Advantages of nitrous oxide

Pain relief doesn't necessarily mean taking drugs. Fear - of not knowing what's happening or what to expect - can make pain feel worse than it actually is. Learning to relax can make a big difference, as can feeling in control. Midwives should support women in their choice of using entenox and answer their questions.

Nitrous oxide/entenox are the most common form of pain relief used routinely in both hospital birthing suites and for homebirth. It is basically 50% Nitrous Oxide (laughing gas) and 50% air (oxygen, nitrogen, carbon dioxide etc).

The benefits of gas and air are that although it does cross the placental barrier to the baby the effects are very short lived and therefore there are not known to be any serious side effects with its use for the baby.  The patient holds the mask to her face and breathes the gases into the lungs where it very quickly enters the blood stream. Nitrous Oxide reaches the brain within 15 seconds. 

Nitrous oxide doesn’t stop the pain entirely, but takes the ‘edge’ off the intensity of each contraction. If the mother is relax, she will progress. If she is tense, she will not progress. Entenox helps to relax the muscles, and once the muscles are relaxed, the cervix will open.

What are the disadvantages of gas and air? 

·         It is only a mild painkiller.

·         It may make a person feel light-headed or sick, but it means it works well.

·         It dries out the mouth if you use it for long periods, so water will help.

·         Some hospitals have mobile entenox machines which means a person can mobilize easily and getting into a comfortable position.

It may take a while to get the timing right so that it's effective at the peak of your contractions.

Gas and air is perfectly safe for a labouring woman to use during labour. Although Nitrous Oxide can make the patient drowsy and does pass through the placenta, it is eliminated very quickly by both mother and baby. Research has not found any negative effects to the baby when Nitrous Oxide is used.

History of Entenox/Nitrous Oxide

Childbirth is not easy. Many women suffer during childbirth. Childbirth is meant to be hard, long, and painful – but women are strong  and our bodies are made to handle a lot during this difficult time. Thousands of women have been giving birth in spite of the labour pain. Unfortunately many women do not cope well with labour pain. For some, the pain can be overwhelming.

Several studies had been done on childbirth. Hundreds of women in different countries were interviewed, and all participants said birth contractions were bittersweet, with paradoxial, feelings of love and the challenges of pain culminating in the birth of a child. The description of the pain included burning stinging, cramping, stabbing, hot, heavy, throbbing, tiring, exhausting and intense. The participants of the study also said that giving birth was seen as a difficult, yet empowering experience.

It is for this reason that scientist having been looking for ways to relieve the pain associated with childbirth. The history of childbirth fascinates me and I found it hard to focus on just one detail. I set out to explore the reason behind the development of anesthesia. I came across the birth of Queen Victoria and the birth of her last two babies. I was curious to how and when she changed the mind of the clergy for good.

 

Anaesthetics came into use in the mid-1800 as new chemical compounds were discovered and became available for experiments. Many of the commonly used anaesthetics are simple chemical compounds, and cover a surprising range of substances. The literature shows that the first anaesthetics were discovered when experimenters tried inhaling gases, or the vapours of volatile liquids. It all started with the brilliant mind of Sir James Young Simpson, who was a Scottish obstetrician in the 1800. Simpson had begun using ether to relieve the pain of childbirth, but he was dissatisfied with some of ether's drawbacks, such as its disagreeable smell, the large quantities required, and the lung irritation it caused. Ether was also explosive so and many did not like to use.

It was during this time when a Liverpool chemist, David Waldie, suggested that Simpson try chloroform. On the evening of November 4, 1847, Simpson and two doctor friends inhaled some chloroform and, after feeling very happy and talkative, promptly passed out. They were so impressed with chloroform's potency and rapid effects, that Dr Simpson immediately began using it in his obstetrical practice. Because of this experience the first baby born to a mother who received chloroform for pain was named Anaesthesia.

Unfortunately, the church objected to the use of chloroform, insisting the pain of childbirth was ordained by God, referring to the Bible where God punish Eve somewhere in Genesis. "To the woman He said, "I will greatly increase your pains in childbearing; with pain you will give birth to children." The argument continued until 1853, when Queen Victoria chose to be chloroformed for the birth of her 8^th son Prince Leopold. Dr. John Snow (1813-1858), who administered the chloroform to the queen, became the foremost authority on anesthesia and is recognized today as the world's first professional anesthetist, a pioneer of a new medical specialty.

The queen enjoyed the birth of her son and used it again for her last pregnancy. This event quieted the clergy and made chloroform the most fashionable anesthetic—especially in England —for the next 50 years. Jason Priestly, an English chemist produced nitrous oxide in 1776. He could not use this because of the church but after Queen Victoria used chloroform successfully, it was time to investigate the matter further. However the first medical use seems to have been in the U.S. in 1844, for a tooth extraction.  Nitrous oxide was further investigated by Humphrey Davy in 1800 at the Pneumatic Medical Institution in Bristol.  Humphrey Davy discovered the gas's anesthetic properties when inhaled. Davy’s student, Michael Faraday, showed in1818 that inhalation of ether had the same effect.

In his book on nitrous oxide, Davy recorded that breathing the gas helped to relieve toothache - from which he was suffering at the time - and suggested: "it may probably be used with advantage in surgical operations." But the pain-relieving properties of nitrous oxide were not explored any further until nearly fifty years later. Initially, society was more interested in nitrous oxide as a source of amusement and entertainment. What a waste of valuable time!

So the literature informed us that nitrous oxide was used alone, without any supplementary air or oxygen. In the latter part of the century, it was found that the gas mixture should comprise at least 21% oxygen by volume in order to avoid risks and side effects.  In 1881 nitrous oxide was introduced for pain relief in childbirth. Then in 1911, the American anaesthetist, Arthur Ernest Guedel, described an analgesic technique where patients themselves were allowed to control the administration of a mixture of nitrous oxide and air during childbirth and minor surgery.  In 1933, Dr R J Minnitt invented the gas and air machine which allow labouring women to breathe in a mixture of the nitrous oxide with room air, therefore, achieving a level of pain relieve, but not anaesthetising her to a point of losing consciousness.

In 1961, Michael Tunstall et al described for the first time the medical use of a pre mixed gas consisting of 50% nitrous oxide and 50% oxygen as an analgesic during childbirth. It was found that it was possible to store a homogeneous gas mixture containing up to about 75% nitrous oxide at a pressure of 132 bars, at ambient temperature. This led to the premixed gas patent – and to the entenox product introduced by BOC Medical. The machines used in hospitals today allover the world mix nitrous oxide gas with pure oxygen instead of room air.

Watts. G. (2011). Michael Tunstall. BMJ. Vol. 343:d4977

Callister, L. C., Khalaf, I., Semenic, S., Kartchner, R.,  Vehvilainen-Julkunen, K. (2003). Medscape

 http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/PDF/History/Entonoxdevelopment.pdf

 

Childbirth without interventions

To give birth to a baby is a miracle. Most women dream about this wonderful moment. Giving birth is a natural part of life. Yet, birth is also political and a business. It is a business controlled by powerful people telling women where and how to give birth. Most women give birth in hospitals, with beautiful maternity unit layouts. But these very same beautiful units are built to create interventions. Most pregnant women have no idea what birth is all about and the problems in the hospital system.

