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A Glimpse at the Incredible Life of Patsy Harman

At Cascade HealthCare Products we are often in awe of the incredible midwives we work with. These are women who have not only played an integral role in the lives of hundreds of families, but who have often led exceptionally interesting lives of their own. One such woman is Patsy Harman - midwife, mother, author, wife, childbirth educator and life explorer. Sit back and join us as we journey through the intriguing life moments that led extraordinary women like Patsy into the passionate world of midwifery.

 

How did you get started as a midwife? 

I began my life as a midwife and childbirth educator in 1972, in Duluth Minnesota. At that time there were no Lamaze classes or any way to have a father at the birth. My partner and I took the Greyhound bus to Minneapolis for 6 weeks to learn how to breathe! After that, we found a small hospital about thirty miles away that would let us be together. Twenty-four hours of back labor and a forceps delivery of my first boy made me want to help other women. It wasn’t an awful birth, it was just hard. That’s why they call it hard labor, right? Nowadays, I would have had a C/S, no question.

A few years later, I began attending hospital births as a labor coach and began to read everything I could about natural birth. I read Varney’s Midwifery, Spiritual Midwifery, Childbirth Without Fear, Bradley [author of Husband-Coached Childbirth] ... everything from cover to cover. 

In the late seventies we moved to a rural commune in West Virginia where childbirth was even more behind the times. I started teaching childbirth classes to the other hippie homesteaders and soon found myself delivering babies. At one point I hitchhiked with another woman to Texas and did a two month rotation with the home birth midwives in Austin. Sometimes, it feels like I’m making this up! I didn’t plan to be a midwife, but I was called.

*For more on these incredible stories, read Harman's second book, Arms Wide Open: A Midwife's Journey1.

What were the barriers you had to face as a midwife?

I didn’t find many barriers, I just went out and started delivering babies. At that time we were young, strong, fearless and healthy. We didn’t know anything about 'living off the land', but we got books and we learned. It was the same way with delivering babies - get a book, deliver a baby. It all seemed straight forward and natural, but keep in mind the women I was helping were all in their twenties - lean, strong, had no risk factors, could drag a log out of the woods and carry two 5 gallon buckets of water a 1/4 mile and weren’t afraid of pain. In 100 deliveries we had one C-section.

As a CNM I also didn’t have many barriers, because my hippie, bee-keeper-string bass player became an OB-Gyn and we practiced together.

You were doing so well as a self-taught home birth midwife, why did you go back to school to become a CNM? 

I had a part time job, through the War on Poverty, to visit the poorest of the poor in West Virginia. With 3 years of college experience, I would go to homes of women who had been identified as eager to help their families, and I would teach them skills in sewing and nutrition. We would get to talking about childbirth and I realized I wanted to help them in that area too, but they were too high risk and needed to be in a hospital setting. So began my journey of going back to school to get certified. That was the only reason. I knew I needed to get credentials so I could work in a medical setting that helped the poor as well as the hippie elite.

Where did you get support? 

I got support from my husband, my commune and the families that I had helped. I also got support from the WV Coalition of Home Birth Midwives that we founded. We would meet every few months to share stories, thoughts and feelings. I miss those meetings. The midwifery meetings I go to now are more research-political.

How long did it take to get through your training? 

I started as an LPN, because the War on Poverty was giving out grants to go back to school. Then I got a two year RN. I worked in a low-tech hospital labor and delivery in Ohio, while I got B.S. in Health Care Administration on-line. I never thought of being an administrator, I just needed some kind of 4 year degree to get into a nurse-midwifery school. A year later I got into the University of Minnesota graduate program which took two years to finish. So all told it took about five years. Keep in mind, I also had 3 little boys and a husband who was going back to school too.

What was the most memorable moment you had as a midwife? 

Too many to remember!  Maybe the first baby I delivered in a commune by candlelight (see Arms Wide Open: A Midwife's Journey for more on this story). I was only supposed to be the coach, but I ended up delivering the baby during a snow storm and that's where I found my true calling.

What are you passionate about besides delivering babies? 

Saving Mother Earth. Everyone in the world having enough clean water and food. Everyone having warmth and love.  Everyone!

What motivated you to start writing?

