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/