Jan Tritten's Blog

Marion’s Update From Uganda

2010-02-11T22:50:00Z

Marion Toepke McLean, who has written Marion’s Message from Issue #1 in Midwifery Today is serving in Uganda for 2 months. She has retired from her job at Planned Parenthood but not from Midwifery Today! She is my mentor and my friend. Love, Jan Tritten

I got to catch another baby. The midwife wasn't feeling real well, and the baby was thought to be large (actually he was a bit over 8 lb, but there was lots and lots of clear fluid, which made her belly look bigger and she reported her previous child as having been 9-1/2 lb). Also, she took quite a while to push, considering it was her third child. So, at her request, I was happy to come and help.

When I arrived, I found just a thin anterior lip, the mom with a major spontaneous pushing effort, and a head of black hair just becoming visible. I pushed back the lip—she didn't make a bit of complaint about that. Had to push it back a second time a few pushes later, then she brought him down steadily. The whole second stage was 1 hour and 15 minutes long, from when she was first called complete—this was when her bag of waters broke—to the birth. He was born 45 minutes after I came in. 

You know, most of the births here just pop out. They tend to have smaller babies than we do at home, 7 lb or 7-1/2 lb is what we commonly see, which of course is plenty big enough! But we have so many big babies in the US, and I felt totally comfortable with the progress of the mother.

 Anyway, it is a treat for me to have my name down in the birth log as “midwife” for the second time out of the 12 births here since my arrival! I helped one of our midwifery assistants create her own e-mail account this evening, that was pretty exciting as well!

Love to all, Marion

Read some of Marion's articles:

Birth is a Human Rights Issue

2010-02-02T23:15:00Z

I have thought a lot about “Birth is a Human Rights Issue,” possibly because of hearing so many brutal birth stories. We have been publishing Midwifery Today for 24 years, since 1986. In those years of publishing birth and midwifery information many, many birth stories have come across my desk. There have been stories of incredible highs and empowerment in birth, forming a strong foundation for mothering. However, often these stories are accompanied by preludes to this birth of one or more horrendous stories the author has endured. Many are just horrible stories with no good birth after.

My own stories are similar in impact. Bad birth followed by good birth often prompts a women to become a midwife or other birth practitioner. I prefer women come to birth work with all good births! You can be just as good a midwife having had all great births yourself. Every birth is a real story of a woman and baby and her family. This really played in my mind when I learned that Strasbourg was the Human Rights Capital of the European Union. The idea that “Birth is a Human Rights Issue” jelled in my mind for the first time when I learned that. The idea of the theme came from the place.

If you can, read ICAN’s book of birth stories, which Midwifery Today was privileged to choose stories from to reprint in our magazine. All are stories of pain, mostly from “unnecessarians.” I cried every time I read them. I still do. They have been made into a book now. I have seen and felt with my sisters both the devastation and the joy these memories contain. Memories of birth, whether good or horrendous, are some of the strongest we have. They are not forgotten. We all want to love our birth stories. It is a right to have the most optimal birth possible. Birth really is a human rights issue. The whole world has offended this right. Let’s change that. Our conference in Strasbourg, France September 29-October 3, 2010 will explore this issue.

Love Jan Tritten,
Mother of Midwifery Today

Documented Causes of UnneCesareans by Judy Slome Cohain

Survivor Moms - Healing after Sexual Abuse

2009-11-10T19:54:00Z

Midwives are called upon to help each of their clients have the best birth possible. As many as one in three or four women have suffered sexual abuse or rape. The effects of such abuse often play out in the childbearing year, as well as in other aspects of a person’s life. In that the experience of giving birth has such great potential either to heal or to hurt, it is important that we, as midwives, know as much as possible about how to work with these women. We can definitely be a part of the healing process, but it is a double edged sword. We can also re-traumatize these moms.

