Editorial: ICM and Hemorrhage

by Jan Tritten

© 2003 Midwifery Today, Inc. All rights reserved.

[Editor's note: This editorial first appeared in Midwifery Today Issue 71, Autumn 2004.]

The International Confederation of Midwives (ICM) and the Federation of Gynecologists and Obstetricians (FIGO) recently made a clandestine and potentially dangerous decision about midwifery practice. A new protocol was established privately before being introduced to member countries at the ICM conference in Trinidad: ALL midwives and doctors should "offer" all birthing women active management of third stage. This means every woman would be "offered" a shot of 10 IU of synthetic oxytocin within one minute of the delivery of her baby. This is to be done with controlled cord traction and uterine massage. In other words the placenta is pulled out of her—probably causing the hemorrhage in the first place. I put quotes around "offered," because we all know most doctors either do just what they want or bully women with lies. Here is a letter from one of our readers:

As you can see, the medical community cannot be trusted to "offer" active management of third stage. They are oriented toward intervention in birth, so expecting them to understand physiological birth is a dream.

The motivation for the move is to save lives. Hemorrhage is a killer of women. But I don't think this is a well-thought-out decision. Most deaths from hemorrhage occur in poor countries. The mandate is not needed in the West, where women seldom die from hemorrhage (a miracle, since so many hemorrhages are iatrogenic). The many techniques to stop hemorrhage are well developed and taught. Internal or external bi-manual compression with a shot of Pitocin is easily administered, if needed, even at home. Many herbs are helpful, and an array of tricks of the trade prevent or control hemorrhage.

My immediate objection is that Pitocin disturbs the mother's own oxytocin at the time when it is highest. It is designed by God to help her get to know her baby. One can only wonder if this disturbance has influenced our society toward detachment and violence. Why can't the medical culture trust and encourage this beautiful process of birth?

There are many issues associated with this, but the biggest effect on midwives is that you, by trusting birth, will be going against a stated global protocol, should you decide against this routine invasive procedure. It can, of course, be a life saver, but midwives should be free to use their own judgment. There is already a tremendous witch hunt going on against midwives. It seems to have escalated recently, especially in the United States. Even direct-entry midwives have often had to become more medicalized in order to practice legally. This decision could have dangerous and far-reaching effects on the midwifery model of care. States may bring it into their guidelines and protocols.

This issue fuels my severe frustration with the state of childbirth and midwifery today. My goal has always been for women to have beautiful and rewarding births. So few women get this chance. I am only heartened by the knowledge that you, too, are fighting for women and their babies.

For more about this issue see E-news issue 6:15.

Toward Better Birth,
 jan

Jan Tritten Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine and a midwife who was in active practice from 1977–1989. She became a midwife in 1977 after the powerful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world! [ PHOTO BY ANDREA NOLL ]   >  Editorials  Click here to read some of Jan’s Midwifery Today editorials.   >  Curriculum Vitae  1947 Born in Los Angeles, California. 1965 Graduated from Placer High School in Auburn, California. 1966 Trained for one year as a psychiatric technician. Courses included basic nursing, pharmacology, microbiology, anatomy and physiology, psychology. 1966–1971 Worked at DeWitt State Hospital in Auburn, California as a psychiatric technician. 1968 Graduated from Sierra College with an Associate of Arts degree. 1970 Graduated with honors from Sacramento State College with a Bachelor of Arts degree in Social Science. 1971 Earned Lifetime California teaching credential with fifth-year program from Sacramento State College. 1972 First daughter born in a hospital. It changed my life forever. It was an unsatisfactory birth experience, but I had a wonderful postpartum experience with 2-1/2 years of breastfeeding. 1976 Second daughter born. She was born at home with a doctor who talked me into a homebirth. The difference between the two births sent me on a path to do something to help women have positive birth experiences. 1976 Began training as a midwife. Because I was raising young children and running a business, and because there were no CNM schools in my area, becoming a CNM was not within my reach. 1977 Began attending births with the Birth Co-op in Eugene while organizing courses in our community taught by CNMs, physicians, nutritionists, etc. 1978 Began a midwifery practice, New Life Care, with a partner, Chris Howard, and apprentice Monika Dunsmore. 1979 Son born at home. 1980 Did a one-year program with Marion Toepke McLean, CNM. Four of us completed the program, which was modeled after CNM curriculum at that time. She took a year off from her practice to teach us and to go to our births with us. 1982 First group of midwives certified by the Oregon Midwives Council. Our board was composed of CNMs and physicians. 1986 Slowed down practice and started Midwifery Today magazine.

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