Most perinatal nurses or hospital midwives can’t cope with the stresses of an under-resourced and over-medicalised system. I have seen lives placed at risks. Hospitals are short-staffed and underresourced. So it is evident that staff shortages are linked to an increase of medical interventions, the rise in caesarean sections, and, in the worst scenarios, cases where babies had had some degree of oxygen deprivation. Poor birth experience can be linked to women suffering profound birth trauma, and these cases are on the increase. Most perinatal nurses never learn about birthing support but rather about following protocols, guidelines. They know more about documentation and technology instead of supporting the woman during birth.

Medical interventions were meant to assist the process of birth, making it a bit easier for a labouring woman. Unfortunately this has not always been the case. Medical interventions are there to help save the life of a mother and her baby when necessary, here they are seen as a help, but they can be a problem. If an intervention cause an unnecessary cesarean, they’re without a doubt a hindrance.

The majority of the pregnant women I have known and cared for have expressed a desire to give birth naturally. However, what many of us have found to be lacking in today’s society is enough support, education and encouragement to help women achieve the natural birth they hope for. Not only that, labour pain has recently become something that has been seen by some as ‘unnecessary’ or ‘bad’ pain – when it is, in fact, a very useful pain. There is also an epidemic of fear in labour which prevents some women to achieve this.

Today, childbirth has become more of a medical procedure than a natural function of our bodies. Many women who do have a desire for a natural birth are often looking for resources and information on how to achieve that experience. I like the mother advocacy website. The website provides great information to new mothers to help focus on themselves and their need during childbirth. 

Some of the common medical interventions during birth?

• An IV for Fluids
• Epidural Anesthesia
• Electronic Fetal Monitoring
• Pitocin
• Breaking the bag of water
• Episiotomy

Most of which are unnecessary in many of the cases we see them in today, an IV for example. The purpose of an IV could be cut by simply allowing a woman to eat and drink during labor. You'll have more energy during labor if you're not restricted from food or drink. It makes no sense to require you to do extensive and exhausting work with no food or drink. Several studies have shown that there is no need to starve a woman while she is in labour. Offcourse, there are women who need interention but not for the pleasure of a hospital. Many hospitals around the world do not have a problem but I found that the anaesthesiology department’s guideline of not allowing women to eat/drink are more important than those providers in the maternity units.

Most hospitals routinely use IV line birth interventions. Usually they do this because they forbid food (and sometimes drink) during labor. This has negative consequences above and beyond the IV. Having the IV inserted is painful for many women. The cold fluids can cause pain and irritation. The IV pole limits movement. Excess fluids can cause the labouring woman to have to go the bathroom constantly. 

IV lines do not solve this problem. A supportive person, relative, doula or good midwife with a labouring woman will bring comfort and stay with the woman, all the time, not leaving the woman alone during birth. If a woman receive this kind of  support they are more likely to give birth more quickly and easily. They will also use less pain relief than someone without continuous support. I never leave my own labouring woman alone. I stay with them until the baby is born. If they are born in the hospital, I will not let any other person touch them. If they are born at home with me, even better, but my presence as a midiwfe means everything to a woman during childbirth.  The emotional wellbeing of a pregnant woman is of outmost importance. 

“The main concern of those around pregnant women or for people who care for a pregnant woman should be to ensure their emotional wellbeing.” ~ Michel Odent

 http://www.youtube.com/watch?v=ZVvRklrnB1Q&feature=player_embedded#!

Pain in Childbirth

Giving birth is a painful process. For many women childbirth is a frightening experience and it is only natural for a birthing mother to voice her concerns.  Fear is an important factor of childbirth. Even in the scriptures childbirth is portrayed as involving hard labour and pressure. Childbirth is a unique pain at a deeply emotional time for women. The pain in labour is the result of many complex interactions, physiological and psychological, excitatory as well as inhibitory.

We ask the question why there is pain during childbirth. Pain is the psychological, emotional and learnt response to signals induced by noxious stimuli sent from around the body via the spinal cord, to the brain. How we react to them and perceive them is what we feel as pain. But pain in labour is a normal physiological reaction. It is normal to have pain in childbirth and there for a reason for it. In an uneventful pregnancy, labour, pain can be used in a positive manner. But women react against the pain by becoming tense and fighting it. Labour pain is positive pain that will have a positive end-the baby. Labour pain is not like cancer pain that never goes away. Nobody has been in labour forever, so the pain will go away. The pain of each contraction will not be experienced again when it passes.

We know that labour pain is difficult to explain. Labour pain is the result of many complex interactions, physiological and psychological, excitatory as well as inhibitory. Pain during the first stage of labour is due to distention of the lower uterine segment, mechanical dilatation of the cervix and lastly due to stretching of excitatory nociceptive afferents resulting from the contraction of the uterine muscles. The severity of pain parallels with the duration and intensity of contraction. In the second stage additional factors such as traction and pessure on the parietal peritoneum, uterine ligaments, urethra, bladder, rectum, lumbosacral plexus, fascia and muscles of the pelvic floor increase the intensity of pain.

The McGill Questionnaire describes it best. The McGill Pain Questionnaire consists of groupings of words that describe pain. The person rating their pain ranks the words in each grouping. The sensory words most commonly used by mothers to describe the pain during labour are sharp, cramping, aching, throbbing, stabbing, hot, shooting, tight, and heavy. For the emotional affective feelings, the most common words were tiring and exhausting.  

Also each woman has different reactions towards labour pains. Pain relief can come in many forms. Most importantly, a support person who believes in the laboring woman can make a difference. Several studies have shown that good labour support reduce the fear and anxiety during childbirth.

Each woman has different reactions to pain, so pain relief should be individualised and not a routine offer from a list. Most pain relief does not take pain away as completely as the name suggests. It makes pain easier to accept and can help a woman relax and concentrate on the birth if it is used positively. Pain relief can come in many forms. Good nutrition, comfortable position, mobility, and feeling supported-all can be pain relievers.  

Squatting

Squatting position is a basic and natural human posture. People in ancient times didn't have chair-like toilets; they assumed the natural crouching position (squatting) that two-thirds of humanity still uses today. What many may not be aware is that in the sitting position, there is a natural kink between the rectum and anus. One has to strain and bear downwards in an attempt to force a turd around the bend. The ability to squat is important because it is intended that human beings evacuate waste in the squatting position. The Western habit of sitting is actually a recent development which began about 150 years ago, during the Industrial Revolution, when sitting-type toilets were introduced to the masses.

