Tuesday, April 05, 2011

Being With Wombyn

Edinburgh, Amsterdam, Portland, Eugene, Eugene, Seattle, Amsterdam, Edinburgh in 6 days, 8000 miles covered and 30+ hours of travel and...was it worth it...Absoblummin'-lootly!

It was even worth wearing the same clothes two days in a row as my luggage was delayed and didn't arrive at the same time as me (okay, well, I do speak for myself here, my roomie may not agree!)

I last went to the Midwifery Today conference in March 2006 in Philadelphia. That time I had just begun working as a doula, I think I'd had one client! I drove down with a friend and we spent the weekend in various sessions. I don't remember too much about that conference, partly because lots of it was all new to me and I was just beginning to take it all in in depth, so I think the only classes that really stuck were Debra Pascagli Bonaro (she of "Orgasmic Birth" fame) and her class on doula comfort measures and the rebozo class, which, although very useful and practical, didn't go in verbally as the class was lead in Spanish by a Mexican Midwife - (god darn learning German and French at school!) so whilst very tactile and hands on, was a little bit guess work as to what the contraindicators were for certain uses, thus I've not been overly confident in using it in the last few years.

This time around, I'm a good five years down the line - I've been a doula since 2005 for over 30 couples, I've taught over 400 hours of classes both here and in the US and I'm on my way to becoming a midwife, so the reading, reading, reading...

This time, I was so geared up for it I knew exactly which classes I wanted to take and it was worth every last moment. The classes I attended were mainly ones on practical issues in midwifery from which I wanted to learn great tips.

Midwifery Today as a publication, if you are unsure, is very much a "word from the wise women" type of magazine. Yes, it's evidence based, of course, but it also has dying skills and anectdotal tips from other midwives who have been practising for decades and just see wonderful results with a certain technique so want to share and pass it on. It also celebrates the fact that we are women, being a woman is a beautiful and amazing thing and what I love about MT is that it encapsulates this as well as being a journal that teaches. Thus their conferences are always very hands on and practical, very unlike any conferences I've really attended in the UK. The attitude is to learn by doing, which ultimately, is what I won't learn in any text book.

The opening pre-conference days were about midwifery skills, Day one I chose to learn about first and second stage difficulties, doing a full physical exam, herbs for birth and philosophy of care. Day two I went to; keeping birth normal, third stage difficulties, hands on midwifery and how is the baby?
These two pre conference days were full day classes lead by a variety of midwives in differing situations - one was a midwife who was currently living and working in the Phillipines, another was a midwife who'd been midwifin' for around 35 years, another was a woman who worked with the native people etc. All of these women had fascinating stories to tell in themselves, not to mention knowledge and wisdom to impart that was worth a week's worth of reading text books.

Day three was a day that consisted of a general session in the morning, then the afternoon was divided into two classes that you pre booked from a list of around five. I chose to do Shoulder Dystocia and Third stage difficulties and haemorrhage as I felt that often it's important to visualise how to help a dystocia rather than just read about it, I hoped it would up my confidence if the need ever arose.

Ina May Gaskin and Elizabeth Davis (Hearts and Hands; a midwifery textbook) lead the session on Dystocia and, as I'd hoped, it was a visual demonstration using a pelvis and baby as well as lots of Ina May and Elizabeth's tried and tested, calm wisdom. Dystocia will always make my heart race, but clearing up how to try different manoeuvres including Gaskin and McRoberts and being given tips as to how to clear bi lateral shoulders was easier to retain seeing them demonstrate.
Ina May Gaskin and Elizabeth Davis teaching various tips on Shoulder Dystocia

We learned how to recognise for shoulder dystocia:
  • The head of the baby accomplishes interior rotation but the anterior shoulder becomes impacted, therefore the head will not extend.
  • The head pulls back on the perineum - known as "turtling"
  • Lack of restitution
  • As a final sign - the colour of the baby will change
Carol Gautschi teaching how to palpate.
Some of the session was spent talking about fear as this particular obstruction is one that puts a lot of fear into midwives. We were told that, under no circumstances should we allay any fear to our clients, even if we're crapping a moose poop. Our homework is to watch our response to fear for the next week and write it down and see if we can work on this so that we outwardly display calm even though our hearts might be charging round Silverstone!