Motherbaby Press, a subsidiary of Midwifery Today, has published a book that can help you gain the knowledge you need in this area. When I practiced midwifery in the 1970s through the 1990s, this was not even on our radar as an issue. It is now very well known and documented. I continue to be amazed by the awesome power placed in our hands as midwives. We have the power to affect human lives in many life-changing ways. The reverse side is that we have the power to hurt if we are not at our educated and sensitive best. For most of us, our training does not touch on the delicate subject of sexual abuse or rape, even though we may study psychological issues.

The midwifery calling brings with it so much responsibility. I hope that, moving forward, all midwifery education will train midwives in how to best serve these mothers. I hope all midwives will educate themselves about these issues in order to help more mothers and, in the long run, improve outcomes not only for the birth, but for life.

The Motherbaby Press book, Survivor Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse by Mickey Sperlich, CPM, and Julia Seng, CNM, and When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women by Penny Simkin and Phyllis Klaus, are musts for both your personal library and your client library.

You can also learn about this issue at many Midwifery Today conferences, and by listening to conference tapes. This is an important part of your education because, to repeat, one out of every three to four of the women you serve will have experienced—and may still be suffering from—this travesty.

Jan Tritten, Midwifery Today

Your Birth

2009-10-06T18:37:00Z

This is what I want to say to every young woman in the world: your birth is the most important event in shaping your life as a mother. It is imperative that you be properly cared for, nurtured and, in this culture, educated. You need a loving midwife, because the effects of the birth year—positive or negative—will affect your whole life, your baby’s whole life, and indeed society, as your decisions reverberate through herstory. Even with good midwifery care, prenatal self-care is essential—this is what you do between your visits with your midwife.

If you think you cannot afford the midwife of your choice, because maybe insurance doesn’t cover her or maybe you have no insurance, please think again. Even as an out-of-pocket expense, it is nothing compared to a traumatic birth year. As I sit at my desk and read the many birth stories that women submit to us, I read of the trauma and pain they have endured and realize that loving midwifery care may be the single most important thing we can do as a society. Many of the stories we receive are of a horrendous first birth, after which the mother goes on to have a miraculous second birth with a midwife. The cost of a midwife’s care is the best insurance in the world, at any price.

If you must go to the hospital be sure to get yourself a doula, because in almost every hospital birth you need an advocate and a protector. It is a sad testament to what is going on this world, but it is true.

Jan Tritten,

Midwifery Today

Tips for Maintaining a Healthy Pregnancy by Robin Lim, CPM

The Prenatal Water Workout by Jill Cohen

The Complexities of Birth

2009-09-22T20:47:00Z

A mother’s birth is first a physical event, but if the psychological aspect takes over it may be impossible for the birth to proceed as a straight-out physical event. In this case, the mind needs to be cleared in order to fall into the primal brain, where the birth works best. And then there are the physical realities of position, flexion, fit, pelvic shape, and the weight of the baby. Now add to all of this the reality that birth is also a spiritual and sacred passage. Birth is so incredibly complex and yet so amazingly simple, with so much room in between for glitches.

Medicalized hospital birth does not deal with these realities and subtleties, as it rolls over motherbaby birth rights with interventions, including inductions, drugs and cesareans, often for something it has created. As birth practitioners, we totally individualize care. When you do this you really see, smell and feel this sacred passage, and try to do your best for each family unit.

Why, when the loving beauty of relationship and individual care can be an integral part of birth, are more families not choosing us? Is it lack of knowledge about us or fear that stops them? How can we turn the tide?

Jan Tritten

Midwifery Today

Editorial: The Power Belongs to Motherbaby - by Jan Tritten

Editorial: We Can Improve Primal Health - by Jan Tritten

Working in the Same Community over Time

2009-08-25T20:50:00Z

In our birth practice, we always had so much trouble saying goodbye to the mothers we served. You know how accustomed you get to seeing them weekly, by the end of the pregnancy? Prenatal visits often happened with a lot of laughing and information flying, blended with the seriousness of the most important passage in a mom’s life. I have been blessed with working and living in the same community for almost 36 years. This has made the finishing of care (until the next time mom would get pregnant) easier.

