Showing posts with label midwifery. Show all posts
Showing posts with label midwifery. Show all posts

Friday, October 29, 2010

Doula Ambitions


My week has been crazy! I spent the last five days in Gainesville for my HIV/AIDS workshop and then class. On Tuesday we had another anatomy exam. Not everyone is doing great and I really don't want anyone not to pass! That's been making me anxious. I don't want any of my sister midwives to leave school!

On Thursday I went to Baby Love and met up with AnthroDoula. It was so nice to meet an anthropologist/doula, especially since I myself was in graduate school for the same thing less than two years ago! We had such a great time! She told me that she met a couple local doulas and they mentioned a huge divide between the home birth vs hospital birth sect. Hopefully, we can bridge that divide. We shall see.

Friday, September 17, 2010

Biomedicine, a love story


"The techno-medical model of maternity care, unlike the midwifery model, is comparatively new on the world scene, having existed for barely two centuries. This male-derived framework for care is a product of the industrial revolution. As anthropologist Robbie Davis-Floyd has described in detail, underlying the technocratic mode of care of our own time is an assumption that the human body is a machine and that the female body in particular is a machine full of shortcomings and defects. Pregnancy and labor are seen as illnesses, which, in order not to be harmful to mother or baby, must be treated with drugs and medical equipment. Within the techno-medical model of birth, some medical intervention is considered necessary for every birth, and birth is safe only in retrospect."
— Ina May Gaskin (Ina May's Guide to Childbirth)

Can you even imagine having a baby without an epidural, an IV bolus, Pitocin, a foley catheter, a blood pressure cuff, continuous electronic fetal monitoring, an intrauterine pressure catheter, a pulse oximeter, coached purple pushing with fundal pressure in the lithotomy position, an episiotomy, a vacuum extraction, immediate cord clamping followed by seperation of mother and baby? Me neither! Crazy hippies!

Saturday, September 11, 2010

Midwifery with a side of Anthropology



I love school! The days are long, the classroom is cramped and gets hot, but nothing is better. It's amazing! I feel so happy when I'm waking up at 5am for my three hour drive to Gainesville. I cannot express in words how much fun it is to be in school and to be learning something I am truly passionate about.

I spent 4 years at USF and I never felt this type of passion, ever! I can only imagine how much more successful I would have been in graduate school if I had discovered and established my passion two years ago.

I've thought about how much different my life would be if I hadn't gone to USF first, if I had went straight to FSTM after graduating high school. I mean, I would be a MIDWIFE by now with three years of independent practice under my belt. Plus, I wouldn't have 30,000 dollars of student loans to be paying off.

However, my undergraduate education was more than a four year detour on the path to midwifery school. It was an education in cultural relativism. Without my degree in Anthropology I know that I wouldn't have the background knowledge and skills to be objective and culturally conscious. Cultural relativism is the ability to see other cultures, practices and belief systems through the eyes of that culture, not your own. Plus, cultural relativism applies to more than just foreign belief systems and traditions. The United States is a heterogeneous mixture of all different types of cultures and belief systems.



Take maternity care in the US for example. You have the medical model of care which has its own practices and beliefs. The culture of the medical model views the female body as unable to birth a baby, fears the natural process of childbirth and sees danger as lurking around every corner. Tests and procedures are routinely used in excess because of this belief that the female body is flawed and childbirth is a faulty process in need of medical intervention. Like a fish that doesn't see the water it lives in, people who live in the medical model of maternity care often do not realize that their system is not evidence based and often does more harm than good.



As I become a contemporary midwife, I am also become a postmodern midwife. Anthropologist Robbie Davis-Floyd writes on postmoderm midwives:

"For past millennia, midwives have served women in childbirth. In premodern times, midwives were usually the only birth attendants. With the Industrial Revolution and the arrival of modernism, male physicians either replaced midwives or superseded them in the modernist medical hierarchy, leaving them with plenty of women to attend but with relatively little autonomy. As the new millennium dawns on a growing worldwide biomedical hegemony over birth, midwives, the daughters of time and tradition, find themselves negotiating their identities, searching for appropriate roles, and seeking new rationales for their continued existence.

“Modernity” is a narrow canal through which the vast majority of contemporary cultures have passed or are passing. It arrived in various parts of the world at different times; first in the industrializing countries of the North, and more slowly in the colonized and exploited countries of the South. So anthropologists consider “modernism” not to be a particular point in time but rather a univariate (single-pointed, single-minded, unvarying) orientation toward “progress,” defined in terms of Westernized forms of education, technologization, infrastructural development (highway, rail, water, and air systems etc.), factory production, economic growth, and the development of the global marketplace. This univariate orientation identifies a single point in a given area toward which development should be progressing: in economics, that single point is capitalism; in health care, it is Western biomedicine. Thus in modernizing societies traditional systems of healing, including midwifery, have become increasingly regarded by members of the growing middle and upper classes as “premodern vestiges” of a more backward time that must necessarily vanish as modernization/biomedicalization progresses.

Yet around the world, the univariate orientation of modernization is increasingly contested. Postmodern thinking widens the narrow canal of modernization beyond uncritical acceptance of modernization as good, noting the enormous environmental, social, and cultural damage modernization entails, and seeking to generate more polymorphous societies in which multiple knowledge and belief systems can coexist and complement each other. In postmodern societies and groups, conservation and preservation of the environment and of indigenous or traditional languages, cosmologies, health care, and economic systems take on particular urgency and importance, and such endeavors are sometimes considered to be more important than expanding the reach of industrialization, capitalism, and biomedicine.

