Monday, October 15, 2007

African Birth Collective

I am in my final days of packing for a journey to Senegal. I am getting prepared to spend three weeks working in three birth centers where I will deliver an average of 30 babies. Not the kind of midwifery I am accustom to! A woman, Kaya Skye, started a program in Senegal a while back, where midwives and midwives in training can go and teach and learn.

Here is some information about the program and how you can help!

It is our experience that there is a real crisis of education among the matrons in Sénégal, who deliver the vast majority of babies. They spend six months in practical training in a local clinic and are then often posted to more rural outposts. During this time they follow and learn from the other matrons and sage-femmes, but they have no academic component to their education. The result is generally an unclear understanding of the anatomy and physiology involved in birth. They are taught “protocol”, which is based on outdated Western medical practices such as extreme fundal pressure, supine delivery positions with stirrups, standard pitocin drips, placental extractions and routine postpartum methergine shots. They are not taught problem solving techniques that facilitate good management decisions or allowed to incorporate traditional methods or alternative positions. There is currently no system of peer review in place, and they do not use charts to document the woman’s labor progress or communicate with other matrons. The sage-femme who heads the clinic is responsible for all the women who come in and is on call 24 hours a day for complications. She has very little time to train the new matrons in special skills or theory. The cumulative effect is that Senegal has one of the highest infant mortality rates in the world: 79 deaths per 1000 live births (World Bank 2002).

African Birth Collective has been able to counter the Western obstetric model that has been handed down through post-colonial education with an alternative view. We support women to walk around during labor, deliver in non-supine positions, and support the perineum to allow for slow restitution of the head and prevent tears. We have also been able to learn effective techniques commonly practiced in Sénégal, such as the “milking” of the cord and inverted resuscitation methods.
Together we are able to understand a wider perspective with which midwifery knowledge can be seen as something always growing and changing, drawing on traditions as well as new experiences. In this light, “protocol” must always be reevaluated to determine if it is both useful and appropriate.

To address the need for a larger transformation of the matrones’ education, African Birth Collective is seeking funding for ENDA Santé to translate “A Book for Midwives” (Hesperian Foundation) into French to use as a teaching tool and reference. We are seeking to develop a closer relationship with the Association des Sages-Femmes Senegalaises, to work together to provide resources and opportunities for rural matrons to expand their knowledge, understanding and respect for birth. We sincerely encourage the appropriate use of both traditional and modern knowledge within this model.

We welcome all midwives, midwifery students and those interested in supporting safe birth in Africa! Your support and love makes all of this possible. Please contact us to find out how you can help. Donations of baby blankets, hats, socks and newborn “onesies” [I think onsies might be a trade name so I would use the quotation marks, at least] are put together in ziplocs for new mothers. Any amount of financial donations will be put toward the purchase of needed supplies or go into our ambulance fund. Local birth centers and hospitals often have expired meds and other supplies that might get thrown away. These will be gladly taken to Sénégal and shared with rural clinics that often have no latex gloves or suture, lidocaine or basic instruments. African Birth Collective has 501(c)(3) status and tax deductions can be taken for all donations. Thank you!

African Birth Collective (a Not for Profit Corp.)
Kaya Skye
595 Weller Ln.
Ashland, OR 97520

Wednesday, October 10, 2007

Sterile Water Papules for Back Labor Relief

I have seen this method of pain relief work at births where the baby was in a posterior position. It can be safe and effective alternative for women wanting to avoid an epidural. It has been reported that the pain relief lasts for 2-3 hours and it can be repeated. The sterile water is injected just unde the skin surface, near the spine, in four places.

In 1965, Melzack and Wall introduced what is now known as the "Gate Control Theory" which suggests that nerve cells from touch fibers can actually close the gate on pain signals to the brain, thus giving the perception of minimized pain. Therefore, for a woman in labor, the brain has the ability to influence the course of her labor and her perception of pain.

In 1975, Melzack and Fox determined that the perception of pain could be altered by introducing a brief period of pain. This, in turn, would alleviate the chronic back pain. An example of this theory is the use of a TENS (transcutaneous electrical nerve stimulation) unit. The TENS unit sends pulses which interrupts the brain's awareness of pain and may also cause a release of endorphins which is the body's natural pain coping mechanism.

Then in 1989, Lytzen, Cederberg, and Moller-Nielsen presented their study on "Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules" in a medical journal. This study included 83 women with lower back pain during the first stage of labor. These women were given injections of sterile water intracutaneously over the sacrum. All but six of the women noticed instant and complete pain relief which lasted up to three hours. The procedure could then be repeated. Sixty-seven of the eighty-three were pleased with the results.

Trolle, Moller, Kronborg and Thomsen introduced their study of "The effect of sterile water blocks on low back labor pain" in the American Journal of Obstetrics and Gynecology in 1991. This study contained 272 women complaining of severe low back pain. The women were randomly assigned to receive either a sterile water injection or a saline solution block. There was a significantly higher degree of analgesic relief for those in the sterile water group (89.4%) than those in the saline group (45%). No adverse effects were noted and the patient satisfaction was high.

The Procedure
The woman's back is cleansed. Then 0.1-0.15cc of sterile water is injected intradermally into four places on the women's sacrum. Preferably, the procedure should be done with two people doing the injections simultaneously. The injections cause an intense burning sensation which lasts 30-90 seconds. Relief from the procedure should be noticed in 2-3 minutes. Because of the intensity of the pain, the woman should have constant support and encouragement during the time of the injections.

Sterile water injections is an excellent alternative for pain relief due to back labor. Even though it may not provide relief from contraction pain, often once the back pain is alleviated, the laboring women can cope better with her labor. Likewise, often the relaxation of the back can assist in the proper decent and positioning of the baby, leading to a shorter labor. With no known side effects and no medications entering the body, sterile water injections may become the choice for the relief of back labor for many laboring women.

Wednesday, October 03, 2007

After A Long Silence

I am sorry I went away for so long. Its been a long year! And really I feel like I am starting this whole blogging thing all over again...we'll see what comes of it. I wonder if there are even any readers still out there (ha!). I recently went to the Waterbirth International Conference and the Free Baby Expo in Portland and felt my desire to write more about midwifery get rekindled. There was a lot of amazing information presented and I think I am back on the rampage. Ricki Lake's movie "The Business of Being Born" was one of the highlights and Ricki Lake was present to field questions. The movie brought up a lot of emotion for many of us around current issues in childbirth. She had a medicated vaginal delivery with her first child, in a hospital, and a homebirth with her second. She addresses issues of choice, education, and the rising cesarean rate--and she does so in a beautiful, non-judgemental way, yet with some fierceness. It is truly a beautiful movie. And, she is making it possible for it to be shown around the country before it comes to theaters. If you click on the link you can watch exerpts from the movie and also find out when and where it is showing.

Ok....more later...I promise!