A Midwife Impact on Her Community
Sondra Jones
English 102 034W
Professor Leslie Jewkes
Fall Semester 2011
Tuesday, November 22, 2011
Introduction
Welcome
This blog contains information on midwifes such as what a midwife does, how they provide emotional support, and how they help accomplish Millennial Development Goals in India. This blog was created by the instruction of Ms. Leslie Jewkes in the fall semester of 2011, during the course of the English 102 034W class. I hope that you will find the information posted below both interesting and helpful. I hope that you find as much enjoyment out of this blog as I did.
Sondra Jones
Monday, November 21, 2011
Local Paper
College of Western Idaho
Emotional Support of Certified or Licensed Midwives versus Obstetric Gynecologists and Certified Nurse Midwives
Sondra Jones
English 102 034W
Leslie Jewkes
10 October 2011
Abstract
The differences between Obstetric Gynecologists, Certified Nurse Midwifes, and Certified/Licensed Midwifes are often misunderstood and misjudged. The obstetrician and Certified Nurse Midwife are often seen as the more reliable healthcare professionals because they work in hospital settings. Yet, can a cold hospital room be compared to the comfort of a home? Or a doctor and nurse yelling push as opposed to a woman’s body naturally contracting as it is ready? Certified/Licensed Midwives come to the family’s home and make the mother the center of care. These healthcare professionals see that each family member is emotionally cared for not just physically. Certified/Licensed Midwives do indeed grow closer to their clients because of the one on one attention. Midwifes use a model of care that encompasses not only the physical attributes of pregnancy but the emotional health and well being of the mother. The care of the Obstetric Gynecologist or Certified Nurse Midwife often does not meet the emotional need.
Pregnancy comes with many feelings and emotions. With any circumstances there is anxiety and joy. Each woman has expectations, hopes, dreams, and fears about bringing a new life into the world. A healthcare provider can bring comfort and support to the mothers and families that are experiencing so many changes. Both an Obstetric Gynecologist’s and a midwife’s goal is to deliver a child safely into the world while providing optimum care to the mother. The emotional health of the mother impacts the pregnancy, birth and life of the newborn. A healthcare provider must offer emotional support to the mother and family and a midwife can often do this best.
Prenatal care of a woman starts when she becomes pregnant and contacts a healthcare provider such as a midwife or an obstetrician. The individual chosen to be the healthcare provider for a family can be influenced by many things: primary care doctors, family members, friends, culture and personal opinions. When a mother chooses to give birth with a midwife she generally prefers limited medical intervention. A family will choose a Certified Nurse Midwife (CNM) who generally delivers in a hospital setting or, a Certified/Licensed Midwife (CN/LM) who generally delivers in a birthing center or home setting. In 2006 it was reported by Vital Statistics that only 0.90 percent of births were outside a hospital and that 61 percent of home births were attended by midwifes (MacDorman 4). An OB/GYN and CNM has less influence and observation time because they are not frequently around families nor do they see clients as often during their pregnancy. CN/LM’s see their clients quite often, conducting home appointments and request to meet with partners and other children. A midwife is able to better emotionally support a women because of the more intimate relationship.
Some healthcare professionals feel that midwifery is not safe when practiced outside a hospital. Jeffery Kluger from Time Health reported, “It's this fact that has always been responsible for the fault line between obstetricians — who are trained to view birth as a medical procedure — and midwives, who see it as that but as something less clinical too." Midwives see birth as an experience, from conception until a family is in a new routine with the new baby. An OB/GYN sees it as a secluded event that must be dealt with and handled. Not all obstetricians feel this way; however, it is hard to get that optimum care when they have so many patients to care for.
In 2006, Idaho had 47,246 births, 45,932 being in a hospital setting and 1,301 being outside of a hospital. (MacDorman, 11) As you can see, home birth is still not generally accepted but is becoming more and more common. Throughout the country, midwifery is becoming more popular as well. MSNBC wrote an article about a family, the Teeples, delivering with local midwife stating, “The Teeples are a part of a small but growing contingent of people choosing to give birth with midwives, caregivers who view birth as a natural, rather than medical, experience and one that should be tailored to a mother’s needs” (More mothers choose midwives for delivery: Number of women giving birth without doctor has doubled since 1990) This article attests to the fact that many families are discovering the joys of giving birth with a midwife.
Generally a midwife will be able to give more time and attention to each one of her clients as she often has a fewer number of clients than an OB/GYN would. Kelley Vandersys is a proud mother of four children who has delivered once in a hospital setting with an OB/GYN, once in a hospital setting with a CNM; and twice at home with two different LM’s. In an interview conducted on the 17th of September 2011, Mrs. Vandersys, when asked about the emotional support received during and after her individual pregnancies, stated that there was “None offered from the OB/GYN or Midwife in the hospital” however, in her first home birth “some, but there was still a chasm because of spiritual beliefs” and with her final birth the LM “stepped into my home and offered support in ways I did not know I needed.”
Generally a midwife will be able to give more time and attention to each one of her clients as she often has a fewer number of clients than an OB/GYN would. Kelley Vandersys is a proud mother of four children who has delivered once in a hospital setting with an OB/GYN, once in a hospital setting with a CNM; and twice at home with two different LM’s. In an interview conducted on the 17th of September 2011, Mrs. Vandersys, when asked about the emotional support received during and after her individual pregnancies, stated that there was “None offered from the OB/GYN or Midwife in the hospital” however, in her first home birth “some, but there was still a chasm because of spiritual beliefs” and with her final birth the LM “stepped into my home and offered support in ways I did not know I needed.”
When a woman becomes pregnant her body begins to change. Hormones inside her body must adjust to provide an acceptable environment for the fetus to develop. The hormone, human chorionic gonadotrophin (hCG) developed by the placenta, notify the woman’s body that ovulation no longer needs to take place (Nilsson, Lars, 84); hCG is also the hormone that is measured on a pregnancy test. (Puryerar, 36) Progesterone, a mussel soothing hormone, (Brown, Struck, 20) and estrogen, which increases the amount of protein production that is essential for fetal growth, will also increase throughout your pregnancy. The fluctuation in these hormones can cause discomfort, sickness, fatigue or moodiness. Having these hormone changes explained in a comprehensive way will aid both mother and father in dealing with these symptoms. Midwifes are often more personable than a doctor and easier to talk to. Many people experience the feeling of walking into the doctor’s office; waiting for 20 minuets; and then not remembering any of the intended questions to ask. The doctor proceeds to talk at the client as opposed to with them. Being open, honest and curious is much easier when the healthcare provider has time to sit and go over the things you are wondering about as well as get to know you as a midwife would.
A mother’s appearance can also affect her emotional state of mind. Some mothers are happy with the way that her body is changing and love the expanding of the stomach as the child grows. Yet others are very self-conscious about the weight that is gained, as well as sexuality, appetite, energy levels, and ones general appearance. Midwifes can continually remind the mother that these changes are normal in pregnancy, giving a woman comfort through the rough days. Suggestions of new ways to sleep, positions to try to reduce pressure, home remedies or nonmedical ways to reduce discomfort can be shared with the mother. While an obstetrician or CNM may offer some of the same ideas, more medical terminology and possibly more intervention would be suggested.