I make lemonade at both the Saturday Market (our local crafts market) and the Oregon Country Fair (our big annual “hippy” fair). One day before this year’s fair opened I was walking over to the line to get my wristband (needed for entrance into the fair), and I ran into a mom and her 31-year-old “baby.” I had not seen either of them since their postnatal visits, but there they were. Women almost always remember their midwife. We chatted a bit and I continued over to the line, where I ran into another one of my mothers with her “baby.” This time, the “baby” had a charming little baby of her own. The circle of life is always amazing to me.

We now have a great intern at Midwifery Today, and I was her midwife. She was the baby. I have had the privilege of ongoing relationships with many of the mothers and babies I served, simply because I was at the Saturday Market every week and they would often come and find me and ask questions or just share their lives with me. These little pleasures are the joy of living and working in the same community over time. They are the little pleasures that make life so rich.

Jan Tritten

Midwifery Today

Editorial: 20 Years of Carrying Out a Calling - Jan Tritten

Editorial: Carry Out Your Visions and Dreams - Jan Tritten

Editorial: Molly and Mary - Jan Tritten

Health Care Needs Midwives

2009-08-11T20:14:00Z

Midwifery is the answer to the question, “how can we afford national health care?” If every motherbaby were attended by a non-interventive but knowledgeable midwife, a national health care program would save billions of dollars on the four million births that occur in the US each year. Imagine the cost savings on drugs, induction, hospital--yes, normal births should be out of hospital. We are trying to save money and improve care. Then, with midwifery care, most mothers would breastfeed because midwives take the time to educate. Think of all the health care dollars we will save on the long-term health of mothers and their children--who, of course, are the adults of the future. I wonder if we can even afford national health coverage without midwives.

Please support the Mothers and Midwives in Action (MAMA) Campaign’s effort to make Certified Professional Midwives a part of the health care system. You can donate or volunteer at the above site. I pray that we will not get co-opted into the system, but can be leaders for mothers and babies in getting the care they need. I also pray that once a part of the system, CPMs will support their non-CPM midwife sisters in their efforts to serve motherbaby. As I have said before, we all need each other. We will make it only with respect and cooperation.

Jan Tritten

Midwifery Today

American College of Nurse-Midwives’ (ACNM) Declaration

2009-08-05T17:32:00Z

I was horrified when I read the American College of Nurse-Midwives’ (ACNM) declaration of opposition to federal recognition for the CPM, or Certified Professional Midwife. One of my most recent blogs was on unity within the midwifery profession, and was written before this declaration came out. I had wanted to write something on this topic, but found that Geradine Simkins, Certified Nurse-Midwife and MANA Board President, had already written a well-thought-out open letter to the ACNM Board of Directors and Executive Director. Please read it, as the future of midwifery is in the balance.

If you are a CNM, please write to your board and state your objection. It is more powerful coming from each of you. We must--let me repeat, must--work together for the good of motherbaby and midwifery or this division will result in our failure. We each have areas of expertise and influence, but divided we will fall.

Jan Tritten

Midwifery Today

What is a "Real" Midwife?

2009-07-07T17:58:00Z

Guest Post by Lynn Baptisti Richards

(Lynn Baptisti Richards, BS, Ed, LM, is a performing and visual artist, a midwife and a writer.)

I thought I was the only one (or nearly the only one) who feels that midwives have been sold a load of crap. The desperate need for us to be legally safe from prosecution produced a co-option of midwifery into the medical system—the very thing we so despised. We are supposed to be the alternative to medicine, not mini-doctors. The rules and regulations allow the State to make decisions that the parents and the loving attendants (now called midwives) should be making. Women have lost their power again, and they think they have gained it! What a farce!

