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Welcome to November’s Musings! This month I am going to introduce what I hope will become a regular feature of Midwifery Musings: an interview with a midwife. It is my intent to provide readers with an in-depth look at each midwife’s practice, an overview of the legal and professional aspects of midwifery in their location, and a discussion about the contributions they are making in the provision of maternity care.

This month I had the pleasure of interviewing Simone Valk, a midwife practicing in Rotterdam, Holland. Simone graciously gave of her time to share a bit about herself, the training of midwives in Holland and the general nature of maternity care in Holland. The differences between our systems of healthcare is quite evident, but I found the differences in philosophy most impressive, and sobering.

As a midwife, I am often privileged to witness displays of human emotion that seem to occur exclusively within the context of birth. There are few other transitions of life that elicit the sort of emotion, be it positive or negative, that childbirth does. At every birth I attend there is always a memorable moment, often subtle and intimate, little insights into human nature that I tuck away in my subconscious.

In the United States, nearly one in four births is a cesarean birth. Many of these cesareans are unexpected, so it is a good idea for the expectant mother to become informed and educated about the procedure before her baby arrives.

The possibility of twins or more passes through the minds of every pregnant mother, but nevertheless having the presence of more than one fetus confirmed on ultrasound is a shock. Thankfully the length of the pregnancy allows plenty of time to adapt. Indeed, 'it' rapidly becomes 'they' and one feels a sense of incompleteness for those friends who are expecting just one.

As mothers-to-be, most women imagine a picture perfect pregnancy-- mild or no morning sickness in the first weeks, and within the fourth month, the soft kicking of new life within. Along with the growing, telltale tummy of an expectant mother, comes the choosing of a name decorating a nursery, buying baby clothes, and baby showers in honor of the mommy-to-be and the impending "arrival".

Twins

Multiple gestation is the medical term that refers to a woman who is pregnant with twins, triplets, or other higher-order multiple pregnancies. This will occur in slightly less than 2% of all pregnancies. Within the category of multiple gestation, twin births are by far the most common, accounting for 95% of all multiple pregnancies.

All obstetricians and reproductive endocrinologists know the placenta as the uppermost important organ for normal fetal growth till maturity. This endocrinological organ can be affected by many pathological states like other maternal organs.

Cesarean deliveries are now the most commonly performed abdominal surgery in the United States. In 2005, an estimated 30.3 % of all births involved C-section procedures, and preliminary estimates from the Centers for Disease Control and Prevention indicate that the incidence of C-sections will continue to rise in the coming decade.

Although Group B Streptococcus was first described over one hundred years ago, GBS began becoming noticed as a leading cause of infection and death in newborns only in 1961. According to the CDC, roughly 1 to 3 babies out of every 1,000 children born in the United States suffers invasive Group B Strep disease, mostly in the first week of life.

The word "ectopic" means "out of place." An ectopic pregnancy is a pregnancy that is not growing in the usual location (the uterine cavity). Ectopic pregnancies can occur in a number of abnormal locations, each with different characteristic growth patterns and treatment options.

Ectopic Pregnancy

Ectopic pregnancy, or preembryo implantation outside the endometrial cavity (i.e., fallopian tube, cervix, abdominal or pelvic cavity), is a potentially fatal condition with an incidence of ~1:150 diagnosed pregnancies.

As soon as a pregnancy becomes recognized, each (prospective) parent generally starts to accept and plan for their new arrival. If the pregnancy is lost, this is often considered a "death within the family" and the couple will go through an intense grieving process. The loss of a pregnancy can be devastating for a couple, regardless of the number of children in the family or the cause for the loss.

She just paged you again. It is “urgent”, just like the last 5 times. You sigh deeply: no matter how many times you tell her that her labs are normal, explain that some shortness of breath is expected in the last trimester, or reassure her that her heartburn is not a first sign of a heart attack (yes, you checked) – it simply won’t stick.

Vulvodynia is a general term which means, simply and literally, "pain in the vulva." It is not the name of a disease, but a symptom, just like "headache." Vulvar vestibulitis is a syndrome in which there is pain at specific points in the vulvar vestibule (the portion surrounding the entrance to the vagina).