My husband, Tom, became in OB/Gyn in 1987 and we delivered babies as partners in the hospital and the birthing rooms for 20 years. Then about 10 years ago, there was a big medical liability insurance crisis, our premium doubled to $140,000 a year and we had to stop doing OB. It was a great loss to our patients, our city and to us, but it gave me more time and energy to reflect on the human condition and the state of childbirth. I began to listen more to women’s stories and I wanted to share them, so I wrote my first book, The Blue Cotton Gown2. It is a memoir about the courage of ordinary women.

What is it like to be an author?

It is great fun to write, especially fiction, like my first novel, The Midwife of Hope River3 and the sequel, The Reluctant Midwife4. A surprise benefit is that I go to book clubs, book festivals and book stores where I talk to people about midwifery and the state of childbirth in the United States. I feel I’ve become a spokesperson and that’s vey gratifying. I was honored that The Midwife of Hope River was chosen as The Book of the Year in 2014 by The American College of Nurse Midwives and it was also a USA Today best seller. Not to mention, it has also been translated into eight languages!

Have you faced any difficulties writing about midwifery?

The trickiest part is protecting each patient’s privacy. In my non-fiction books I had to deeply disguise everyone and most of the time, I also let them read the chapters they were in  so they could give their consent. I also try not to make anything too gross when I write about childbirth or illness or death. Not everyone is as comfortable with body parts and secretions as midwives, doulas, lactation guides and doctors. 

Can you describe the essence of your books in one sentence?  

My books are about the power of childbirth, family and community, as well as healing, hope, love and courage.

 

***

Written By: Samantha Darling for Cascade HealthCare Products

 

References

1Beacon Press
2Beacon Press
3William Morrow and Company
4William Morrow and Company

How To Choose Sutures

When selecting sutures, there are a variety of options to choose from. Knowing the difference between suture materials is key to ensuring you purchase the right product for your practice. Below we have briefly outlined the different types of sutures available and why you would choose one over the other depending on its application.

There are a couple of key features to know before choosing a suture. Knowing the material that your suture is made from and the absorbency of the suture will help you to make an informed decision. And if you are looking for even more in depth information, take a look at the magnificent reference guide that we use daily, Healing Passage: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth, 6th Edition, by Anne Frye!

Nonabsorbable sutures maintain tensile strength - also known as the amount of weight a suture can withstand before snapping - for over 60 days. Nonabsorbable sutures are often used for wounds that have longer healing periods and because they do not naturally break down, they must be removed after the healing process is complete. These sutures aren't ideal for perineal repair.

Absorbable sutures will gradually break down within a shorter period of time, making them an ideal option for suturing perineal tissue. It is important that the suture selected loses its tensile strength within a similar time frame of the healing process, so that it is completely absorbed by the time the healing process is complete.

TYPES OF SUTURES

 

 

Chromic Gut is a natural, absorbable suture made from plain gut that has been treated using chromium trioxide. The treatment process also provides greater resistance to absorption than plain gut. According to Frye, chromic gut is a preferred choice for perineal suturing because it creates less tissue reaction than untreated plain gut.

 

Vicryl Rapide is a rapidly absorbing, braided polyglactin synthetic suture. This particular multifilament suture has been irradiated to alter its molecular structure for an increased rate of absorption. Vicryl Rapide has a better tensile tension than Chromic Gut, except that the strength of the tensile tension breaks down between 7 and 10 days, which is much faster than Chromic Gut. It also has a faster absorbency rate than regular Vicryl making it less likely that removal of sutures will be required after healing is complete. Vicryl Rapide is ideal to use when healthy women without a history of complications during healing, sustain lacerations.

 

Vicryl is a synthetic multifilament suture that is made from Polyglactin 910 and known for keeping its tensile strength for longer than Chromic Gut. It has a longer absorbency time-frame than both Chromic Gut and Vicryl Rapide of 56 to 90 days. Coated Vicryl is normally used for general soft tissue approximation and/or ligation, including use in ophthalmic procedures, but not for use in cardiovascular and neurological tissues.

 

NEEDLE TYPES AND SIZES

Below is a useful reference for suture sizes and types.

 

Click the image below for a Printable Needle Chart.

SIZE/STRENGTH GUIDE

    1-0 and 2-0: Used for high stress areas requiring strong retention
    3-0: Used in areas requiring good retention
    4-0: Used in areas requiring minimal retention. Most commonly used for superficial wound closure.