Since a midwife has more communication with the woman’s family, they can make more of an investment in the daily lives of the mother she can make suggestions based on the woman’s situation. If the woman is a first time mother the midwife may suggest a taking a stroll with the partner or a friend daily or if the mother has other children going to the park and walking around or watching the children play may be encouraged. The midwife will be able to determine the correct level of exercise for each individual mother. Eliminating foods that contain allergens and making healthier food choices is always a good option. Diets and exercise if used correctly in pregnancy can greatly benefit both the mother and child. Two Medical Doctors, Dr. Michael F. Roizen M.D. and Dr Mehmet C. Oz M.D., give ideas on a diet plan in their book You Having A Baby. (82-87) Both obstetricians and midwifes can give specialized instructions to the expecting mother on how to handle food allergies and incorporate foods her whole family can eat. Since a CM or LM interaction with not only the mother but the family is so much more intimate and personal that the CM/LM may have a better idea of what is going on and get a better response.
A midwife can offer a great deal of emotional support by offering as much information as possible to the expecting family. Giving the family reasonable expectations about pregnancy, childbirth and postpartum care is critically important to the parents feeling prepared and excited for the birth. Kelly Vandersys stated, “there was an honesty” in referring to the second midwife experience. Setting up friends to bring meals, having a birth plan, making arrangements for children if they need to be cared for during the birth should all be part of a midwifes prenatal visits. This personal care can not always be given by CNM or OB/GYN’s because they have a greater volume of clients.
Screening for problems in pregnancy, as well as possible depression both during and post childbirth is highly recommended to all healthcare providers. Both midwives and obstetricians can reduce fears and frustrations by offering suggestions to mothers struggling with their pregnancy. Giving a woman medical reasons for why she is feeling the way she is as well as offering emotional comfort can aid in reducing stress and anxiety. However, sometimes all a midwife will do is sit and hold the expecting mothers hand and reassure these symptoms will go away and until they do she will be right with her which is something more difficult to do when you have a larger clientele.
A hospital setting offers some peace of mind in that there is emergency medical attention that can be given if anything goes wrong at anytime, however the majority of births that have limited to no medical intervention are completely normal.
After delivery the job does not come to an end for a healthcare provider. The mother still needs a great deal of emotional support and training. She will have questions on how to breastfeed her child if that is her choice. The midwife can teach the mother how to position the baby; how often the newborn must be feed, and how to deal with any complications. If problems arise beyond the knowledge and instruction of the midwife, a lactation consultant may be contacted but generally the encouragement and advice to solve any problems that arise can be provided. In a hospital setting instruction could be offered but not as conveniently or comfortably as in the family home or birthing center.
The mother will also have questions about what happened during childbirth. Kelley Vandersys stated that after each delivery she had no debrief in the hospital; with her first home birth the midwife spoke about the actual birth and worked though questions and concerns, and with her final birth “I was not debriefed as well… partially because my dad died the week after.” Circumstances prevented a formal debrief but the midwife kept in contact to answer any questions Mrs. Vandersys might have had. Mrs. Vandersys stated that she wished she could have had a more complete debriefing. It would seem that talking about the events of ones birth extensively would have a constructive effect on decreasing postpartum anxiety and depression, however, a study conducted by Selkirk, et al and published in the Journal of Reproduction and Infant Physiology concluded that a debriefing session with a midwife dose not decrease post pregnancy depression. (145)
Having several follow up sessions after birth is critically important; not only for screening of physical problems of the mother and infant, but also for physiological and emotional disorders. Shaila Misri, MD, et al states in a study published in the Canadian Journal of Psychology, “Our study suggests that antenatal depression and anxiety contribute to increased maternal postpartum parenting stress. Parenting stress should be included routinely in clinical assessment of women at risk.” (227) A midwife or OB/GYN should be invested in their client to the point that the professional would know what are normal behaviors for the woman, how she interacts with her children, her husband and her family. This is not always possible when you have so few visits with an OB/GYN or CNM. A midwife should be encouraging family members to help the mother care for the baby and the household. Meals should be prepared so that a husband or older child can then put in the oven themselves. Family bonding should be promoted so that each member of the family has a special connection to the new infant.
The midwife often acts as a mother figure when things are going wrong in pregnancy. She is seen as someone trustworthy and dependable. This enables the midwife to be able to more easily identify and remedy problems before they grow to extremes.
Depression; both during and after pregnancy is a serious condition that affects about 12.7 (Palladino, 953) percent of women and is not to be taken lightly by the healthcare provider. If the woman has had a problem with depression in the past or is on an antidepressant while pregnant this should be identified right away; action should be taken to determine if the medication should be continued, modified or safer drugs considered. Discontinuing all medications, when becoming pregnant, has been shown to lead to adverse maternal side affects such as serious postpartum depression or mood disorders. (Bennett, Idman, 37)
The causes of depression during and after pregnancy are many. Hormone changes, lifestyle changes, fears and apprehensions of having a child, outside stressors such as moving, financial trouble, marital problems are all stressors that could affect the mother’s moral. Diana Lynn Barns Psy. D states in her article from “Midwifery Today”, “Besides the myriad feelings that surface, the tremendous chemical changes that occur around the time of delivery and in the months following predispose women to a variety of reactions. During pregnancy, hormonal levels elevate dramatically, particularly levels of progesterone and estrogen. They drop just as dramatically, often within hours to days of childbirth. In addition, the amount of endorphins (those substances responsible for feelings of well-being) produced by the placenta during pregnancy drop significantly after delivery”
A healthcare provider must be conscious to ask questions and get personal with the mother. Once trust is gained a midwife can more easily be a supporter in whatever the mother is going through at the current time. If this emotional support is not enough it is possible that a professional physiologist may be needed to help cope with this depression.
Current studies have shown that depression during and before pregnancies have also been shown to lead to extended hospital stays (Palladino, et al 953-962) if the parents choose a hospital setting. Since CM and LM’s practice outside a hospital this cause of depression is taken out completely unless complications arise.
What is known as the “Baby Blues” is a time shortly after childbirth where the mother is slightly depressed. This could include; sadness, fatigue, anxiety, mood swings, disappointment in herself, her birth, and her baby, an emotional letdown, as well as feelings of being overwhelmed and insufficient. (Bennett, Indman, 38-39) These “Blues” as they are commonly referred to occur in seventy to eighty percent of women (Brown, Struck, 210-215; Bennett, Indman, 38-39) and is not determined to be unusual or a mood disorder. A midwife can be physically present or a spoken with immediately if these symptoms start becoming overwhelming for the mother. It is much harder to explain anxieties in a hospital and often the woman will end up talking with nurses.
More serious depression and mood disorders can occur after childbirth and the midwife must be actively looking for signs and symptoms of these destructive and dangerous behaviors. These behaviors include; depression or anxiety disorders, obsessive compulsive disorders, panic disorders, post traumatic stress disorders and psychosis. (Bennett, Indman, 39-48) The symptoms can range from extreme mood swings and feelings of hopelessness to thoughts of physically injuring the baby or themselves. If these symptoms develop the woman should be referred to a psychologist who has experience with postpartum depression. Midwifes generally do not deal with these issues. Physiologists and Medical Doctors must take the lead with the midwife as a support and point of reference.
Through each of the forms of post partum depression a woman should be assured by the midwife that she is not alone and that the feelings she is having are not her fault. A midwife can give a woman hope by reveling that others have succeeded in overcoming these illnesses and she will too. The midwife can also give personal references to the woman. A healthcare provider associated with a hospital can easily find support groups and specialists for the mother if need be. It is at times easier for the obstetrician or CNM to transfer the mother quickly to other providers in their group or network; however, a midwife will generally give more options and attempt to find someone who the mother connects with not just in a network.
