Abstract
The editor of The Journal of Perinatal Education describes the content of this issue, along with a general plan for the new layout and design of the journal as it is relaunched.
Keywords: normal birth, Lamaze Philosophy of Birth, childbirth educators
Sharron S. Humenick Editor
Subscribers will note an updated, new look beginning with this fourteenth volume of The Journal of Perinatal Education (JPE). In addition to a fresh design for the cover, new features are included on the inside. This issue and future issues will contain three sections: editorials, articles, and perinatal exchange. Each issue will begin with a birth story that helps us all envision the benefits of Lamaze International's mission of advancing normal birth. We begin this issue with a story from Casey Goldberg, who works in the Lamaze International administrative office. The described contrast between her two birth experiences speaks volumes and is an example of giving voice to childbearing women.
Each issue will also contain a guest editorial. In this issue, Lamaze International President Raymond De Vries kicks off this feature with, “JPE—The Journal of a True Profession.” The planned guest editorial for our Volume 14, Number 2 issue will be by Penny Simkin. Additionally, each issue will include a continuing education module. In this issue, it is the “Research Update” column by Julie Heringhausen and Kristen Montgomery, wherein the authors help readers stay up to date on the latest findings on calcium and pregnancy.
The articles section of JPE will continue to feature a selection of original research, reviews of the literature, and occasionally a description of exemplary services. In this issue, the first article addresses the theme of caring. Returning author Marie Berg of Sweden presents qualitative research resulting in a midwifery model of care labeled, “Genuine Caring in Caring for the Genuine.” She describes the elements of the caring relationship, the genuineness to oneself in providing care, and care that promotes a woman's inborn capacity to be a mother and give birth in a natural manner. As an editor, I am pleased Dr. Berg picked JPE in which to present this model. As a reader, you may want to compare her work to Ms. Goldberg's birth story. One author speaks from the perspective of a mother and the other from the perspective of a care provider who has analyzed mothers' stories. It is clear they are sharing from the same page.
The next two articles present models of advocacy. Lest we forget our history, Lorraine Kushner describes her professional journey as a childbirth educator and normal birth advocate since 1960. Her journey is representative of many of the early Lamaze teachers and advocates. As perinatal educators, reviewing our origins may help us gain clarity about how to proceed with the work of advancing birth. Diane Spatz presents an article in which she outlines a multifaceted approach in a children's hospital to develop a comprehensive, hospital-wide system to support and promote breastfeeding for vulnerable infants.
The perinatal exchange section of this and future issues includes Judith Lothian's column with a new name, “Navigating the Maze,” wherein she continues to strive to help make sense of the systems and nonsystems of childbirth. Barbara Hotelling's column, “Tools for Teaching,” will still provide innovative insights and excellent resources for childbirth educators to introduce in their classes. The “Ask a Lawyer” column by Nayna Philipsen will be replaced by “Ask an Expert.” Dr. Philipsen will continue to coordinate the column, but the area of expertise will vary from issue to issue. This is a slot in which some of our readers with relevant areas of expertise are encouraged to submit an article. Teri Shilling will coordinate a column in which books, videos, CDs, and Web pages are reviewed. Last in this and future issues, we continue with the humor column by Deb Gauldin, who always reminds us that it is important to find humor in our work no matter how serious our mission.
Another new feature in JPE's design is the scholar's margin — that is, the wider margin on one side of each page. We will use this extra space to insert valuable references and appropriate Web links that complement and expand on the information presented in an article or column.
The journal's Volume 13, Number 4 issue contained the last research review column by Mary Lou Moore, who asked to retire from this columnist position. I thank Dr. Moore for the hours she spent faithfully submitting to previous issues. Joan Moon also retired from writing the “Verse and Vision” column that began each issue for seven years. Thank you, Ms. Moon. The journal will continue to publish poems and photographs submitted by our readers.
Letter to the Editor
Ottawa
December 8, 2004
RE: Editorial by Sharron S. Humenick in the Winter 2004, Number 1 [JPE issue; “Will Birth Attendants Need to Promote High-Tech Intervention to Afford Malpractice Insurance?”]
Dear Editor,
I would like to respond to the editorial by Sharron S. Humenick in the winter [2004] issue of The Journal of Perinatal Education. The Society of Obstetricians and Gynaecologists of Canada (SOGC) is a strong supporter of midwifery care in Canada. We have demonstrated this by having a full-time voting member midwife on our board now since many years. At this time of crisis in the provision of obstetrical care, I believe we have to work together towards collaborative practice that will help physicians, nurses, and midwives working together rather than blaming each other for the terrible medical climate that exists both in the USA and Canada.
I do not believe that the present system of practice by gynaecologists or by the American College of Obstetricians and Gynecologists (ACOG) has promoted a higher malpractice insurance cost for midwives. Whether we like it or not, women and their families expect nearly 100% results from the birthing process. Unfortunately in the last few years, we have promised more than we can deliver to women of our respective countries.