As always, if you have questions about the sutures we carry, let us know! Don't forget to take a look at our Suturing Kits, specially designed to include all of the instruments you need for suturing from brands like Vantage, König andMiltex. We strongly recommend looking at Anne Frye's Healing Passage book, no matter what level of experience you have. It is extremely in depth and an invaluable resource for referencing instruments, materials and applications for tissue repair required after birth.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Why Do We Use Fetoscopes?', 'How to Choose the Right Doppler', and 'Entering the New Age of Midwifery'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products

 

Resources

Healing Passage: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth, 6th Ed, Anne Frye.

Wound Closure, Ethicon Inc.

Sutures and Suturing Kits, Cascade HealthCare Products Inc.

Making Urine Test Strips Last Longer

 

Not many people know that there is a simple way to keep your urine test strips intact, especially since they should be lasting on average for about 90 days if stored appropriately. So if you have recently purchased urine strips or are involved in a profession where urine analysis is a large part of your practice, here are a few tips for improving the longevity of your product.

AVOID LIGHT EXPOSURE

All urine test strips are light-sensitive, so no matter what brand you purchase it is imperative that you keep them away from direct light sources. Exposure to light causes a color reaction in the test strips, which will obviously interfere with an attempt to garner an accurate reading when used.

When choosing a spot to store your urine strips keep the following in mind:

  • Avoid window sills
  • Avoid shelves and surfaces that are regularly in direct sunlight
  • Always close the cap of the container tightly to ensure it is sealed properly

AVOID EXTREME HEAT OR COLD

Urine test strips are as sensitive to extreme temperatures as they are to sunlight, so always be careful to store them at moderate room temperature. Keeping the container away from souces of extreme heat or cold will help to prolong the life of the strips. So that means:

  • Avoid window sills (sound familiar? Windows often have poor insulation leading to extreme temperatures)
  • Avoid storing your container of strips by a heater or air conditioner
  • Never refrigerate or store strips in a cold basement or storage room
  • Be conscious not to leave strips in a car (mostly for midwives or those whose frequent client homes with their supplies)

Remember, proper product care not only saves you time but it also saves you money. So taking a few extra precautionary steps will definitely be beneficial in the long run!

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Why Do We Use Fetoscopes?', 'How to Choose the Right Doppler', and 'How to Properly Clean and Sterilize Your Instruments'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products

The Voice of Midwifery - Anne Frye

Like any profession, one of the most useful tools in midwifery is to have a comprehensive reference guide at your disposal. During childbirth there is always the possibility of something transpiring that does not fit the 'norm' of delivery, requiring a strong foundation of knowledge for immediate application. At Cascade we carry a truly extensive selection of educational resources on midwifery, but the literature we have on practical skills application by Anne Frye is by far among the best.

Anne Frye has an extensive background in midwifery that spans over 35 years. At the time of her studies, she became increasingly aware of the lack in midwifery resource materials for practical application. She started writing while still in clinical training and after graduation she began teaching midwifery skills workshops at Informed Homebirth, Inc., with a literary career already unfolding.

Frye's books are extensive and extremely thorough. From Holistic Midwifery Volume I and Volume II to numerous editions of her works Healing Passage and Understanding Diagnostic Tests in the Childbearing Year, Frye presents information in a clear, concise and thorough manner that makes it easy to follow and reference. It will be hard not to refer to her books as midwifery encyclopedias as their breadth and appearance are clear indicators that they reach areas of study that few others achieve.


     

Holistic Midwifery Volume I: Care During Pregnancy, is a comprehensive textbook for midwives in homebirth practice that discusses care from conception through to the onset of labor. It captures the essence of the midwifery model of care by weaving together midwifery knowledge, philosophy and clinical practice.

Holistic Midwifery Volume II: Care During Labor & Birth, contains a number of revisions that focus on clinical care. Particular emphasis is placed on the latest material on neonatal resuscitation, assisting breech births and dealing with shoulder dystocia, fetal-to-newborn cardiopulmonary transition and more.

Healing Passage: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth, 6th Edition, is a complete guide to the care of the pelvic tissues and explores theories about perineal responses to fetal descent and how to prepare for and support a tear-free birth. This book can be used as a step-by-step manual for learning to suture, with chapters on equipment, how to use common surgical tools, tying knots and creating stitches.

Understanding Diagnostic Tests in the Childbearing Year, 7th Edition, helps practitioners understand diagnostic tests and provides a holistic perspective on test results. It is an invaluable resource for parents and childbirth professionals from midwives to doulas, educators and nurses.