A midwife can offer much knowledge and is involved in every part of the birth process. She makes suggestions, holds the mothers hand, and is a shoulder to cry on. Kelly Vandersys describes it as, “A common bond… an intimacy.” The midwife will be alert and responsive to warning signs of depression and should be involved and have gained enough trust that the mother would be willing to take her suggestions to heart. Though an obstetrician may be the more traditional route, a midwife can not only be the one to welcome your newborn baby into the world, but the guiding strength to lead you through pregnancy and beyond.
Works Cited
Barnes, Diana Lynn Psy. D. “What Midwives Need to Know about Postpartum Depression”. Midwifery Today. Spring 2002. Web. 15 September 2011.
Bennett, Shoshana S. Ph.D, Pec Indman, Ed.D., MFT. Beyond the Blues. San Jose: Moodswings Press, 2003. Print
Brown, Sylvia, Mary Dowd Struck, R.N. M.S. C.N.M. The Post-pregnancy Handbook. New York: St. Martins Press, 2002. Print
Kluger, Jeffrey. “Doctors Versus Midwifes: The Birth Wars Rage On.” Time Health. 16 May 2009. Web. 6 October 2011.
MacDorman, Marian F Ph.D, and Fay Menaker, Dr. P.H. C.P.N.P. "Trends and Chareteristics of Home and Other Out-ofHospital Births in the United States, 1990-2006". National Vital Statistics Report. 3 March 2010. Web. 2 October 2011.
Misri, Shaila MD, FRCPC, Kristin Kendrick, BA, Tim F. Oberlander MD, FRCPC, Sandhaya Norris MD, FRCPC, Lianne Tomfohr BA, Hongbin Zhang, MSc MEng, Ruth E Grunau, PhD, RPsych “Antenatal Depression and Anxiety Affect Postpartum Parenting Stress: A Longitudinal, Prospective Study” Canadian Journal of Psychiatry. 55.4 (April 2010): 222-228. EBSCOhost. Web. 15 September 2011.
“More mothers choose midwives for delivery: Number of women giving birth without doctor has doubled since 1990”. MSNBC.com. 28 October 2006. Web. 5 October 2011
Nilsson, Lennart, Lars Hamberger. A Child Is Born. New York: Random House Inc., 2004. Print
Palladino, Christie Lancaster M.D, M.Sc., Heather A. Flynn, Ph.D., Caroline Richardson, M.D., Sheila M. Marcus M.D., Timothy R.B. Johnson, M.D., and Matthew M. Davis M.D. MAPP. “Lengthened Predelivery Stay and Antepartum Complications in Women with Depressive Symptoms During Pregnancy.” Journal of Womens Health 20.6 (2011): 953-962. EBSCOhost. Web. 16 September 2011.
Puryear, Lucy J. M.D. Understanding Your Moods When You’re Expecting. Boston, New York: Houghton Mifflin Company, 2007. Print
Roizen, Michael F. M.D., Mehmet C. Oz M.D. YOU Having a Baby. New York, London, Toronto, Sydney. Free Press. 2009. Print
Selkirk, Rosemary, Suzanne McLaren, Alison Ollerennshaw, Angus J. McLachlan, Julie Moten. “The longitude effects of midwife-lead postnatal debriefing on the psychological health of mothers” Journal of Reproductive and Infant Psychology, 24.2. (May 2006) 133-147. EBSCOhost. Web. 16 September 2011.
Vandersys, Kelly. Personal Interview. 17 September 2011. Poem
Sondra Jones
Collage of Western Idaho
English 102 034W
Leslie Jewkes
5 December 2011
Midwife
English Sonnet Format
The one who supports and offers strength
When constant discomfort plagues your day
Your pregnancy has reached its length
And the labor pains have come your way
Knowledge and wisdom flow from her soul
Answers to questions will surface
She guides and comforts you as a whole
And reminds you of your purpose
Her hands bring love and security
To all who feel her touch
Delivering love and purity
An infant loved so much
Though her title is simply midwife
She brings peace to the circle of life
Obituary
Obituary
Sondra Jones
Collage of Western Idaho
English 102 034W
Leslie Jewkes
Martha Moore Ballard
Feb 1735 through May 1812
Wife, Mother, Midwife, Friend.
Martha worked as a midwife both in her place of birth, Massachusetts and in Maine. She was a respected member of her community and was called upon in times of sickness as well as birth. She was a healer and comforter. She was a woman who loved her children and trained each of them up in the best way she saw fit. Martha loved and enjoyed her work. She enjoyed working in her garden and moved it wherever she went. She carefully documented her life through a personal journal. She moved from Massachusetts to Main in 1777, and later to a home built by her husband and sons. She enjoyed her family and caring for the people around her. She worked hard throughout her life, both in the trying times and the joyful ones. Proceeded in death by three daughters Triphena, Dorothy, and Martha, and her niece, Parthenia Barton Pitts, survived by her husband Ephraim Ballard (Married December 19, 1754) and children; Cyrus, Ephraim and Lucy Towne, Jonathan and Sally (Pierce), Moses and Hannah Pollard, Barnabas and Dolly Lambard and Ephraim Jr. and Mary (Farwell) and many grandchildren. She was seen as a mother to all those around her and loved and respected by everyone. She will be loved and missed and her legacy will carry on through generations.
Visual Element
Sondra Jones
sondrajones@mycwi.cc
English 102 034W
Visual Element
5 December 2011
sondrajones@mycwi.cc
English 102 034W
Visual Element
5 December 2011
A Midwifes Tools
Kelley Vandersys Interview
Sondra Jones
sondrajones@mycwi.cc
English 034W
Kelley Vandersys Interview
5 December 2011
9-17-11
Kelley Vandersys (KV) interview
Interview Sondra Jones (SJ)
SJ: How many children do you have?
KV: I have four children.
SJ: How many of your children have you had with midwifes?
KV: 3
SJ: Did your births take place at home or in another facility such as a hospital or birthing center?
KV: 2 in the hospital
2 in the home
SJ: Why did you chose to give birth with a midwife as opposed to traditional methods of birthing?
KV: Majority of my exposure to delivering with a midwife was with a girlfriend of mine who was a dula speaking of how our bodies are made to give birth, and how drugs and medical birth “sharing that information” encouraging to deliver with a midwife. Fear of wanting to be in a hospital if something went wrong midwife in hospital was compromise.
SJ: How did your family react to you’re decision to give birth with a midwife?
KV: Hospital- extended family did not know. Mother knew. No negative from extended that new Husband supportive in seeking out. Knew doula desire to be in a midwife
Home- labored with doula in house with second child. Worst part of labor driving to hospital and examination. Doula only did hospital births. After experience more in tune with body. She wished doula had delivered baby.
SJ: What did your friends think of your decision?
KV: Home- grandma and aunts nervous. No negativity. ‘oh I could never do that’
SJ: How were you first introduced to the art of midwifery?
KV: Doula. Started ordering mothering magazine
SJ: Did you know other people who had giving birth with midwifes prior to your own pregnancy?
KV: Home- 1
SJ: Is there a large midwifery community in your area?
KV: Yes
SJ: How did you find a midwife?
KV: Home- The Doula suggested for the first
Hospital- insurance referral
SJ: Did you have the same midwife for all your children or different ones?
KV: Different midwifes
SJ: What were some differences that you experienced with different midwifes?
KV: Hospital- essentially medical prenatal care and birth empowerment mostly from dual did not feel like I sad say or knowledge of why things were being done
Home- much more personal apps being at home. Much more personal laid on bed not examine table know me as a person table. Informed not all these tests taken. Given info and pros and cons about tests. Risk factors empowered by knowledge wit TVM educated me a lot and were very supportive body’s were designed to give birth and interfere as least as possible. Kids were able to meet midwife. Kids were involved in pregnancy and birth family participation
Karen- realized no tests needed. Less concern. Honesty and openness. Having a faith understanding creation . hormones in depth. Completely involved kids.