Steven Arnott, in his book “Wash Your Hands!” points out that squatting is a healthier option because it aligns the rectum and anus in a near vertical position. Sitting tends to create a kink between the rectum and anus, often necessitating much straining to force a turd around the bend.  Squatting also spreads the buttocks to reveal the anus, whereas sitting can do the opposite.

 Another is an Iraeli physician, Dr. Berko Sikirov, who discovered that hemorrhoids, found in approximately 50 percent of people over forty in western societies, is caused by the continual aggravation of straining that is needed to force out a turd while in the sitting position. The sit-down toilet was an effect of the increasing class and racial stratification of the Victorian Era in England (1837-1901).  The flushing sit-down toilet was invented in 1596 by Sir John Harrington, a godson of Queen Elizabeth I (Wolf) who knew nothing about human physiology.

Squatting during childbirth is common in Africa. The practice of squatting to give birth has its roots in ancient history. As far back as we have records or stories about birthing; we see references to women giving birth in an upright or squatting position. There have been ancient art created to depict women squatting during birth.  Artfully crafted birthing stools and chairs have been built to assist mothers.  Where are they now? Unfortunately since the medicalization of birth, women are pushing on their backs with their legs in the air. Physiologically, this is a very poor position in which to facilitate maternal pushing efforts as it opposes gravity. It is also not ideal for the baby, as the large uterus rests against the major vessels leading to the uterus and can impede blood flow during labor when the vessels may already be somewhat compromised due to strong contractions. Low fetal heart tones often recover when the mother assumes an upright position.

Some women in western countries often find the squatting position very uncomfortable, so they do not usually wish to assume this position for a long time. These western women do not squat to conduct business, or converse with friends, as they do in many African cultures. And because this position many women’s leg muscles and tendons do not support this position for long.

In central Africa, a tree is placed between two other trees or stakes hammered into the ground. The woman then grasps the branch of the tree, and bends her knees into a squatting position as she pushes. It is customary for delivery to occur with the woman squatting on the ground surrounded by sisters and female relatives, some of whom function as midwives. Other parts in Africa a women would kneel, leaned forward and grasp a pole or tree. Here are some real definitions on positions:

Squatting
Squatting is the position the body is designed to use to eliminate and give birth in. It opens the outlet of the pelvis to allows for an easier passage of the baby. It also helps to prevent perineal tears. Some women find that using an upright squatting position helps them focus their efforts to push with the right muscles. Other women feel that being upright makes them more in control of their pushing. Some mothers find that a squatting position is uncomfortable because their bodies are not familiar with it. In that case, tools or props can be used to help the mother maintain a squatting position, such as a squat bar on a hospital bed, a birth stool or a handle or counter that the mother can hold onto for support while she squats.

Hands and Knees
For mothers who are experiencing back pain during labor, a hands and knees position can help to relieve some of the back pressure. It also uses gravity to help encourage the baby to turn to an easier position. Some care givers are uncomfortable with the hands and knees position because the "upside down" view is unfamiliar to them, and that makes it difficult for them to assess progress.

Toilet Sitting
Some mothers find it difficult to isolate the muscles necessary to push effectively. Other mothers are embarrassed by the sensations of pushing, concerned that body fluids may be excreted. In these case, sitting on the toilet to push may allow the mother to feel more free with her pushing efforts. By imitating the pushing she does for a bowel movement, a mother can improve her pushing technique. Having the toilet to catch body fluids can make the mother feel more comfortable with the effects of her pushes. I find this position as the best for me to get a woman out of her bed.

Sources:

http://www.touregypt.net/featurestories/mothers.htm

Traditional Midwife instead of Birth Attendant: Does the Name Carry Honour?

The history of Traditional Midwifery is quite fascinating. Traditional Midwives practice midwifery as it has been handed down to them from generation to generation. Some of them have no formal training. I am a traditional midwife and I love my work. I learn to connect with pregnant women. We connect during stressful times. We connect through the gift of trust.

Traditional midwives were keen observers of physiological  signs & symptoms and monitored fetal health by addressing the mother's intuitive process, and, more recently,  by using wooden acoustic listening devices today called Pinard horns, still used by many midwives, and later, fetoscopes, as did all early physicians. 

Traditional midwives relied on maternal signs and symptoms and dialogue much more than constant vaginal exams, doing very few, when necessary, did not practice surgeries such as episiotomies, nor did they administration intravenous fluids and drugs.  Such practices would have been considered the domain of doctors rather than the art of midwifery. The women of Africa continued the use of traditional midwives as primary practitioners in the arena of women's health care.

The rights of traditional midwives are grossly violated around the world. Several midwives around the world debate on this topic. I find this to be a derogayory term. The article by Debbie Diaz-Ortiz will help us understand the basic issues facing traditional midwives.

The use of the phrase “skilled birth attendance” or the acronym TBA traditional birth attendant concerns and disturbs me and others I have communicated with in this region of our world and in other informal conversations. Instead, it is more accurate with our history and gentle to our emotions to create a definition for the term traditional midwife for the women who learn with colleagues and/or through experience.

Considering only those who have formal studies to be midwives is to deny the beauty and uniqueness of our history that I and many I have communicated with or read about are so proud of. Studying history in its depth (my B.A.) we repeatedly see life and learn that in situations where change is attempted by force, converted, [or denied], it just doesn’t happen. On the contrary, whatever is to change stays stronger or because of a noticeable sacrifice naturally, genetically remains in life and/or in our memories. As we have persisted through centuries, our name lives on.

When will all midwives have formal studies? Mostly when poverty ends [in the] continents of the world. When will poverty end? Maybe god has a date. When will midwives in this region of the world be called by other names between their neighbors? Never. Can we just define the term traditional midwife instead of use TBA for them? Most of them will never know about it, but in respect of their hard work, knowledge and the noble service they offer to women others are so afraid to give service to, we honor them. It’s all about our name and definitions. It’s a matter that should not pass unnoticed. And, the change should be a democratic decision of many, not of one—a real leader will never ask people to accept their opinion as the last word.

Do the strategies to formalize midwifery work in this region of the world? Really, no, it is an unnecessary battle. It has been so stressful for many who follow midwifery closely, who have seen it for years in other continents. It has caused injury so deep, the wound is so open. Let’s be midwives to our feelings; naturally this will protect, make an international recognition, open a door, go deeper in the importance of our linage, to justly integrate the elegance of our history. Projecting midwifery to the world proudly, in its essence, and, as it is, just exquisitely formidable in its wholeness. A name carries honuor and history.

Debbie A. Díaz-Ortiz, midwife

Latin-American & Caribbean Network for the Humanization of Childbirth

Puerto Rico, Caribbean

Pregnancy and Childbirth

Becoming pregnant is the happiest moment in a woman's life and also the most important one! There is a saying that a woman is not complete if she hasn't gone through even one pregnancy in her whole lifetime. It is important to remain happy and active through the pregnancy month by month so that healthy development of fetus takes place.