Elizabeth lead the session on Third stage difficulties and Haemorrhage as well and she was just as inspiring as the previous class. Tips we learned were how to observe the mother's face as well as observing the cord. She gave me absolute faith in knowing what signs to look for in a suspected accreta, how to manually remove a partially separated placenta (should the need arise), how much blood loss is good and how much is bad.

Of course, all this learning is has not set me up to be able to go out and do all this tomorrow, but with all the experience I'll gain from September onwards, the learning and reading I'll do on the course, hopefully this will bury itself into a part of my brain that awakens should need arise.

The most fantastic part of the conference was just the spirit of the whole week, the vibe, without any hesitation, is that birth is a beautiful, natural process and yes, there is sometimes the need to intervene, but if a mother is given the respect that she needs, the space and time that she needs and the love that she deserves, her own body will provide the drugs, the pain relief, the extraction tools. Her body will encourage her baby to breathe on its own, to clear its lungs of mucus and to feed and take the nutrition it needs. Being immersed with women who also feel this way was such a forceful energy that has come home with me, there was also an amazing feeling and sense of peace and contentment at what we do to help these women. I'm hoping the energy lasts long enough for me to save up and go to another conference for another fix of reassurance!

Amazing midwives, students, doulas, aspiring midwives, sisters and women, sharing stories and music.

As Sister Morningstar said "you need to be in the river with the woman, not on the shore".
Sister Morningstar taking us into the river!
 Many, many times, the message was "less is more, unless there really is an emergency in which case you need to know how to react and deal with it"

90% of birth, if left well alone and not given any drugs or help, not undermining the mother's ability and not rushing her to a schedule to fit a protocol, will happen without any need for panic or intervention and I am going to stick my neck out here and say that 90% of c sections probably occurred after an earlier intervention be that waters being broken, induction, epidurals etc. It is our job as women to realise that birth is normal in the majority of situations, that if we holistically care for our bodies, eat well and exercise both body and mind, we can achieve this if we so desire.  It is okay to sit and knit as a doula or midwife, it will empower the woman to look up and see you quietly knitting or just observing, she will have the confidence and power in the fact that you are confident that everything is normal and going well.

What greater gift can we give women than to believe in themselves?

Textbooks are vital, but alone, they still only keep you waterside. Being with woman (oh look!), listening to her, working with her, creating an environment that is empowering to her, reassuring her that birth is normal will get you in to your waist. Having the confidence and wisdom given to you by elders who've gone before you will encourage you to swim!

Michael Odent and Robbie Davis-Floyd enacting a skit about Dr Impatient.

Finally, if you found yourself alone in a lift with Ina May Gaskin for a whole 20 seconds - what would you ask her?

I'd love to know because my moment came and well...put it this way, I didn't exactly encourage my own piece of itemised wisdom.

Now, is there anyway I can wrangle a quick trip to Bad Wildbad in the fall? - hmmm....

Jan Tritten and myself sharing a Eugene "hot cheek" greeting! (and me looking incredibly over fed in too many baggy layers oops - that's down to the lost luggage - too scared I'd lose it again I've decided to wear it all at once!)


Lynn said...

Sounds like you had an amazing experience. Shoulder dystocia was the reason for my c-section... Did they cover anything about predicting it or was it covering the manoeuvres to deal with it during labour?

The Beehive said...

Not so much, other than to say that it generally isn't a big baby (which is often the common understanding. There are many other reasons that could cause it, baby in a more unusual position, not a typical gynacoid pelvis (apparently android pelvi can cause a problem) another reason is a broken coccyx that basically mends inwards and is inflexible caused by a woman falling on her back or bum.

It was very confidence- boosting though to learn that there are many ways to help a shoulder baby out vaginally. Basically they said that if the head slips through the brim of the pelvis then the shoulders are likely to slip through the ischial spines in most cases. So ideally they were calling for midwives to learn to do pelvimetry rather than relying on stations which don't actually tell an awful lot about the woman and the baby.

~*Beth Durden*~ said...

SOOO so fun to meet you in person!! Wish we could have had more time to chat :)