SJ: What sort of emotional support did you receive from your midwifes?
KV: “None from midwife in hospital”
Home- no nursing support chasm between midwifes because of spiritual believes patient doing job but still more personal
Karen- stepped into home emotionally in ways she didn’t know she needed. Teams of support for labor post partum labor, lost dad 7 days after birth because of Karen and her treatment allowed me to drive to California 9 days after birth. Was not just a job emotional investment to me and my family. Lasted far beyond 6 week checkup daily checks or assistant daily checks someone at home emotionally and physically lasted till child weaned at 22 months physical and emotional
SJ: Did you midwife offer you spiritual support as well?
KV: Only Karen
SJ: What sort of pre natal advice/ support did your midwifes offer?
KV: Hospital slim to none, nothing
Home- promoted more whole foods, diet, aside from kids coming noting much child included child cut umbilical cord
Karen- eliminate food allergies, extreme diet with provided recipes food prep and buying food, promote acidophilus, no reflux baby. Talking with children about helping mom and being big siblings, oldest child respocilbiity. Given them a job gave them a role in everything in visits gave children an importance
SJ: During your pregnancy what type of relationship did you develop with your midwife?
KV: Hospital hardy any
TVM verry little
Karen incredibly emotional connection spiritual aspect almost a sisterhood common bond an intimacy
SJ: Were you satisfied with your birth experience?
KV: Hospital- out of control epidural knew nothing as satisfied as knew to be. Out of control
Hospital midwife- physically in control. Not emotionally. Doula and midwife knew least med intervention.
Home - yes extremely happy to be home even though I was sick pushing part was not rushed. Delivery controlled
Karen- very satisfied. Less in control of pushing part end was a rush. Could be getting out of water. Rushed a lot more chaos more going on.
SJ: Would you recommend giving birth with a midwife to other women?
KV: At home absolutely. Encourage in a birthing center
SJ: Did your midwife debrief you
SJ: Hospital No
Home Yes. Good conversation talk through confusion
Karen. Not debriefed as well partially with dad dying. Some but not as much as would have liked. Circumstance .
Nora Kropp Interview
sondrajones@mycwi.cc
English 034W
Letters of Inquiry
5 December 2011
11-9-11
Nora Kropp (NK) Interview
Interviewer Sondra Jones (SJ)
Conducted over the phone.
SJ: What are your Credentials?
NK: Certified Practical Midwife Trained Masters of public health specializing in maternal and child heath
SK: How long have you been a midwife?
NK: 10 in the US and 6 in India
SJ: Different certifications?
NK: Just US
SJ: Where did you receive your training?
NK: Maternidad La Luz
SJ: Where is it located?
NK: El Paso Texas
SJ: How many midwifes do you have working with you?
NK: I don’t actually work as a midwife. I work on the research end but the midwifes there are some foreign some auxiliary midwives and government midwifes some Dias who are self taught low tech midwifes.
NK: I don’t actually work as a midwife. I work on the research end but the midwifes there are some foreign some auxiliary midwives and government midwifes some Dias who are self taught low tech midwifes.
SJ: Where did the majority of them receive their training?
NK: Usually from government school nursing schools, private education coming up for midwifes in agreement with the government.
SJ: How much does it cost to become a midwife in India?
NK: That’s a good question. I don’t know but you could look it up on Google, look up Auxiliary Nurse Midwife General NM in India look for an education program
ANM one and a half to 2 GNM 3 based on quality of school
SJ: Are private a better quality?
NK: usually.
Had to stop for the night because of circumstances… plan to continue tomorrow.
11/10/11
NK: What exactly is your topic about?
SJ: Midwifery’s impact on the MDG’s
NK: Oh that’s an awesome but broad topic.
Experts from conversation….
The biggest problem in India is there are not enough skilled birth attendants.
Upper and middle class Urban India is over medicalized but poor Urban and rural areas often have no care.
National Family Health Survey shows that high maternal mortality is driven by rural India mostly in the North. There is a huge rural population and do doctor for sometimes 80 miles. And they have no transportation.
The three Delays are generally responsible for maternal Death in India.
The thee delays that need to be addressed to save motherhood are
Delay in recognizing a problem. Delay in seeking care. Delay once care is sought classically this is how it happens. In urban areas when care is sought there is a chance people will reject by the hospital because of no insurance or not enough doctors.
There are two types of facilities people can go to government and private.
SJ: Are private facilities generally better?
NK: Government are not as good as private institutes (hospitals). Doctors and nurses are over worked and under paid. Nurses do a lot of delivery. Doctors will not show up a lot of the time. Doctors that the government employs will often have privet office. So they will work in the government hospital in the morning and in the evening in their practice so that they can make more money.
The government has mainly focused on putting money into institute system.
SJ: so the government has basically said to decrease maternal mortality just put everyone in an institute.
NK: Yes but they can be full. Like we talked about in the third Delay
The main problem is hiring and keeping specialists like OB’s, anesthesiologists, surgeons, and other healthcare professionals for lifesaving measures.” They have trouble figuring out how to attract good and quality practitioners in rural areas because of Water quality, lack of reliable electricity, bugs, wild animals, lack of education opportunities for children, and lack of social companionship
NRCHM is a good resource.
OSHA workers are hired by the government to attract women and increase institute activities to get all women into institutes.
Auxiliary Nurse Midwifes did not meet WHO qualifications as skilled birth attendants. So many countries including India attempted to give more training and allow ANM’s to do more. In India sometime in the 80’s I think they conducted a study where they trained the ANM’s for 10 years but the training was not very good and the program did not decrease mortality rates. So they discounted the program and started funneling money into institutions.
But all around the world they are finding that continual training of ANM’s is less expensive and more effective.
But ANM’s do so many things.
There is suppose to be 2 ANM’s per public health clinic but there is only one. They do many other things like polio vaccines, tuberculosis programs, education. May is not skilled in labor and delivery. Some really good ANM and make the huge differences in the community. They defiantly make an impact.
Many never take up the path of attending childbirth.
On paper all the government is doing is a good thing but in reality they can get paid and do other things other than attend births.
SJ: Wow that is so much information thank you so much for being willing to work with me and fit me into your busy schedule
NK: No problem. If you need me any further go ahead and send me an e-mail
SJ: Thank you have a safe trip back
NK: Thank you goodbye.
Letters of Inquiry
Sondra Jones
sondrajones@mycwi.cc
English 034W
Letters of Inquiry
5 December 2011
Nora Kropp
Midwifery Consultation
Bangalore India
Sent on November 9, 2011
Hello,
My name is Sondra Jones and I am a student from Boise, Idaho USA. I am doing a project on midwifery and childbirth and a specific paper about India and the Millennial Developmental Goals. I have a few questions I would love to be able to ask you. If you have any time at all please let me know. I would very much like to have your input.
Thank You
Sondra Jones
Received Reply November 9, 2011
Hi Sondra, My name is Nora Kropp. I am a member of the Bangalore Birth Network and Birth India and am a midwife and public health professional. I am currently in the US until Tuesday. Feel free to give me a call to discuss. Best, Nora 847 256 0314
Achieved Interview 11-12-11
And
Divya Deswal
Childbirth Educator, Doula, Hypnobirthing Practioner
Delhi India
Sent on November 9, 2011
Hello,
My name is Sondra Jones and I am a student from Boise, Idaho USA. I am doing a project on midwifery and childbirth and a specific paper about India and the Millennial Developmental Goals. I have a few questions I would love to be able to ask you. If you have any time at all please let me know. I would very much like to have your input.