The birth of a baby is awesome. As young girls we are taught by our culture to fear birth and look at it as an unpleasant, dangerous and bothersome time, instead of a glorious, life changing experience. We have lost our passion for embracing who we are as women and what we can accomplish when left to do what comes naturally. Our bodies and minds cannot fully engage in the powerful moments of childbirth when there is a constant deluge of media-based fear running rampant through our heads. This affects us on a very cellular level and instills in us a loss of accomplishment, a loss of empowerment, a loss of who we truly can be as women. This blog aims to reeducate, re-center and change the way we view our bodies, ourselves and the way we give birth in today’s hectic life.

My personal birth philosophy is that women were made to birth babies beautifully. That why I am writing this blog to increase awareness of the pregnancy and childbirth. A parent experiences boundless love. While two people can love each other deeply, the unconditional and uncontrollable love for a child is unmatched in creation. And the miracle of watching an embryo become a live being with feelings, needs, and a personality that is an extension of yours is an experience that no one should choose to miss.

Pregnancy and Childbirth is a special time in a person’s life. The remarkable journey of new life is a positive, transformative experience. Pregnancy offers expectant parents an opportunity to prepare physically, mentally, and emotionally for parenthood. Pregnancy can be the most joyful and the most vulnerable time of a woman’s life. Making informed decisions about childbirth, newborn care, and parenting practices is a critical investment in the attachment relationship between parent and child.  That is why I feel all parents should be prepared for this role. Very often new parents are completely unprepared, and overwhelmed with their roles as parents.

We require automobile operators to have licenses. We forbid people from practicing medicine, law, pharmacy, or psychiatry unless they have satisfied certain licensing requirements. We require drivers to be licensed because driving a car is an activity which is potentially harmful to others. So, I believe that future parents should also learn about parenting. They can become responsible when midwives can assist them in making the right choices through education.

Education is a key to help new parents. Parenting is a process of learning and one that is not easy, it comes with joys and challenges. But as we all know, to become a parent is a matter of choice that any mature adult can make. It’s the first thing people should remember before trying to get pregnant. If a couple decides to become a mother or father, it can only mean they are ready for the responsibilities that go with it.

When preparing for the birth of a child, parents can create a peaceful, loving environment in which to grow, birth, and care for a new life. Parenthood means sleepless nights and a major lifestyle adjustment, but it is the most humbling and rewarding adjustment you will ever make.

Preparing for parenthood also means preparing for the birthing process. The process of childbirth, for all practical purposes, starts weeks before a woman feels her first contraction. The body will be preparing for the upcoming event in several ways and a person may or may not notice. Even if the woman does not recognize these events, they are happening.

Sometimes pregnancy and childbirth isn't pleasant. Pregnancy is a fragile time when a woman's body needs special care. Sometimes a pregnant woman is swollen, bloated, and sore, but whatever the case, she is beautiful. Her body goes through changes during pregnancy. It is even more obvious that some women are affected emotionally by those changes. Other than hormones, a woman’s self-image is lowered during pregnancy. During this time it is not uncommon for a woman to feel less attractive, unwanted, and in some cases, disgusting. But pregnancy gives a woman a glow and a presence that can inspire those around them. I think pregnant woman are beautiful and sexy. They are brining life into this world and what is better than that.

When most women talk to each other, all they talk about is how bad it hurt and how horrible childbirth is. I personally heard and witnessed many birth stories. The majority of women will have an uncomplicated and will bring healthy babies into this world.  There are those who will not have the same experience of pregnancy and childbirth. The formal act of childbirth starts with labour contractions. This begins the first stage of labor. This stage ends and the next stage begins with the cervix is fully dilated. It’s usually longer for first time deliveries.

The second stage of labour ends with the delivery of the baby. During the second stage is the exciting crowning phase where the baby can be seen for the first time. During the third phase of labour is the Placenta is delivered. By this time a woman will be so excited to have delivered a baby. Some wmen experience severe pain and just want it over. So I do think that we as midwives need to talk more freely to pregnant women about the birthing process and how to make it easier for them.  Our support during the birthing process is of outmost importance.

I do know that birth is not always so painful. Maybe we do overplay that and women therefore expect that it is always painful. This may well increase fear and anxiety. None of us want to experience pain. However our bodies have amazing ability to help us cope with this experience of birth. We have these lovely things called endorphins which help to make the experience bearable and even enjoyable. Endorphins will not be released if we are fearful and anxious, then we have the opposite hormonal response where catecholamine’s are released which can make the labour more painful. So the more fearful and anxious we are, the more likely it is that labour will be painful, a self-fulfilling prophecy.

On a personal note, each pregnant woman should surround herself with people who share her believes, who will help her to relax and have a great experience when bring new life into this world. There midiwves should be able to maintain a watchful eye on the progress of your labour without interfering. Midwives should be able to reassure a woman that labour is progressing at a pace that is fine for her and her baby. A midwife should also be able to identify if a woman needs extra help or support and help her to get that when and where needed.

Caesarian Sections

A Caesarian section is a major abdominal surgery involving 2 incisions (cuts): One is an incision through the abdominal wall and the second is an incision involving the uterus to deliver the baby. While at times absolutely necessary, especially in emergencies or for the safety of the mother or the baby, caesarean childbirth is not a procedure to be undertaken lightly by the physician or the mother. It should be performed medically necessary and definitely not for the convenience of women and surgeons.

History has it that the Roman leader Julius Caesar was delivered by this operation and the procedure was named after him. Shrewd historians, however, doubt the truth of this.  Julius Caesar seems unlikely to be the first since his mother Aurelia is reputed to have lived to hear of her son's invasion of Britain. C-sections were reserved for the dead.  So during that time the procedure was performed only when the mother was dead or dying, as an attempt to save the child, so that means that Julius Caesar could not have been the first caesarisn section. Roman law under Caesar decreed that all women who were so fated by childbirth must be cut open; hence, caesarian.

Latin language has many explanations for this. Other possible Latin origins include the verb "caedare," meaning to cut, and the term "caesones" that was applied to infants born by postmortem operations. Ultimately, though, we cannot be sure of where or when the term caesarean was derived. Until the sixteenth and seventeenth centuries the procedure was known as caesarean operation. This began to change following the publication in 1598 of Jacques Guillimeau's book on midwifery in which he introduced the term “section.” Increasingly thereafter "section" replaced “operation.” Caesarian sections remained rare before anaesthesia, which came along in the mid-1800.

History told us that sections took of around the turn of the 20th century when rickets began to plague malnourished families in crowded cities. The deficiency led to malformed bones, including the pelvis that could make normal childbirth impossible. Until today the term small pelvis is grossly overused to justify the reason for the alarming high caesarian section rates in the world. Almost every OB/GYN will tell a woman that they have a small pelvis and the fun part is that women actually believe that. Imagine if we as women all have a small pelvis, no woman would give birth via the vagina.