I bet you didn't know that in order for the licensed midwives in the State of Arizona to get better rules and regulations, they supported the criminalization of the practice of unlicensed midwives! And we call one another "sisters"?

I had practiced illegally in NY for more than 15 years, primarily attending VBACs, breeches, and twins—the women who, without me, would have been "sectioned." I was the alternative! I told every woman, "All of the decisions are yours, unless we have an emergency. Then, all of the decisions are mine!" And so, there was "true informed consent." My classes, which went to the core of the matter of birth, death and life, were the most important thing I ever did. Women discovered themselves, in all aspects of their lives. When they shouted, "I did it... I did it... I did it!" they had not only given birth to their babies, they had given birth to themselves. What we have now is nothing like a woman-empowered birth!

When I arrived in Arizona, I got a license and kept a double set of records, "the birth that actually happened" and "the birth which the State wished had happened." But the worst was that it was the other midwives who reported me to the State for doing VBACs! That was it for me! I was done.

The midwives of today see themselves as professionals. I wonder how many of them would have been midwives in the climate of the ‘70s and ‘80s. We were revolutionary outcasts, pushing up against the very system the midwives have now joined.

Of course, I do not ever want to see a midwife arrested for her practice, but I believe that to be a "real" midwife, you have to be willing and ready to put everything, who you really are, on the line, for the sake of the empowerment of the woman!

Editorial: Don't Sell Your Sisters Down the River - by Jan Tritten

Editorial: How Do You Feel About Giving Up Your Freedom? - by Jan Tritten

Support All Types of Midwives

2009-06-24T21:46:00Z

My role in midwifery, besides being a midwife and journalist, is to support and encourage all midwives. I do support “The Big Push for Midwives.” I really want to see CPMs (Certified Professional Midwife) be part of the healthcare system, and I support CNMs (Certified Nurse Midwife) as well. We are all called to reach mothers and babies in different circles and from differing beliefs and backgrounds. As a midwife in the 1970s, I knew that many of our mothers who chose homebirth would have had their babies at home whether we were there or not. We became midwives with this particular push. These women needed midwives and they called us out serve. We were, and many of us are, proud lay or empirical midwives.

I encourage each of you, no matter what your license or certification, to respect each other. There are many midwives with the experience of thousands of births who have decided not to become certified. There are many entry level CPMs. There are CNMs who do homebirth, and there are high-risk-serving CNMs. I have been promoting unity within this profession for over three decades. We are so very far from that, but at the very least I say we can respect each other. We all respect the women we serve. I find that midwives in the US respect women so, so much. If we extend that respect to each other—most us are women—we will make it. That is, midwifery will become the norm. Division will only tear us apart. It is tearing us apart.

My one concern is shared by a Facebook friend:

“Personally, I am concerned that the push for midwives right now will end up excluding the very women that need and desire midwifery care. I hope that those who are helping to get CPMs as the standard for maternity care are also pushing for women to be able to have choices ... even VBACs, twins, breeches, etc. I would hate to see midwives sacrifice those women in favor of being able to serve 'more women' in the long run. As a student midwife, a consumer of midwifery care, and a VBAC mother I am afraid for what is happening to our choices as birthing women.”

I am concerned that if CPMs give up too much in order to get recognition, that they will end up serving the profession rather than women and babies. At Midwifery Today, we are working with midwives who are good at Twin, Breech and VBAC births, and we are doing conference classes on reclaiming those areas. Midwives are generally the only practitioners who will handle these as variations of normal. Midwives are the practitioners who recognize and approach birth as normal to begin with (this, of course, includes doulas, childbirth educators, and activists). The world is in a sorry state in the way birth is viewed. That is why we must all work together to make change—each in our own sphere of influence, and respecting others. If we don’t, we will be seeing more women choosing to birth by themselves because midwives aren’t there to help them. AND—as I have been predicting for decades—if we get too absorbed into the medical system, a new grassroots, lay midwife movement will start and I’ll respect, encourage and support that too.