Thank You
Sondra Jones
Dr. Karen Erickson,
NP, LM
Sent on 16 November, 2011
Dear Dr. Karen Erickson,
Here is a list of questions for you that will help me in my research if you would fill this out as soon as possible I would appreciate it. I can come by and pick it up from you as well.
Some of these questions might seem silly but I need them for this class.
What are Your Qualifications?
Where did you attend school?
How long have you practiced as a midwife?
If women were to only get one feeling or idea from working with you what would you want that to be?
How do you promote that?
What kind of emotional support do you offer prenatally?
How do you encourage women to avoid depression during pregnancy?
What lifestyle changes when women become pregnant such as diet, exercise plan?
What are your feelings on antidepressants in pregnancy?
What kind of emotional support do you offer postpartum?
How do you deal with postpartum depression?
What are the major causes of depression postpartum other than hormonal changes?
Why do you think homebirth is superior to a hospital birth?
Do you believe any woman with a low risk pregnancy could have a home birth?
Why do you teach others the art of midwifery?
What kind of breastfeeding support do you supply?
Do you include families in you care or just mother baby?
How widely accepted is Midwifery in Idaho?
In the United States?
What in your opinion causes women to turn to home birth as opposed to a hospital setting?
How do you promote emotional well being throughout pregnancy, child birth and postpartum care?
Is there any other comments you have regarding why a midwifes physical care is better than another healthcare professional?
Is there any other comments you have regarding why a midwives emotional care is better than another healthcare professional?
Thank you Dr. Karen for being willing to participate with me in this!
Sincerely,
Sondra Jones
No Reply was given.
Requested interviews
September 16
September 22
October 18
November 7
Did not work it out.
From: Red Miller <red@birthindia.org>
To: Sondra Jones <jones.sondra10@yahoo.com>
Sent: Tuesday, September 6, 2011 10:39 PM
Subject: Re: Website Submission - A few questions
To: Sondra Jones <jones.sondra10@yahoo.com>
Sent: Tuesday, September 6, 2011 10:39 PM
Subject: Re: Website Submission - A few questions
Dear Sondra,
Thanks for contacting Birth India!
Of course I would be happy to help you!
You are welcome to send your questions and I will try to answer as soon as possible. I am a midwife from the states and the director of Birthvillage Natural Birthing Center in Kerala.
If you would like to interview other professionals in India please feel free to return to the Services Directory on the Birth India website and contact any other birth professional directly!
Kindly
Red Miller
Midwife
Birth India Advisory Board Member
Thanks for contacting Birth India!
Of course I would be happy to help you!
You are welcome to send your questions and I will try to answer as soon as possible. I am a midwife from the states and the director of Birthvillage Natural Birthing Center in Kerala.
If you would like to interview other professionals in India please feel free to return to the Services Directory on the Birth India website and contact any other birth professional directly!
Kindly
Red Miller
Midwife
Birth India Advisory Board Member
On Wed, Sep 7, 2011 at 5:44 AM, Sondra Jones <jones.sondra10@yahoo.com> wrote:
Hello,
I am a student in the United States taking an English class that I need before I enter a Midwifery Program. I am writing a paper on midwifery in India and I was wondering If I could interview you over e-mail for my paper. Thank you for your time,
Sondra Jones
I am a student in the United States taking an English class that I need before I enter a Midwifery Program. I am writing a paper on midwifery in India and I was wondering If I could interview you over e-mail for my paper. Thank you for your time,
Sondra Jones
--
There is power that comes to women when they give birth. They don't ask for it, it simply invades them. Accumulates like clouds on the horizon and passes through, carrying the child with it.
~Sheryl Feldman
Red Miller
From Sondra Jones
To: Amanda Taylor
For school this year I am taking an English class as part of my prerequisists for midwifery school, however we were allowed to choose our own topics to write on and I chose "A Midwifes Impact on Her community." So I was wondering If you would mind sending me sort of a synopsis of your experiences with midwifes. Ranging from prenatal care to when your care ended if ever :) this does not need to be too detailed but just a birth of information. If you a re able to get it to me by Wed or Thurs I can use it for the project I am currently working on if not I can use it in an upcoming paper.
I compleatley understand if you are buys and do not have time. Please do not feel pressured at all! I have other resources I can use but I would love to have your perspective!
Also please do not be worried about what you say. If you had any negatives as part of your experience pleas express them! If you had any concerns express them! These papers I am presenting should show a realistic look on midwifes strengths and weaknesses and getting the views of mothers and families iis incredibly vital!
Why did you choose a midwife for your care?
What did you experience during your prenatal care?
What was the best advice you were given?
How did the midwife treat you?
How did the midwife treat your family?
Were family members included in your care and delivery?
Were you comfortable with the midwife you used?
What feeling did you leave your birth experience with?
What resources were made available to you?
What emotional support did you recevive?
Thank You !!!
Answer:
I seriously only have a few minuets (we're moving my Mom in with us this week and it's crazy!) but ill just answer the questions you put below as fast as I'm able to (good thing I type fast!)... I hope this helps!!
Sample Questions:
Why did you choose a midwife for your care?
I had given birth in a hospital 2x and both times my wishes were not only ignored but things we expressly said we did NOT want to happen were forced upon us. I felt taken advantage of in my fragile state and I felt like the hospital looked out for their interests over mine and my child's.
What did you experience during your prenatal care?
I've had 2 babies at home with a midwife. The first midwife (for my 3rd child) was more like the expected prenatal visits at an office OBGYN. She came over on a regurlurly scheduled visits which increased in frequency as birth nearned. She would take urine samples, take my BP, ask me questions, ask me if I had any, discuss my diet and prepare me little by little of the home-birth experinece since I didn't quite know what to expect. She also gave me videos to watch (Gentile Birth Choices was one of them) so I could get a better sense of what was going to happen. During childbirth, she was very hands-off. My husband was my main coach (not something we planned but ended up happening probably becuase of the fact that my Midwife made "space" for it to) and she would ask questions, watch, listen, answer any questions and give advice or input as needed. She knew right where I was, based on my emotional state and speed of contractions. After Selma was born, she kicked into high-gear and really guided everthing more proactively (afterbirth, mother check, my BP, baby APGAR, etc). The post-partum care was fairly basic. She came over 2x the following day, 1x the next and then over the next week she probably came 3-4 more times. She also answered many phone calls and was available to come if I had wanted to her to, but there were not many pressing things I needed since it was my 3rd child.
With my 4th, my Midwife was drastically diffrent, but she is a good friend and it was my 2nd homebirth and 4th child. She did a few prenatal visits but I knew what things to do and look for, for the most part. If I didn't, she was just a phone call away. She did urine samples regularly over the first 4 moths or so, but when things were normal and all else was going well we decreased in the consistency of that as things progressed. BUT, when I went into labor EVERYTHING changed and she was extremely proactive and in charge during my labor and delivery. She was definitely my coach during the 4th child (which I've gone back and forth on weather that was a good thing- I did miss the beautiful experience my husband and I had with my 3rd birth but the progress of my labor was MUCH faster and I attribute most of that to her coaching me into new positions and attitudes, where my first Midwife really just let me stay comfortable and it was my longes labor of all my 4 children). The post-partum was extraordinary! I didn't know what I needed and kept telling her I didn't need her to come but every time she would, she would guide and direct me in ways that made things easier all around. Nursing, cord care, my postpartum diet, the help I received while I recovered, the rest I got... she guided me through it all with more of a plan of action than the first Midwife and I realized that she had been available for about 6 weeks after i gave birth for this and that- which was a total blessing!!!