In Africa, which is the cradle of mankind, history told us that British Dr Robert Felkin observed a caesarian section performed by an traditional healer in Kahura, Uganda in 1879 by giving the woman banana wine, with a couple of men holding her tight. The traditional healer cleaned his hands and made a vertical cut through the skin and a second through the uterus. The wound was cauterized with a red-hot iron. How they know that is indeed very impressive. The baby was lifted out and the placenta removed. The woman was rolled over so the fluid could drain out of her abdomen, and then the abdominal wall, but not the uterus, was sutured with bark cloth and sharp skewers. A paste made of chewed roots was slathered over the incision and covered with a banana leaf and a cloth bandage. The skewers were removed after a week. Dr. Felkin, reported that both mother and baby “were doing fine, “when he left the village.

In the last 3 decades, the number of sections worldwide has doubled to more than 30 percent of all birth. The World Health Organization says that the c-section rate should be around 10% and no more than 15%. The section rates have been rising in the world and are a growing concern in many countries. The United States rate is now over 32% - and rising - and the maternal mortality rate is rising right along with it. Evidence shows that caesareans place women and babies at increased risk for morbidity and mortality immediately and long term. In the South Africa it is at 98% in private hospitals. It has become the most common surgical procedure in private hospitals in South Africa and women dont see to question that at all. 

The year I graduated from nursing school was a time for normal birth-- when C-sections accounted for 1.9 percent of all births. Caesareans were the prerogative of the obstetrician, not the mother, and were performed only when the physician thought that it was a matter of safety for both mother and child. That is all change now because every woman wants surgery. A woman’s body basically is having her internal organs cut, clamp, moved around and then put back again, with the possible risk of infection. It isn't worth it unless it is medically needed. I can't believe the women who will go through it, and the risks, so they won't have to go through labour. I think women need to be educated about the choices. There are countries in the world where this operation is a desperate need and in my own country it is hitting an all-time high. It is so wrong!

Sources:

http://www.news24.com/SouthAfrica/Politics/Caesareans-for-profit-to-end-minister-vows-20111031

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720922/pdf/v080p0F250.pdf

http://blog.ican-online.org/2010/12/21/cesarean-rate-reaches-another-record-high/

Oxytocin Induction

Oxytocin is a powerful hormone. When we hug or kiss a loved one, oxytocin levels drive up. It also acts as a neurotransmitter in the brain. In fact, the hormone plays a huge role in pair bonding. This hormone is also greatly stimulated during sex, birth, breast feeding, and the list goes on.  In lactating mothers who are breastfeeding, oxytocin causes milk to be released in the breasts, so that the infant can feed at the mother's nipple. Oxytocin is also responsible for the dilation of the cervix during birth, and for contractions during labour. During labor, oxytocin stimulates the uterine muscle to contract.

Pitocin is the synthetic form of oxytocin. Oxytocin was discovered in 1909 when Sir Henry H. Dale found that an extract from the human posterior pituitary gland contracted the uterus of a pregnant cat. Dale named the unknown substance oxytocin, using the Greek words for "quick" and "birth." Pitocin was successfully synthesized in 1953, and two years later it was available to physicians for the inducing and augmenting of labor. In 1971 Peter Kopfler discovered that oxytocin was involved with mothering.  Kopfler called it a hormone of mother love.

By 1974 it was well known that Pitocin had a 40-50% induction failure rate and in 1978, largely due to the work of Doris Haire, Pitocin was investigated by the US Senate and the General Accounting Office. Between 1978 and 1981, Haire testified at three ongressional hearings on obstetric care, which included reports on the dangers to mothers and babies of the routine and elective induction of labour.

Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby. There is absolutely no doubt that induction oxytocin/pitocin can be a lifesaving intervention, and is necessary in some circumstances to protect the health and well-being of both mother and baby. Having said all that, it is the most abused drug in the world today.  In his classic book Husband-Coached childbirth, Robert Bradley, MD, compares the arrival of human babies by nature's schedule to fruit ripening on a tree. Some apples ripen early, some late, but most show up right in season. Bradley advocated relaxation, trusting nature, and allowing babies to show up when nature intended.

The question I’d like to explore is not whether induction with Pitocin is sometimes necessary– but whether the frequency of its use today in hospital birth is justified. As is the case with all medical interventions, it’s important to critically examine the balance between benefit and risk – especially when we’re talking about the use of powerful drugs with otherwise healthy pregnant mothers and their babies. The problem with augmentation is that it produces an abnormal labour. Synthetic oxytocin can interfere with the delicate orchestration of the mother’s natural hormones during birth, and according to some research, with the baby’s brain and hormones as well.

It’s crucial to understand that the effect of synthetic oxytocin is not the same as that of natural oxytocin produced by a labouring woman. The uterine contractions produced by synthetic oxytocin/pitocin are different than the contractions which are stimulated by natural oxytocin – probably because Pitocin is administered continuously via IV whereas natural oxytocin is released in pulses. We are just beginning to understand the long-term effects on the fetal brain of drugs such as Pitocin, and the exact long-term effects of inducing or augmenting labour are unknown. In practice it seems that pitocin is used much more frequently, even when its usefulness and safety are still questioned. About 80% of women who have had pitocin say that there is more pain with pitocin than without. Unlike natural contractions, you do not get the slow build up with pitocin induced contractions. Most women surveyed say stated that they would rather try alternatives to pitocin with their next labour.

 According to Williams Obstetrics, a pitocin induction and augmentation should only be performed when there is a clinical diagnosis of "hypotonic uterine dysfunction." This is a condition in which the contractions become ineffective at producing cervical dilation. This means that even when it comes to OB/GYNs, they should only use pitocin when indicated in abnormal labours. Moreover, contrary to popular belief, a truly "abnormal labour" is a very rare occurrence. However, even though doctors are warned of the dangers of using pitocin, it remains the most used labour and delivery drug and it is used routinely to "control" normal labours. It has become so common in maternity units that nurses and physicians dont even mention it when ask.

The medical system considers all labours as abnormal and therefore requiring "assistance. That is why Pitocin is such a controversial topic in childbearing today. We learn and know that oxytocin is a natural hormone produced by a woman's body.  Pregnant women owe it to themselves and their unborn babies to do everything they can to stay healthy and thereby minimize or prevent the need for medical induction. Babies born from natural, spontaneous labours have the best overall outcomes, and their mothers experience easier labours and quicker postpartum recoveries. This is because Pitocin is a strong anti-diuretic - meaning you can't pass urine. Even at very low doses, pitocin in combination with IV fluids administered to starving - fasting - labouring moms can result in water intoxication. Water intoxication heightens your risk of pulmonary edema.

I am very concerned about its widespread use, though. It is a powerful drug that should be approached with a lot of caution and respect. I also hope that we will continue to conduct research on the long-term effects of commonly used drugs at birth. Doesn't mean that their use will be eradicated, but it's important to know what implications Pit during labour may have down the road. Some women may be okay with accepting that set or risks; others may not be. As long as new mothers and healthcare professional know that pitocin is a drug. It is medical intervention and carry risks with it.