Midwives, family physicians, and obstetricians cannot promise 100% results in obstetrics! Our failure to help the public realize this has led in great part to the outlandish medico-legal costs.
Unfortunately, lawyers—who also have families—have failed to realize that what they are requesting is impossible to do. Although many women will experience the Post-Ecstatic Birth Syndrome, many other women find labor and delivery difficult, painful, and do not wish to repeat the experience. These women also talk with other women, and they spread the news very quickly that the birthing process is inhumane, etc.… In order to alleviate this, I believe we need to join together in offering many more choices to women, from a natural childbirth with no use of pain medication to childbirth that uses effectively epidural analgesia.
Hearsay of comments “…25 years ago…” have no place in your journal, which is promoting evidence-based medicine. There are many physicians in the USA and Canada who have strongly and continuously supported the Lamaze International organization and other natural childbirth initiatives. These physicians have earned our respect.
Whether we like it or not, the elective caesarian discussions are with us and will not disappear by promising results to women that we cannot deliver. The SOGC and ACOG still promote natural childbirth as the first choice for pregnant women in both of our countries. However, the pattern of natural childbirth will not fit all of the women who decide to have a pregnancy. We must be ready to assume this and be ready to modify our attitude and our beliefs so that women do not have to please health-care professionals but that health-care professionals are there to answer their needs even if it is sometimes beyond our own philosophy.
At the international level, the International Confederation of Midwives (ICM) and the Federation International of Gynecology and Obstetrics (FIGO) have joined together on a number of very important programs to reduce maternal mortality and morbidity. In Canada, we have joined our colleagues of the Canadian Association of Midwives to reduce the barriers and the stresses between the professions. This collaboration should be promoted worldwide.
Yours sincerely,
André B. Lalonde, MD, FRCSC, FSOGC, FACS, MSc
Executive Vice-President
The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario
cc: Ralph W. Hale, Executive Vice-President (ACOG)
Editor's Response
I am pleased The Society of Obstetricians and Gynaecologists of Canada (SOGC) has entered into a dialogue with The Journal of Perinatal Education editor, readers, and thus Lamaze International. For too long, we in childbirth education have communicated largely among ourselves, and Dr. Lalonde is correct in calling for an effort to promote collaboration between professions.
I agree, as stated in the letter above, that obstetricians should not be accused of being the ones responsible for the increase in malpractice fees for midwives and general-practice physicians—an increase that has driven some of these practitioners out of business. I also agree that many complex forces are at work, here, including legal and economic influences, cultural expectations, and other factors. However, as I wrote in my editorial, the evolving system seems headed in a direction “wherein only care providers who carry out a significant number of high-cost birthing procedures can afford a practice of attending childbirth.” I also expressed concern for normal birth if we see a continued drift “towards a ‘system’ where low-tech, low-cost childbirth is unaffordable while high-tech, expensive childbirth is the affordable norm.”
In my editorial, I also expressed concern that a “percentage” of obstetricians will encourage nonmedically indicated cesarean birth, as some already do “with the flimsiest of ‘medical indications.’” To express fear that some physicians will promote cesarean birth to less than fully informed pregnant women is not to paint the entire profession with that brush. I am pleased to hear from Dr. Lalonde that SOGC and ACOG continue to promote natural childbirth as a first choice for pregnant women. Yet, I fear the United States and Canada could go down the path of Brazil, for example, where the cesarean rate is 75% for private-pay women. It would be helpful for Lamaze International to open a dialogue with SOGC and ACOG about potential strategies that discourage nonmedically indicated cesarean birth from being a choice that is strongly sold to women who are only partially informed.
Lamaze International has never suggested that all women must choose normal birth, although we may differ from some of our medical colleagues on our definitions of normal birth and fully informed choice. We believe that, as choices are made, care providers and pregnant women should understand deeply the biological and lifelong psychological benefits of a well-supported normal birth experience. We recognize not everyone can achieve the goal of a normal birth, and effective support during labor is not available for some. Yet, we continue to promote normal birth as a goal. Similarly, college educations or athletic championships are not attainable goals for all, but society promotes them as desirable achievements and does not withhold promoting the benefits of reaching these goals just because some people might aim for and, then, fail to attain them.
In order to assist people to envision and understand the benefits or importance of normal birth to women and their families as they make their choices, Lamaze International has directed JPE to publish a personal birth story in each issue. We begin that directive with this issue (see “Celebrate Birth!” pp. 4–6).
As childbirth educators and obstetrical societies learn to increase communication and share information across their professions, perhaps together we could gain a clearer, more common understanding of terms such as natural childbirth, normal birth, well-supported birth, and fully informed choice in birth. I encourage JPE readers to send in their ideas for promoting this collaboration and dialogue.
Footnotes