What was the best advice you were given?
The best advice I was given during lavor was from a friend of mine who had all 4 of her kids at home. She said, when I was starting to have stronger contractions, that every contraction was different and not to expect the next one to be as bad as the current one and fear it before it even came. During delivery, the best advice I got was to thank Jesus for the pain, because the more pain I experinced the closer I was getting to meeting my child.
How did the midwife treat your family?
They both were amazing. But the second Midwife was more directive to my family on how they should care for me during my postpartum healing which I appreciated.
Were family members included in your care and delivery?
Yes. All my children were present. along with my Mom and Dad, sister, best friend, grandma and a few close friends.
Were you comfortable with the midwife you used?
Did you feel the midwife respected what your wishes during birth?
Absolutely, buth the 2nd midwife didn't let me just do whatever made me comfortable like the 1st... my 2nd MW's goal was to "get the baby born" and many times my comfort was (graciously) put aside in order to help me progress. I really trusted her guidance and appreciated the short, fast delivery that resulted. She kept me educated the whole time as to why she was having me to certain things differently than I wanted.
Just things like this and whatever you thingk is critical information for people know about midwifery care!
Thats all I have time for right now! Hope that helps!! Do we get a copy of your paper?? :) That would be fun to read! Hugs to you sweet girl!
-Amanda
To: Amanda Taylor
For school this year I am taking an English class as part of my prerequisists for midwifery school, however we were allowed to choose our own topics to write on and I chose "A Midwifes Impact on Her community." So I was wondering If you would mind sending me sort of a synopsis of your experiences with midwifes. Ranging from prenatal care to when your care ended if ever :) this does not need to be too detailed but just a birth of information. If you a re able to get it to me by Wed or Thurs I can use it for the project I am currently working on if not I can use it in an upcoming paper.
I compleatley understand if you are buys and do not have time. Please do not feel pressured at all! I have other resources I can use but I would love to have your perspective!
Also please do not be worried about what you say. If you had any negatives as part of your experience pleas express them! If you had any concerns express them! These papers I am presenting should show a realistic look on midwifes strengths and weaknesses and getting the views of mothers and families iis incredibly vital!
Why did you choose a midwife for your care?
What did you experience during your prenatal care?
What was the best advice you were given?
How did the midwife treat you?
How did the midwife treat your family?
Were family members included in your care and delivery?
Were you comfortable with the midwife you used?
Did you feel the midwife respected what your wishes during birth?
What feeling did you leave your birth experience with?
What resources were made available to you?
What emotional support did you recevive?
Thank You !!!
Answer:
I seriously only have a few minuets (we're moving my Mom in with us this week and it's crazy!) but ill just answer the questions you put below as fast as I'm able to (good thing I type fast!)... I hope this helps!!
Sample Questions:
Why did you choose a midwife for your care?
I had given birth in a hospital 2x and both times my wishes were not only ignored but things we expressly said we did NOT want to happen were forced upon us. I felt taken advantage of in my fragile state and I felt like the hospital looked out for their interests over mine and my child's.
What did you experience during your prenatal care?
I've had 2 babies at home with a midwife. The first midwife (for my 3rd child) was more like the expected prenatal visits at an office OBGYN. She came over on a regurlurly scheduled visits which increased in frequency as birth nearned. She would take urine samples, take my BP, ask me questions, ask me if I had any, discuss my diet and prepare me little by little of the home-birth experinece since I didn't quite know what to expect. She also gave me videos to watch (Gentile Birth Choices was one of them) so I could get a better sense of what was going to happen. During childbirth, she was very hands-off. My husband was my main coach (not something we planned but ended up happening probably becuase of the fact that my Midwife made "space" for it to) and she would ask questions, watch, listen, answer any questions and give advice or input as needed. She knew right where I was, based on my emotional state and speed of contractions. After Selma was born, she kicked into high-gear and really guided everthing more proactively (afterbirth, mother check, my BP, baby APGAR, etc). The post-partum care was fairly basic. She came over 2x the following day, 1x the next and then over the next week she probably came 3-4 more times. She also answered many phone calls and was available to come if I had wanted to her to, but there were not many pressing things I needed since it was my 3rd child.
With my 4th, my Midwife was drastically diffrent, but she is a good friend and it was my 2nd homebirth and 4th child. She did a few prenatal visits but I knew what things to do and look for, for the most part. If I didn't, she was just a phone call away. She did urine samples regularly over the first 4 moths or so, but when things were normal and all else was going well we decreased in the consistency of that as things progressed. BUT, when I went into labor EVERYTHING changed and she was extremely proactive and in charge during my labor and delivery. She was definitely my coach during the 4th child (which I've gone back and forth on weather that was a good thing- I did miss the beautiful experience my husband and I had with my 3rd birth but the progress of my labor was MUCH faster and I attribute most of that to her coaching me into new positions and attitudes, where my first Midwife really just let me stay comfortable and it was my longes labor of all my 4 children). The post-partum was extraordinary! I didn't know what I needed and kept telling her I didn't need her to come but every time she would, she would guide and direct me in ways that made things easier all around. Nursing, cord care, my postpartum diet, the help I received while I recovered, the rest I got... she guided me through it all with more of a plan of action than the first Midwife and I realized that she had been available for about 6 weeks after i gave birth for this and that- which was a total blessing!!!
What was the best advice you were given?
The best advice I was given during lavor was from a friend of mine who had all 4 of her kids at home. She said, when I was starting to have stronger contractions, that every contraction was different and not to expect the next one to be as bad as the current one and fear it before it even came. During delivery, the best advice I got was to thank Jesus for the pain, because the more pain I experinced the closer I was getting to meeting my child.
How did the midwife treat your family?
They both were amazing. But the second Midwife was more directive to my family on how they should care for me during my postpartum healing which I appreciated.
Were family members included in your care and delivery?
Yes. All my children were present. along with my Mom and Dad, sister, best friend, grandma and a few close friends.
Were you comfortable with the midwife you used?
Did you feel the midwife respected what your wishes during birth?
Absolutely, buth the 2nd midwife didn't let me just do whatever made me comfortable like the 1st... my 2nd MW's goal was to "get the baby born" and many times my comfort was (graciously) put aside in order to help me progress. I really trusted her guidance and appreciated the short, fast delivery that resulted. She kept me educated the whole time as to why she was having me to certain things differently than I wanted.
Just things like this and whatever you thingk is critical information for people know about midwifery care!
Thats all I have time for right now! Hope that helps!! Do we get a copy of your paper?? :) That would be fun to read! Hugs to you sweet girl!
-Amanda
Film Analysis
Collage of Western Idaho
Film Analysis
“Jessica”
Sondra Jones
English 102 034W
Leslie Jewkes
7 November 2011
In the film simply titled, “Jessica” a striking young American travels to a small village in Sicily to become the local midwife. Though proficient in her trade, she creates an uproar from the local woman because their husbands and brothers are attracted to this lovely woman. The women of the village chose to deny intimacy to their husbands as punishment for giving attentions to the unknowingly seductive midwife, Jessica. This film aims to both teach women to be submissive to their husbands and for each member of the community to embrace the tasks society demands of them.
