January 22, 1999
Volume 1, Issue 4
Midwifery Today E-News
“VBAC”
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In This Week's Issue:

1) Quote of the Week
2) Welcome!
3) The Art of Midwifery
4) News Flashes
5) Home VBAC
6) Working With VBAC Moms
7) Quick VBAC Facts
8) Book Review
9) Letters
10) Coming E-News Themes

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1) Quote of the Week:

"Know the normal inside out and backward. Then you'll know what's abnormal."

- Sr. Angela Murdaugh, CNM

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2) Welcome!

Welcome to Midwifery Today E-News!

Quick, direct communication is a dream come true for us. Our goal is to weave an extensive network of people interested in the midwifery model of care. With it we can "safety net" more and more mothers and babies all around the globe. Modern technology is providing the means--let's take advantage of it! Please forward issues of this newsletter to every midwife, doula, childbirth educator and interested parent you know. As well, if you have a web page, please post information about this newsletter on it and help us get the word out.

Thank you for being part of this important network. Please email us at: mtensubmit@midwiferytoday.com if you have ideas, articles, techniques or news for the newsletter.

- Jan Tritten

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3) The Art of Midwifery

Keep It Quiet

Advise moms who are planning a VBAC birth to avoid people--whether family, friends or co-workers--who will discourage them from seeking a VBAC. Help them protect themselves and their unborn babies from criticism of what they know is the right thing to do (see 'Home VBAC" below).

- The VBAC Companion by Diana Korte, The Harvard Common Press

Better Descent

To assist the descent of a slow coming baby, first have the mother partially recline, ideally with a support person behind her. Then with both hands, she grasps the knee on the side of her body that the baby's back is on, or the side that corresponds to where she has added room in her pelvis. She then uses both hands to pull back on that knee/leg when she pushes. This aligns the baby within the pelvis for better descent.

- Terri McDowell, CNM

At Midwifery Today, we have lots of tricks up our sleeves! Purchase our two volumes of Tricks of the Trade and you'll see what we mean:

Save $5 when you purchase both Tricks of The Trade Volume I and Volume II. Only $40 plus shipping! Call today to order: 800-743-0974. For more information, visit the links above. Mention code 940 and save an ADDITIONAL $2 when you buy both books. This extra savings offer expires Jan. 31, 1999.

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4) News Flashes

Don't Interfere

Women with large infants may be subjected to labor induction or cesarean section for no reason other than the large size. A review of this practice suggests that there is no benefit to interfering, and that outcomes are similar in women who are permitted to go into spontaneous labor.

- American Journal of Obstetrics and Gynecology, 172 (Pt. 2)293), 1995

Fetal Heartbeats

Three types of irregular fetal heartbeats--a "wavy" heartbeat pattern, a quickened beat, or an almost undetectable beat--are conditions which typically result in immediate cesarean sections. But Dutch physician Jan G. Nijhuis advises against rushing into drastic measures to deliver or stimulate the fetus. A sinusoidal, or "wavy" heartbeat pattern may be caused by the fetus happily sucking its thumb, and the older the fetus, the stronger the sucking. Tachycardia can occur in a highly active or "jogging" fetus, with the heartbeat dropping when it takes a rest. The silent or flat heartbeat pattern, commonly seen as alarming, may appear when the fetus is asleep, and can last about 90 minutes during labor. In this case, Dr. Nijhuis recommends continuing to monitor the fetal heart rate and asking the woman whether she has noted a sleep-wake pattern in the fetus.

- Medical Tribune, August 11, 1994 as reported in Wisdom of the Midwives: Tricks of the Trade Volume Two, a Midwifery Today, Inc. Book

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5) Home VBAC by Cher Mikkola

Not all of us have had cesarean births because we were manipulated into it by overzealous hospital staff or because we were "in line" for one following previous cesareans. I contracted genital herpes when I was barely twenty-one years old ("free love" wasn't always free, I found out), and by time I was thirty-five and pregnant for the first time, I was still plagued by frequent herpes lesions. Although I tried to reduce stress in my life, get plenty of rest, take my lysine tablets and use the right tinctures, I had increasingly more lesions as I neared my due date--and had a whopper by time I went into labor. In 1983 there was no question that a laboring mother with an active herpes lesion should have a cesarean birth, and even though I'd heard anecdotal stories about women who had risked vaginal birth with an active lesion and their babies were born healthy, I opted out of taking chances. I cried in my midwife's arms, then pulled myself together and went home to labor. