleansed. Then 0.1-0.15cc of sterile water is injected intradermally into four places on the women's sacrum. Preferably, the procedure should be done with two people doing the injections simultaneously. The injections cause an intense burning sensation which lasts 30-90 seconds. Relief from the procedure should be noticed in 2-3 minutes. Because of the intensity of the pain, the woman should have constant support and encouragement during the time of the injections.
Conclusion
Sterile water injections is an excellent alternative for pain relief due to back labor. Even though it may not provide relief from contraction pain, often once the back pain is alleviated, the laboring women can cope better with her labor. Likewise, often the relaxation of the back can assist in the proper decent and positioning of the baby, leading to a shorter labor. With no known side effects and no medications entering the body, sterile water injections may become the choice for the relief of back labor for many laboring women.
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