Filmed in 1962 (IMDb) the film was geared toward an adult audience that was coming out of World War II and was starting the Civil Rights Movement. The 1950’s was also the time when the baby boom started. “Gender roles were strongly held, girls played with Barbie dolls and Dale Evans gear, boys with Roy Rogers and Davy Crockett paraphernalia.” (Bradly) Women had needed to take on more independence through the war but now were struggling to find there place between work and home.
The film portrays men as being the leaders in the home and in town, working at their own trades and women to be keeping house, caring for children, gossiping, and making their husbands happy. Showing images of the woman sewing, cleaning, shopping, caring for children; while picturing men driving, working their trade sets the tone of acceptability to the sexes.
In 1904 a Catholic Italian professor, Minoretti wrote an article that states the roles of men and women. He discusses that “…although man and woman were equal, the two sexes had different missions and, consequently, there were certain tasks in public life for which men were better suited, just as women were solely equipped for motherhood.” (Dawes 484-526) This issue of women’s role in the Sicilian culture is presented when the woman of the town are attempting to decide what to do about the midwife.
While amid a discussion about actions of Greek women, a statement is made that voices the general view of the culture, “Deny their husbands? That would never happen here in Sicily.” (Jessica) Yet the women choose to do so because they do not want the midwife, who is stealing their husbands, in their homes or at their births. Admonished by their local Catholic Father and are continually reminded it is their duty to please their husbands.
The midwife was viewed as a necessity to the town and was expected to do all the things the mother would do; cook, clean, look after children, as well as care for the mother and deliver the baby. She was also a local healer who cared for the people of the village. Women of the town made themselves available to the midwife to observe and help if there was any trouble.
Men are not to be part of the birthing process. Jessica, the midwife, states to an unwelcome father, “Now is not time for a man. Yes, after the baby comes but right now it is your wife’s time and mine.” (Jessica) Men saw midwifery as a task for older women. They see Jessica not as a midwife but merely an object of desire.
When women attempt to deny their husbands, the men retaliate in several ways; anger, frustration, self pity, increased lust for other women and even physical abuse. All these things are seen as acceptable and are continual. The film expresses a right of men to do as they see fit. The prayer of the Catholic father gives an air to this fact,
O Lord I must confess to it; I must have made a mess of it. It cannot be the fault of Thee, so it must be the fault of me. The ladies in the town are right. The gentleman are darn right, right; and Jessica is also right, yet everything is wrong. (Jessica)
By the end of the film the women of the town have all submitted to their husbands and gone back to their duties of housekeeping and raising a growing family, the midwife attaches herself to a rich member of the community, and the men have gone back to their work. The film portrays the idea that when each member of the community is accomplishing the tasks required of them, life will be full and joyous. Men go about their work, woman keep house and please husbands, midwifes deliver babies, and the community is healthy and happy. We know however that if there is no revolution, and if no one steps outside the bonds society has placed upon them improvement will never come.
Generally, midwives do not cause the type of trouble portrayed in the film, yet they can influence how women view their husbands. Different cultures have different views and these are generally promoted by a midwife. Whether a father can be present at birth, father’s role in the family, what decisions are made and by who, if women are treated well, these are all things midwives have the chance to influence before, during, and after childbirth.
In America, the views portrayed in this film are generally viewed as outdated. Although woman submitting to their husband’s authority is a good thing, women have the right to speak their opinion and be their own person. Men are required to treat their wives with respect, honor and basic human rights.
In the introduction to her book “From Eve to Dawn; A History of Women in the World” Volume IV Marilyn French writes,
Human rights are not radical claims, but merely basic rights-the right to walk around in the world at will, to breathe the air and drink water and eat food sufficient to maintain life, to speak at will and control one’s own body and its movements, including its sexuality (3).
These human rights now given to women are a great improvement over the time where abuse was permitted and women could not speak up about being treated with disrespect.
All over the world and throughout history the issue of how men and women should act in society has been highly debated. There is always a radical party who prevents things from running as they should. In American culture a midwife could be such a person. Though midwifery dates back to the beginning of recorded history, promoting natural childbirth, home healthcare and self reliance breaks the current mold of allowing physicians to dominate a person’s health and money. Each individual can choose to keep to the traditions and expectations that our society has placed upon us, or to change their life and thought process to embrace different ideas and improve the world for everyone.
Works Cited
Bradley, Becky . "1950-1959." American Cultural History. Lone Star College- Kingwood Library, 1998. Web. 11 Oct. 2011.
Dawes, Helena. “The Catholic Church and the Woman Question: Catholic Feminism in Italy in the Early 1900s.” Catholic Historical Review 97.3 (July 2011): 484-526. EBSCO Host. Web. 19. October. 2011.
French, Marilyn. From Eve to Dawn: A History of Women in the World. Vol. 4. New York: The Feminist Press, 2008. Print. 4 vols.
Internet Movie Database. Amazon.com. 1999. Web. 13 October 2011.
Jessica. Dir. Jean Negulesco, Oreste Palella. Perf. Maurice Chevalier, Angie Dickinson, Noel-Noel. Dear Film Produzione, 1962. Film
Global Essay
College of Western Idaho
Global
Issue
Midwifery
Accomplishing Millennial Developmental Goal 5 in India
Rough
Draft
Sondra
Jones
English
102 034W
Leslie
Jewkes
5 December
2011
Abstract:
In
America, there are few people who truly understand the tragic reality of infant
and material death, but perusing life in a country as the women of India this
fact presents itself daily. Expectant mothers ponder if they are doing enough
to keep the child inside of them healthy and if when the child is born it will
survive. Because there are not enough healthcare professionals to go around,
women remain lost in the ways of the past and the ignorance that is at times
unhealthy for both mother and child. One solution to this problem is to
integrate midwifes into communities that can both deliver babies and teach
mothers healthy practices for themselves and for their families.
While
contemplating childbirth, one may consider many settings. Images of doctors,
nurses, midwifes all welcoming a new life into the world may come to mind, as
well as a setting such as a peaceful home, hospital, or birthing center. Even
thoughts of pregnancy, checkups, and smiling newborns bring happiness and joy
to the remembrance of this occasion. In India, however, childbirth is a much
more dangerous occasion.
The Central Intelligence Agency
estimates that in 2011, in India, 47.57 out of every 1,000 live births resulted
in infant death as opposed to 6.06 per 1,000 in the United States. (“Infant
Mortality Rate” 1) That means 21% of infants died within the first five months
of being born. The CIA also reports in 2008, 230 out of 100,000 Indian mothers
died while pregnant, during childbirth, or up to 42 days after childbirth. A
report published in 2011 stated, “Approximately one-quarter of all
pregnancy-and delivery-related maternal death worldwide occur in India which
has the highest burden of maternal mortality for any single country.” (Goldie, et al. 1-16) The CIA also reported only 24 out of
100,000 women in the United States die as a result of childbirth. (“Maternal
Mortality Rate” 2)
Because of India’s high
population, reaching over 1 billion in 2000 (Bowden, Humble) and accounting for
17% of the worlds population in 2006 (Bowden, Humble), there are not enough
medical professionals to go around. India is largely split into two sectors,
North and South. The southern half of India is generally more devolved and has
better healthcare. In the north, a generally less populated area, it is
increasingly more difficult to find skilled birth attendants. According to Nora
Kropp, a Certified Practical Midwife with a Masters of Public Education
specializing in maternal and child health, this shortcoming is dominantly due
to the rural environment and culture of these regions. Water quality, lack of
reliable electricity, bugs, wild animals, lack of education opportunities for
children, and lack of social companionship all present themselves as obstacles
to educated and skilled men and women who are familiar with life saving measures
for both mother and infant. (Kropp) In addition to these, some specific
stumbling blocks for midwives are proper training and continuing education,
financial insufficiencies, and basic number of women each midwife has to serve.