For midwives and student-midwives, Anne Frye's resource books will prove to be a constant go-to, no matter what stage of study or practice you are in. They are also excellent guides for understanding the different surgical instruments and equipment commonly used in midwifery, as well as the application of each in various situations.

Written By: Samantha Darling for Cascade HealthCare Products

 

Resources:

Midwifery Educational Books, Cascade HealthCare Products: http://www.1cascade.com/c/10426/midwifery

Official Information and Resource Site for Anne Frye and Labrys Press: http://www.midwiferybooks.com/

The Different Ways to Clamp Umbilical Cords

There is much debate circulating around the appropriate amount of time to wait before clamping a newborn's umbilical cord. A pivotal 2013 study came out in favor of waiting for longer than the standard 60 seconds for clamping, to allow for increased stores of iron in infants. Read more about it in this New York Times article, Study Finds Benefits in Delaying Severing of Umbilical Cord.

There is also a lot of discussion around the most appropriate way to clamp cords, and as many midwives know, a lot of it will come down to personal preference of the practitioner. Whether using traditional, disposable plastic cord clamps, or environmentally-friendly, biodegradable cotton cord tape, we want to make sure you have the best knowledge on what you're using and how best to use it!

Plastic Cord Clamps - Traditionally used by hospitals and midwives, these clamps look similar to a hair clip that lock when closed. The clamps are sterile and because they are disposable, there is no concern for cross-contamination. Another great side-note about these clamps is that they are latex-free! Because plastic cord clamps lock once closed, you will need to have a Plastic Cord Clamp Clipper (disposable) or a Metal Cord Clamp Clipper (floor-grade instruments that are reusable if autoclaved or cold sterilized) to cut the clamp off.

Umbilical Cord Tape - The downside to plastic cord clamps is that they aren't biodegradable, which makes them the least likely choice of environmentally-conscious midwives and childbirth practitioners. Plastic cord clamps are also rather awkward when hanging from the end of a small umbilical cord, which may be a source of irritation to newborns. A great alternative is umbilical cord tape because it is 100% cotton - making it biodegradable - and it is lightweight for increased infant comfort. You can choose from sterile or non-sterile tape.

We know that the timing of umbilical cord clamping is highly important, and scurrying around for the right tools is not the ideal when the seconds start to tick. Which is why we decided to create our an umbilical cord kit specially designed for midwives, to have all the tools you need at your fingertips in an easy to identify bag. Here's why we created the Cascade Cord Clamping Kit the way that we did.

Contents of Cascade Cord Clamping Kit

1. Rochester Pean Forceps, 6.25" straight - These forceps help you clamp the umbilical cord in preparation for severing it.

2. Rochester Pean Forceps, 6.25" curved - These are perfect to have on hand in the event that the umbilical cord is wrapped around the baby's neck. You will need curved forceps to carefully follow the curve of the newborn's neck in order to clamp the cord without causing any harm to the baby.

3. American Umbilical Cord Scissors - Specially designed scissors for severing the umbilical cord.

4. A Plastic Cord Clamp - The traditional way of clamping the cord once it is severed. These clamps are sterile and latex-free and they permanently lock once closed.

5. Cord Tape - For those who want a more environmentally-friendly and lightweight alternative to the plastic cord clamp, cord tape is an effective way of tying the umbilical cord after it has been severed. This strip of cord tape is sterile, 1/4" wide and made from 100% cotton for a gentler, natural touch.

6. Teal Nylon Organizer Bag - Since this isn't the only midwifery kit we offer, we made sure to color code it for easy identification! Our Cascade Cord Clamping Kit comes in a durable teal nylon organizer, so that you can grab the right tools when in a rush.

We also have a wide selection of products for umbilical cord care from Cord Care Powder to Triple Dye Umbilical Antiseptic in our Umbilical Cord Care section. Just click here to see it!

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Why Do We Use Fetoscopes?', 'How to Choose the Right Doppler', and 'How to Properly Clean and Sterilize Your Instruments'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products

 

References

'Study Finds Benefits in Delaying Severing of Umbilical Cord', New York Times, July 10, 2013

'Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes', The Cochrane Database of Systematic Reviews, Susan J McDonald, Philippa Middleton, Therese Dowswell, Peter S Morris, July 11, 2013