Around the world we are witnessing the emergence of a phenomenon that I call “postmodern midwifery” –-a term aimed at capturing those aspects of contemporary midwifery practice that fall outside easy distinctions between traditional birthways, professional midwifery, and modern biomedicine. With this term, I am trying to highlight the qualities that emerge from the practice, the discourse, and the political engagement of a certain kind of contemporary midwife—one who often constructs a radical critique of unexamined conventions and univariate assumptions. Postmodern midwives as I define them are relativistic, articulate, organized, political, and highly conscious of both their cultural uniqueness and their global importance. By "postmodern midwife" I specifically do not mean midwives who accept without criticism either their own folk system or that of biomedicine, but rather midwives who fully understand these in a relative way, as different ways of knowing about birth, discrepant systems that often conflict but can be complementary."

With a background in Anthropology, I am better able to understand Davis-Floyd's interpretation of the postmodern midwife as I strive to become an "agent of change." Who knew six years after changing my major from pre-med to anthropology I'd be embarking on a such a dynamic field with a rich, powerful history?

Friday, September 3, 2010

First Days of School


I just got back from three days in Gainesville for orientation and the first two days of class. I have never been more excited in my life! It is amazing to be in such a positive environment surrounded with women (and one man) who are so passionate about the midwifery profession. I am literally excited to be doing homework!
The first book we've had to read was Witches, Miwives & Nurses. The history of women healers has a violent story. Mothers, daughters, sisters and wives were literally burned at the stake for practicing "a more human, empiral approach to healing." The book continues to talk about the "white, male, middle-class occupation" that became American medicine starting in the 1800's.
I feel honored to be able to join a profession with such a long, often brutal history. Women literally died in order to take care of other women and keep the profession alive. I vow to honor their struggle and carry midwifery on into the twenty-first century!

Friday, July 23, 2010

Sweet Deception


My doula client called me yesterday to let me know how her prenatal visit went on Wednesday. We are expecting her baby any day now so when she called I thought she was going to tell me that she was in labor. In labor she was not. She told me that her midwifes at the Health Department wanted her to go to the hospital on Sunday for an induction because of "borderline high blood sugar."
"Blood sugar?" I repeated to her over the phone again and again. "You're sure they said blood sugar and not blood pressure." She assured me that they said blood sugar. In all my readings I have never come across anything that would suggest that borderline high blood sugar would be a reason for an induction. The reasoning behind the induction, I suspected, was a fear that the baby was going to be too big, a condition called macrosomia. Interesting, I thought, when several highly respected authors, including Marsden Wagner and Jennifer Block, stated that macrosomia is not a justification for induction.
To make sure I wasn't crazy I called my midwife friend for her opinion. "NOT true!" was her first reaction when I told her about the reasoning for the induction. She assured me that I wasn't crazy and that she would never recommend a mom for an induction because of suspected macrosomia, especially not with a diagnosis of "BORDERLINE" high blood sugar. Ultrasounds can be off by as much as two pounds and even the most trained provider cannot predict a baby's birth weight.
When I talk my clients about induction I always want them to ask why the induction is being recommended. If everything is OK with mom and baby? Then why are we inducing? We all know that inductions more than double the chance of the birth being a surgical delivery, so the risk of surgery should always be considered when discussing induction. Does the risk of surgery outweight the risk of staying pregnant? I do not believe that macrosomia should ever be deemed a justification for induction or elective surgical delivery. If the baby is too big the only way we will know that is if the labor starts on its own and then the baby doesn't fit. Period. There is no guarantee when predicting birth weight and weight alone does not mean the baby cannot be born vaginally. A ten pound and a six pound baby could have the same head circumference and if the ten pounder is in a more favorable position than they may be easier to birth. I feel that most inductions are orchestrated cesareans. An obstetrical Münchausen by proxy used by the doctors and medwives to prove their superior medical knowledge in predicting that the baby "just couldn't be born vaginally, see I told you so."
We need to trust birth, trust our bodies and trust our babies. My client is angry that her midwifes would recommend such an invasive procedure. She wants her baby to be born in her own time, on her own terms. This afternoon I'm going to go visit my client, not to give her advice on natural methods for induction, but to support her in her decision not to be induced on Sunday. My midwife friend wants to come by and meet with her as well to assure her that she can birth her baby vaginally. I'm so happy to have such a wonderful friend devoted to honoring babies, respecting women and trusting birth! The world needs more motherbaby friendly midwifes!!!!!

Monday, June 28, 2010

Midwives Model of Care


The Midwives Model of Care includes:

* Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
* Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
* Minimizing technological interventions
* Identifying and referring women who require obstetrical attention

From Citizens for Midwifery

Tuesday, June 22, 2010

Characteristics of the Postmodern Midwife


• An informed relativism that encompasses science, traditional midwifery knowledge, professional midwifery knowledge, and complementary or alternative practice systems
• Local, global, and historical awareness
• Cultural competence
• A sense of mission around preserving midwifery in the interests of women
• A sense of autonomy as practitioners
• Dedication to the midwifery model of care in its humanistic and transnational sense and to midwifery and women’s health care as social movements
• Political engagement, including work with governmental authorities
From: Daughter of Time: The Postmodern Midwife. Robbie Davis-Floyd