Due
to these and other crippling shortcomings in global development, the United
Nations has come up with a series of goals for the world, they are known as the
Millennial Development Goals. The MDG’s are as follows: Goal 1- End Poverty and
Hunger, Goal 2- Universal Education, Goal 3- Gender Equality, Goal 4- Child Health,
Goal 5- Maternal Health, Goal 6- Combat HIV/AIDS, Goal 7- Environment Sustainability,
and Goal 8- Global Partnership. (“We Can End” 1) The United Nations hopes to
complete these goals by 2015. Though progress is being made, there is still
much work to be done
Goals
4 and 5 were put in place because of high maternal and infant mortality rates
all over the world. The United Nations hopes that these goals will make
pregnancy and childbirth a joyful process and remove the fear and danger.
Specifically the United Nations hopes to reduce maternal mortality by three
quarters and make access to maternal health care universally available. (“Goal
5” 2)
The
leading causes of maternal death are Hemorrhage, Anemia and Sepsis; but there
are other causes as well. Nora Kropp believes that the “3 Delays” are the main
problem. “Delay in recognizing a problem. Delay in seeking care. Delay once
care is sought.” (Kropp) Recognizing a problem for mother or baby is often
overlooked; however, if they are identified correctly, these problems can be easily
treated. Once a problem is recognized many women will choose to wait and see
what happens or try to care for themselves at home. Once care is sought issues
of transportation can come into play, and once the destination is reached a
families inability to pay or the sheer volume of clients can cause a delay in care.
(Kropp) All of these things play a major role in maternal mortality.
One
way that that has been suggested to accomplish both goals 4 and 5 is the
presence of a skilled birth attendant at every birth. This would be a properly
trained medical professional such as a Doctor, Nurse Midwife, or other approved
midwife such as Licensed Midwives and some Auxiliary Midwives. In 2008 only
46.9% of all Indian women gave birth with a skilled attendant, (World Health
Organization) and according to a study recorded in the Indian Medical Journal
of Community Medicine, “Fifty percent of the home deliveries were attended by
Trained Birth Attendants and 40% were attended by Untrained Birth Attendants. A
Private Nurse attended 10% of the home deliveries.” (Zulfa et al. 102-107) This
shows a drastic need for home birth attendants in India.
Sadly
these numbers will be slow to diminish because there are not enough healthcare
professionals to meet the needs of the people. Nora Kropp shares her opinion,
“the biggest problem in India is there are not enough skilled birth
attendants.” The World Health Organization reports that there are only 13
nurses and midwives per 10,000 people in India. It is a staggering realization
of the terrific need that is facing this country.
Doctors
are valuable resources but can be hard to find. Nora Kropp states “the main problem is hiring
and keeping specialists like OB’s, anesthesiologists, surgeons, and other
healthcare professionals for lifesaving measures.” Many doctors are employed by
government institutions yet both doctors and nurses are “over worked and under paid.”
(Kropp) Kropp also reveals many doctors will have private practices on the side
because there is more money in the private sector.
Teaching
women to live healthy lives and care for themselves and their families is one
of the key aspects that a midwife can provide aside from childbirth. Midwives
have the opportunity to teach women natural family planning and therefore
decrease both infant and maternal mortality because women who do not wish to be
pregnant and cannot afford to be pregnant will know what to do to prevent
pregnancy. A study shows:
Increased family planning to
reduce the unmet need (for spacing and limiting births) by amounts ranging from
25% to 100%, reduced maternal deaths by amounts ranging from 7.0% to 28.1% in
rural India and 5.8% to 23.5% in urban India. In rural India, eliminating the
unmet need for family planning decreased the TFR (Total Fertility Rate)1 from 2.97 to 2.14, the proportion of deaths that
are pregnancy related from 16.4% to 12.3%, and the lifetime risk of maternal death from 1 in 65 to 1 in 90.” (Goldie, et al. 1-16)
This data shows that teaching women how to manage
their bodies and prevent unwanted pregnancy alone can reduce mortality rates.
In
addition to family planning, midwives can be wonderful teachers of healthy ways
for women to care for themselves and their families. Knowledge of appropriate
hygiene, proper nutrition, and first aide skills for the entire family as well
as quality parenting techniques can be instrumental in lessening the
unnecessary deaths of mothers and children. A study conducted by Khoushabi and
Saraswathi and reported in Pakistan Journal of Nutrition shows that when women
have proper nutrition both the mother and child benefit. (1124-1130). Thus the
role of educating mothers remains a key to not only decreasing infant and
maternal mortality but also the rest of the Millennial Development Goals.
Midwives
can be an instrumental part of accomplishing the MDG’s in India and around the
world. A skilled birth attendant can act as a catalyst to bring about healthier
and more powerful generations; however, there is a great need for finances to
both pay these hard working women and to help families with the costs resulting
from pregnancy and childbirth. Americans must recognize the inequality of care
for mothers and children in the rest of the world and take action. Donating
time, finances, and resources to organizations who are dedicated to the cause
of fighting infant and maternal mortality as well as improving access to
skilled birth attendants will aide both the UN and the world in achieving the
Millennial Development Goals.
Works
Cited
CIA. “The World Factbook: Country Comparison: Infant
Mortality Rate”. Central Intelligence
Agency. Central Intelligence Agency, 2011. Web. 27 September 2011.
- “The World Factbook: Country Comparison: Maternal Mortality
Rate.” Central Intelligence Agency. Central
Intelligence Agency, 2011. Web. 8 November 2011.
Draper, Allison Stark. Primary
Sources of World Cultures: India: A Primary Source Cultrual Guide. New
York: The Rosen Publishing Group, Inc., 2003. Print.
Bowden, Rob, Darryl Humble. Changing World: India. Minnesota: Arcturus Publishing, 2008. Print.
Goldie, Sue J..Steve Sweet. Natalie Carvalho. Uma Chandra
Mouli Natchu. Delphine Hu. “Alternative Strategies to Reduce Maternal Mortality
in India: A Cost-Effectiveness Analysis” PLoS
Medicine 7.4 (2010): 1-16. EBSCOhost.
Web. 9 November, 2011
Khoushabi, Fahimen and G Saraswathi. “Association Between
Maternal Nutrition Status and Birth Weight of Neonates in Selected Hospitals in
Mysore City India.” Pakistan Journal of
Nutrition. 9.12 (2010): 1124-1130. EBSCOhost.
Web. 11 November 2011.
Kropp, Nora. CPM, Masters of Public Health Specializing in
Maternal and Child Health. Personal Interview. 12-13 November 2011.
UN, We Can End Poverty 2015, United Nations, 2010, Web. 11
November 2011.
-“Goal 5
Improve Maternal Health” United Nations.
n.d. Web. 11 November 2011.
World Health Organization. “India, Country Statistics” World Health Organization. Would Health
Organization, 2010. Web. 8 November 2011.
Zulfia, Khan, Saria Mehnaz, Najam Khalique, Mohd Athar
Ansari, Abdul Razzaque Siddiqui. “Poor Perinatal Care Practices in Urban Slums:
Possible Role of Social Mobilization Networks” Indian Journal of Community Medicine. 34.2 (2009): 102-107. EBSCOhost. Web. 8 November 2011.
Notes
1.
Parenthesize added.
Table 1. Source: National Rural Health Mission. National Program Implementation Plan RCH
Phase II-Program Document. NRHM. N.d. Web. 13 November 2011
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