Jan Tritten

Midwifery Today

Editorial: Don't Sell Your Sisters Down the River - by Jan Tritten

Editorial: Let's Work Together - by Jan Tritten

The 10 Commandments of a Good Birth

2009-06-20T21:29:00Z

These were originally posted on our Twitter page. Number 1 is by Gloria Lemay; 2-10 are by Jan Tritten.

A good midwife is worth her weight in gold if you want a good birth experience. Shop carefully and pay her well.
Thou shalt eat a healthy diet: 80-100 grams of protein, salt food to taste and lots of fruits and veggies and eat seafood; and be happy.
Trust Birth, trust yourself. You can do it.
Prenatal care is what you do between your visits to your care provider. Eat well. Love lots. Reduce stress. Your baby will appreciate it!
Homebirth: the gold standard. If possible, stay home for your birth. Birth centers are a good option, too. When necessary, hospitals save lives.
Avoid unnecessary technology like the plague. It may be the plague - including ultrasound (Dopplers and scans) during pregnancy!
Just say no to drugs and intervention.
Your body is perfectly designed to carry, grow and birth your baby. If that isn’t enough, your body can feed your baby too!!
Birth Works; let it. Know that you can do it. It is an awesome and important step to motherhood - a miracle you can achieve.
Thou shalt breastfeed your baby for as long as possible. The health benefit for motherbaby is unsurpassed by any other act. Breast is best.

Jan Tritten

Midwifery Today

Read these articles by Gloria Lemay.

Cytotec for Birth is Dangerous

2009-06-16T19:19:00Z

When I first started doing homebirths 32+ years ago the mortal sin was to use buccal Pitocin (the pill form, which is put under the tongue to begin or augment labor.) The reason that it was a no-no is that it might cause tetanic contractions, which can lead to uterine rupture, problems with the baby, or both. Moreover, once it is begun, the absorption of that dose cannot be controlled or stopped quickly enough to safely stop those extra-hard contractions.

Today the drug Cytotec (misoprostol) is used just as cavalierly. It has the same hazards, plus more (hyperstimulation of the uterus, which can lead to fetal distress, amniotic embolism, uterine rupture, fetal death and postpartum hemorrhage). Several years ago a man called our office crying. His wife and baby had just been killed as a result of the doctor administering Cytotec, which ruptured her uterus and killed them both; or was it manslaughter?

The side effects of Cytotec are well-known, yet its use is rampant in many countries by physicians and midwives. If you are a midwife who uses it, I beg you to stop. It is dangerous. If birth doesn’t happen normally at home it belongs in hospital—without Cytotec.

Marsden Wagner wrote articles for Midwifery Today about deaths associated with Cytotec. Click here to read his articles on our website.

Jan Tritten

Midwifery Today

Stop the Misleading Sensationalism!

2009-06-03T18:56:00Z

The News & Observer of North Carolina ran an article on May 27 entitled “Police probe home birth; baby died.” When I went to the site to read the article, I learned that “A woman who delivered a baby into the toilet and told emergency dispatchers she had not known she was pregnant is now part of a police investigation into possible child abuse.” Excuse me? This is not a homebirth.

If this had occurred in a hospital toilet, would it be a hospital birth? If it occurred in a school would it be a school birth? The use of the term “homebirth” in this context is just sensationalism. This is a tragic situation; it is not a homebirth. Using this kind of language is misleading and only adds to the already difficult task that we have of educating people about homebirth. But then, I guess the media doesn’t really care about that. Anything to sell a newspaper.

Guest post by Cheryl K. Smith, Midwifery Today Managing Editor

Here is some information about homebirth from our site.