Natural Induction of labour

Being pregnant is beautiful. But pregnancy makes people tired and they want to get over with it. Sometimes Mother Nature refuses to deliver the baby and the body shows no indications of prompting labour, it is then that decisions are made to start the process in a natural way. Self-induced labour is common amongst many women. Some traditional midwives expect labour to begin when the woman's feet and ankles become cold, indicating that the body heat is moving towards the womb. For centuries the Chinese used foot massages to induce labour, others used the galloping of horses to stimulate birth pains. Castor bean oil was used by the Egyptians to stimulate labour. Castor oil causes cramping in the intestines which cause uterine cramps. Even today many people today use castor oil to induce labour.

It was a known fact that traditional midwives knew the value of herbs and their benefits to pregnant women. We used herbs during pregnancy to tone the uterus and prepare for birth.  I hope to share some of the idea that works for me and other traditionally midwives. Many midwives used herbal teas to stimulate contractions such as cotton root, motherwort, cumin, cinnamon bark, raspberry leaf, goldenseal, dried ginger and jaggery and black cohosh. Many midwives don’t want to use black cohosh because they notice meconium stained liquor often in their practice.

Whatever the situation, there are many ways to induce labour naturally from the use of herbs, oils, and physical activity such as walking, squatting, drinking herbal tinctures, foods and sex and much more.  I am not a homeopath so everybody should research herbs but these herbs had been very helpful in causing labour when women were overdue.

Though sex is the last thing on a pregnant woman’s mind but intercourse had helped many women to induce labour. Why? Because it all about the chemicals that are released during the act. Sperm contains a hormone, prostaglandins.  Once the prostaglandins are deposited on the cervix it helps to soften it up and prepare it for labour. Also, when a woman reaches an organism, her body released oxytocin which in return stimulates the uterus to begin contractions.

Some women found that eating certain foods can induce labour, spicy food, Italian food and Pineapple or other fruits.  Basically there are three types of food than induce labour. Eating spicy food can stimulate the release of prostaglandin which we know ripens the cervix. Well it is well-known that eating spicy foods that contain capsasins (which is found in many peppers) may help to bring on labour, and it might to the contractions of the bowels that spicy food stimulates which be able to bring on labour pains.

Certain pizza such as the Prego pizza contains breaded eggplant topped with cheese and is served with marinara sauce and Italian herbs. Basil and oregano are known to induce labour. The reason is that these herbs cause the release of prostaglandin which again ripens the cervix and helps to contract the uterine muscle. There is no scientific evidence to proof that the Prego pizza herbs really induce labour, but many women did that and went into labour in 48 hours. I personally don’t know this but friends of mine trust this very much.

Fruits such as mango, kiwi, papaya and pineapples are known to cause labour. These fruits contain the enzyme bromelian, which breaks down proteins and aids in digestion and causes a bowel movement. The same muscles that cause the bowel movement is are the ones which are used to contract the uterus. Bromelian is primarily found in the stem of the pineapple but traces can also be found in the fruit and leaves. Don’t bother to buy canned pineapple because the bromelian is destroyed in the production process. So, it is better to use fresh pineapples. Please take note that too much pineapple causes diarrhoea in some people. It is best to take pineapples on an empty stomach then it works well.

Papapya is rich in Vitamin A and C, it helps with indigestion. Studies done by the British Journal of Nutrition shows that an unripe papaya contains high concentrations of latex. The concentration of latex keeps on reducing as the papaya gets riper. Once the papaya is totally ripe there is no trace of latex left. The papaya contains two major enzymes, papain and chymopapain. Papain acts like prostaglandin and increase uterine contractions. On my recommendation a patient of mine drank papaya juice and 12 hours later her son was born.

Kiwifruit are good for us. It is a jumpstart to labour.  Also a Kiwi fruit contains high dietary fibre. Kiwi fruits are high in Vitamin C and potassium. They have more vitamin C that a similar size orange, more potassium than a banana and more fibre than a cup of bran flakes.

 

Herbs in Pregnancy

Herbs fascinate me. My grandparents used herbs for everything. I have come to appreciate herbs over the years as a gentle and natural healing. I am simply a midwife that enjoys learning and studying herbs the history and uses of herbs. A prominent herbologist wrote, "The more research I do on herbs, the better appreciation I have for God's creations. “Every plan on this earth has a purpose. Plants and herbs provide not only medicines but also vitamins, minerals and macronutrients for optimum benefits. Some example of plant nutrients: calcium, iron, folic acid, magnesium, and vitamin C.

Plants and botanical gardens have been used for women's health and healing for hundreds of years. Most herbs can be taken throughout pregnancy with no ill effects; many herbs are helpful during pregnancy and to be taken through the entire pregnancy until birth. The physiologic changes that occur during pregnancy can lead to a variety of conditions that can usually be self-treated. One thing is certain and that is when a woman is pregnant she has to nourish herself. 

Most herbal products have a long history of safe use. However, they can be dangerous if dosages are not followed correctly or if the products are ingested over a long period of time.  Pregnant women prefer to use herbs in the form of tea. Herbal teas are made from the roots, berries, flowers, seeds, and leaves of a variety of plants—not from actual tea plant leaves. The ritual of making and drinking tea has been practiced for thousands of years, and for good reason. Tea contains polyphenols to protect your heart, antioxidants that may lower your risk of cancer and other nutrients that boost your immune system.

Many of the complications during pregnancy can be traced back to the mother’s diet, which typically lacks in vital nutrients and minerals that she so desperately needs during pregnancy. Women wise to these needs have recommended herbal tonics during the childbearing years for thousands of years to help both mother and baby experience a healthy, normal pregnancy and birth.

The following is a list of herbs that I had used safely during pregnancy for women I cared for. If I had to pick one of my favourite herbs then it is raspberry. I have been recommending Red raspberry Leaf to pregnant women for more than 23 years now and not a single woman ever had a complaint about this benevolent plant.
Raspberry is an amazing plant with so many uses. Red raspberry leaf tea" is made from the leaves of the red raspberry plant. The leaves taste mild and can be taken all day long. Red Raspberry Leaf's major function in a woman's first trimester of pregnancy is to provide necessary nutrition.  Red Raspberry is amazing for milk production and for toning the uterus in preparation for birth. Red Raspberry prevents excessive bleeding during and after labour and will facilitate the birth process by stimulating contractions. Many women drank the raspberry leaf tea religiously during their entire pregnancy.

To make a tea, pour 1 cup boiling water over 2 teaspoons of herb and steep for ten minutes. Strain. During the first two trimesters, drink 1 cup per day. During the final trimester, drink 2-3 cups per day. The tea helps the moods swings due to the hormonal changes and their mental clarity and energy levels are so much better. Raspberry leaf is an excellent energy booster. So if you feel a little anemic or run down, just drink a cup of raspberry leaf tea with a spoonful of molasses stirred in.  It tastes great and gives a person an emotional and physical energy boost.

Ginger has a long history as a remedy for upset stomach, morning sickness and loss of appetite. History has taught us that centuries ago Chinese sailors used ginger to avoid sea sickness. Ginger Root is excellent for morning sickness and sae for pregnant women to use. A 2003 study suggested that ginger was safe to consume during pregnancy, but that the beneficial effects it produced were mild.  On the other hand, a brief study focused specifically on ginger tea reported that women who drank the tea found their nausea significantly improved.  Ginger is simple to use. Just peel it off and place it in hot water and bring it to a boil, strain it and serve.

Catnip is in the mint family, soothing and relaxing. Catnip has been used over the time to relive stomach complaints such as colic, cramps, gas and indigestion because chemicals in it maybe have muscle-relaxing effects. That's why catnip leaves is a well-known menstrual cramp reliever. Catnip is a great help to those who suffer from stress related issues. I love using catnip because it is very relaxing and calming. It is very useful for postpartum women struggling with some kind of anxiety issues and mild depression. The tea is pleasant tasting and can be taken easily.

Oat straw is a very soothing and nourishing herb. It has a very mild and invisible taste. Oat straw is high in nutrients such as calcium and magnesia. Oat straw aids the nervous system, short-term and long-term. Chamomile is a truly irreplaceable plant. It cures just about everything. Tea with chamomile will help a person fall asleep, cleanse eyes and ease slight indisposition. Any woman that have disturbing thoughts, anxiety, insomnia, then quickly brew tea with chamomile and those thoughts will disappear. It is not only a soothing plant; it is also an excellent remedy for any inflammation such as mastitis. It is good for hair while rinsing.

Chamomile is a truly an irreplaceable plant. It cures just about anything. Tea with chamomile will help a person fall sleep, cleanse eyes and ease slight indisposition. Any woman that have disturbing thoughts, anxiety, insomnia, then quickly brew tea with chamomile and those thoughts will disappear. Chamomile is not only a soothing plant; it is also an excellent remedy for any inflammation such as mastitis. It is good for hair while rinsing.

Shepherds’ purse is used to stop heavy bleeding from the uterus. It has been used to treat post-partum haemorrhage. Shepherd’s bag contains vitamins C and K. It increases blood clotting. The herb contributes to postnatal contractions and causes the uterus to retuning to its size and shape before pregnancy. Shepherd purse help with uterine fibroids. It works immediately. I recommend Shepherd purse to all women in any stage of their lives to use it.

I am not a doctor or herbalist but I have used these herbs safely in my practice. What can say is that some herbs are very helpful for breastfeeding. Many herbs have been used to increase breastfeeding. The most common is fenugreek. Fenugreek seed has been used to increase milk supply since biblical times. Oak straw, raspberry, marshmallow and nettle leaves are good for breastfeeding. Nettle leaves are high in iron.

Herbs from Africa are now becoming popular worldwide. Many are still unknown in the western world, but others, such as Hoodia is seen as a massive breakthrough in the weight loss and dietary supplement niche. Wilde Als is one of the most widely used traditional medicines in South Africa.

Kanna, Canna, Channa or kougoed which is sometimes referred to as Sceletium (Sceletium tortuosium) is considered a natural Prozac and is used by many people in South Africa to great effect. Prescription mood enhancers can often be addictive and cause harm to the body; however, kanna does not have the same problems, making it one of the safest mood enhancers available. Sceletium tortuosum is a low-growing plant native to South Africa and it was first used in chewed or smoked. It is very popular amongst traditional midwives because it is natural and calms the woman down. It is also not a hallucinogen and anything developed from it is not addictive. Kanna makes a good mood lifter for when you are feeling blue.

Yohimbe is a popular herb coming originally from South Africa and known worldwide as an excellent aphrodisiac. In fact it is the inner bark of the tropical West African tree Pausinystalia yohimbe (formerly known as Corynanthe yohimbe). For centuries, people have used the crude bark as a tonic to enhance sexual prowess and pleasure. Traditionally it has also been used for fever, coughs, and leprosy in Africa, as well as a mild hallucinogenic. Yohimbe is good for morning sickness.

African herbal medicine is also used to treat ailments such as urinary tract infections and the Buchu shrub (Agathosma betulina) is used widely by African herbalists for those patients who suffer from this and similar health complaints. My thanks go to my grandfather John Murray who was an indigenous herbalist who introduced me to many of the South African indigenous plants and their uses.  Since then I have continuously sought more information and experience with them.

Sources:
http://medherb.com/Materia_Medica/The_Mineral_Content_of_Herbal_Decoctions_.htm
Susun Weed: www.susunweed.com and www.wisewomanbookshop.com

Global Herbal Products. http://www.globalherbal.co.za/contacts.html

Ageless: http://www.ageless.co.za/sa-products.htm

Koren, G. (2005) “Ginger for Nausea and Vomiting.” Internal Medicine News. 38.16: 32.

American Pregnancy Association. (2008).  Drinking Herbal Teas during Pregnancy.

Traditional Care in Pregnancy

 Motherhood is what every woman dream about. Given birth to a child is the greatest gift we could ever imagine. Traditionally, across time and cultures, pregnant women have been surrounded by knowledgeable women, family, and close friends, who supported the transition to motherhood with affirmation and great excitement. Pregnant women were treated differently, given the best food, and protected as much as possible from stress and overly hard physical work. The woman knew she was pregnant when she noticed physical changes: a missed period, sore breasts, darkened areola, nausea, aversion to certain foods, and fatigue.

A woman's due date was determined by noting the start of those signs and, then, the timing of first movements of her baby. She got to know her baby through his movements. The pregnant woman was considered the expert in her pregnancy. She was encouraged to pay careful attention to her changing body, heart, and mind, and to her growing baby. Family rituals insured support during pregnancy and labor and the postpartum period. Pregnancy and birth were family events, and the care and support the pregnant woman received were from people she knew and who knew her well. Although pregnancy and birth carried more risks than today, women developed strong attachments to their unborn babies and worked with family, friends, and caregivers to insure safe passage of their babies. Life was different, healthy and free of tegnology.

Today, pregnancy and childbirth are treated as medical events rather than as normal life events. Women are treated like it is a business. It has become a money making business but at the same time a big cost to healthcare budgets.  Most women take commercial some kind of home pregnancy kits doing their own test to find out if they are pregnant or not and, then, anxiously visit their healthcare provider to confirm the fact of the pregnancy. As we know right from the start, the pregnant woman affirms that the obstetrician is the expert who must be consulted to find out every detail of how things are going.

Obstetricians are the main experts and women around the globe are bragging about their OB/GYN. Because of this, women typically worry from one prenatal visit to the next that everything is going well. “Expecting trouble” has become the trait of contemporary prenatal care. The experts GYN/OB exaggerate the risks of pregnancy and birth and increase women's fears for themselves and their babies. “Expecting trouble” has resulted in an exaggerated concern for safety, “intervention-intensive” pregnancy as well as labour and birth, and, not surprisingly, an escalating caesarean rate around the globe. Having a caesarian section has become the norm.