Developing a Birth Philosophy

2009-05-20T20:11:00Z

A wise and important step in preparing for midwifery is to develop a philosophy of midwifery and birth. We once taught a conference class in London, England called, “Midwifery: A Profession Looking for a Philosophy.” My friend, Suzanne Colson, believes that midwifery is all over the board without a strong underlying philosophy. That means that it is up to the individual to think about, discuss and develop her own philosophy.

Knowing your birth philosophy will help put a strong foundation under you. This foundation will serve you well when the pressures of education and or practice begin to overtake you. What are your ideals?

I believe that the protection of motherbaby is key to a philosophy of birth. We should never compromise them just to make a doctor or institution happy. Love and dedication are the foundation for such a philosophy. Do we serve motherbaby and families or do we serve “the Man” - meaning our certification, licensing, laws or doctor back up?

The midwifery model encompasses being careful, really careful to protect motherbaby. Unnecessary and/or routine tests, ultrasound, fetal monitoring and induction and other non evidence-based “standard(s) of care” - or lack thereof - put motherbaby in the dangerous path of a technological freight train about to hit them. Anything done to a motherbaby should be very carefully considered for safety. No harm - mental, physical or spiritual - should come to this precious motherbaby.

I realize that doulas and midwives have to deal with the added complication of dealing with parent’s philosophies. It is hard to protect those who won’t protect themselves or just don’t know. We need to consider how to better inform them of the miracle they are living, as well as the pitfalls of the mindless use of technology.

What is your philosophy of midwifery and birth? Write and tell me about it. If you are a beginning midwife or doula, it is essential that you take the time to work on this important aspect of answering your call.

Jan Tritten

Midwifery Today

Editorial: Hands-On Care by Jan Tritten

Editorial: Giving Voice to Wisdom by Jan Tritten

Protecting Mother and Baby

2009-05-17T14:56:00Z

I believe that midwives and doulas, despite their already large workload, have a duty to protect mother and baby. This role might not have fallen on us before such intense and dangerous interventions were used in pregnancy and birth. However, because of increasing misinformation, myth and medicalization, if we don’t inform them, many, if not most, women (are led to) believe that every test and intervention is necessary and helpful. Testing creates fear and, I believe, is designed either for bilking more money out of families in the childbearing year or for CYA (cover your ass) politics.

I once asked my favorite backup doctor (after he quit backing us) why so many cesareans were being performed and he honestly said, “because of lawsuits.” That means doctors cut a woman open at the time that should be her miracle because they are afraid of being sued. Focus on that, one third of women are cut open because of the possibility of lawsuits. That blows my mind. (Hmmm, there is a title. Modern birth as a mind blower. But all kidding aside.) Motherbaby has been left with a scar so big that it may never heal. This is horrible and society is beginning to show it.

So you can see why we need to protect them from medicalization, intervention and trauma. But how do we do that? With information, insight and love. Midwives and doulas are incredibly well-set for this because they are often the most loving people you will find. Most are curious and are willing to learn so they can better serve those they come in contact with. We can easily teach our clients, and even our friends and the people we meet. We can protect them with what we know and our willingness to fight fear with faith and love.

But how do we increase our sphere of influence? Our culture is so filled with fear, when faith is what is required and what works. It can be hard to get a baby out when you do not trust that you can do it. Unnecessary testing just undermines momma and puts her head and heart in a space that is hard to overcome when labor starts.

I know that we can influence everyone we come in contact with who will listen. Let your passion out. Let it show. There are also many activist “birth change” acts that we can carry out. Midwifery Today has covered this subject in an ongoing way at conferences, magazine themes and articles. It is a large part of what we are dedicated to. See Sara Wickham’s excellent article, “26 Ways to Change Birth.” Let’s all work at birth change. Robbie Davis-Floyd says if we continue to work at it, we will reach “critical mass,” which is 25%. If 25% of people know about great birth and tell other people, we can get reach a goal of permanently changing birth for the better.

Thank you for doing your part. Don’t give up. You are in good company. Together we can do it.

Jan Tritten

Midwifery Today