The days are gone of just a simple routine care and antenatal visit to the midwife. OB/GYN is doing routine sonograms, sometimes done at every prenatal visit in some countries because an increasing number of routine screening tests are considered standard antenatal care today.  Mostly, pregnant women panic if their OB/GYN did not perform such a tests. Strangely, all these tests lead to large numbers of “positive” results. In most cases, a positive screening result does not mean that there is a problem; in fact, there probably isn't one. The way to find out is, of course, to do more tests, and these further tests become increasingly invasive and risky. Most women feel pressured, once on the merry-go-round, to keep going. Women find themselves having to make decisions they never expected or wanted to be in a position to consider.

I think most women don’t realize that birth can be natural and feel that hospital birth is the normal. Most women don’t realize that even homebirth is a legitimate option because their overwhelming fears of birth and of what they hear from their healthcare provider. Most women probably found labour scary because they didn’t have the assistance of a doula, or midwife, didn’t have an undisturbed birth didn’t work through their fears in advance…nine out of then these couples were on their own, left to stumble through it alone. Now this is scary. I pray that most women become educated in childbirth. I hope women find self confidence to trust their bodies and birth and not believe in the fear by the whole “what if something goes wrong” argument. For me as a midwife, it is beautiful to watch labour progress undisturbed…labour is a challenge…

State of the World's Midwifery Report

The 2011 International Confederation of Midwives (ICM) conference was held in Durban, South Africa from June 19-23, 2011. The conference was attended by more than 3000 midwives from all over the world and was the first time for the continent of Africa. The five day conference was packed full with workshops plenary sessions, symposiums and many presentations. In addition the conference also attracted the submission of posters from local and international participants. The conference is a triennial celebration and the next location will be Prague, Czech Republic 2014. Prague has been a political, cultural and economic centre of Europe during its 1,100 year existence.

The conference got off to a rousing start at the opening ceremony with lively Zulu dancing welcoming the gusts with several guest speakers such as the First Lady of Malawi. The main focus was on ICM president Bridget Lynch. Our ICM conferences are always memorable events.

The State of the Worlds Midwifery Report was lunch. The release of the long awaited State of the World’s Midwifery Report and the powerful, poignant Stories of Midwives provides new information and data gathered from 58 countries in all regions of the world to:Thousands of midwives nurses physicians and doulas travelled from all over the globe to address the challenges faced by midwives today. I met amazing people who are dedicating their lives and careers to this important cause. I was very touched by the energy and commitment as evident as this conference. I knew I was with passionate people from all over the world. I learned a lot from the midwives from Prague. I was so excited with when they introduced Prague to the world. Also at my hotel was delegation from Trinidad and Tobago India and Indonesia.

• examine the number and distribution of health prfessionals involved in the delivery of midwifey services;
• explore emerging issues related to education, regulation, professional associations, policies and external aid;
• analyse globloal issues regarding health personnel with idwifery skills, most of whom are woen, and the constraints and challenges that they face in their lives and work, and
• call for acceleating investments for scaling up midwifery services, as well as "skiling up" the respective providers.

The report includes statistical tables and applicable global standards, collating relavantmidwifery informations into one reference document. Behind The State of the World's Midwifery 2011 stand 26 international partners involved in materal and reproductive health, with s a specific focus on midwifery, including ICM and PMNCH, and led by the UN Population Fund (UNFPA).

http://www.unfpa.org/sowmy/resources/en/main.htm

I was with a passionate group of people after a full agenda of activities the dinner conversations were filled with the day’s event and mostly sharing of ideas and future contacts. I met a midwife from every African country and it helps broaden my knowledge of their day to day work. Underneath the different accents and perspectives there was seething more. Yes there was a common sentiment that much more needs to be done to improve the ives of mothers and babies. We as midwives are 100% committed to the cause. We are here in Africa to make a difference. And we will I know I will. The time is now…I am ready...we are ready. Africa is ready.

International Confederation of Midwives in Durban 2011

The biggest event in maternal and child care will be coming to Africa. South Africa will host the International Confederation of Midwifery Conference on June 19-23, 2011 in Durban. Midwives from allover the globe will be attending. South Africa is well-known for its big 5 in the world of nature and wildlife preservation, and so it is to be the theme of the conference in Durban. The theme of the ICM 2011 congress is “midwives tackling the “Big 5” globally. The ICM congress has turned to underline the Five Big Challenges facing Midwives Globally which are the leading causes of maternal death and morbidity in the world.

The expert advice is clear and that is that maternal mortality in Africa is facing a crisis. Maternal mortality ratio in Africa is the highest in the world. Sub-Saharan Africa suffers from the highest Maternal morality rates such as about 640 maternald deaths per 100,000 live births. Maternal mortality is a major problem in South Africa. South African rates are unacceptably high and far above comparable international norms and is totally preventable. It lacks political will.

The major organizations will be there such as the World Health Organization (WHO), United Nations Population Fund (UNFPA) United Nations Children’s Fund (UNICEFF) and the Bill and Melinda Gates Foundation, just to mention a few. These major organizations of the UN system are all relevant stakeholders whose emblems I expect to see on the conference website, though there are also the major pharmaceutical company’s competing for a place in Durban. They will all have an opportunity to view the conditions prevailing in Africa, my continent.

The countries of Africa will all come together to celebrate birth. Regrettably the numbers of midwives will be few because the majority of needed midwives will not be able to make this journey. The cost is very high. Most midwives in Africa don’t earn the kind of money required to afford the trip.. If they can’t come to an event like this it means they will never get the valuable information that will be presented at the conference. These midwives are the frontline workers, they do the dirty work while the other’s drinking the wine and enjoying the cheese; the sweet life.

I am fortunate to be able to attend these conferences. As a matter of fact I have been attending international conferences for the last 10 years. Many times I am the only person from Africa. Why; because many can't afford the high cost, hotel, airplanes, not to mention visas.

Many countries will come and present their papers. Some of them I have previously heard and listened to. They refer to us as the Third World. Third world is such a derogatory term, but it is the most used term in North America. In 2001 at the UN more then 189 countries agreed that the term third world will never be used again but unfortunately people in the developed world don’t seem to understand that. The term Third World is actually a Cold war nomenclature because at the time they did not know what to do with those countries that neither aligned with the Western World powers nor the Soviets. From day one the term started out to be some kind of a stereotype. 

I feel angry when they us that term. It feels as if they refer to me as nigger. It is so distasteful that I can't explain but many midwives continue to talk like that when writing in journals or presenting papers. In midwifery we do not need demeaning terms like that. I don' expect an organization like ICM will tolerate language like that. Most of the people that will speak at ICM are all graduates, PhDs, so I am sure they will respect us in this beautiful continent of us. I hope they will use “developing world” or “developing nations.”  The Third World Term is just a very very bad label! African nurses do not deserve that label.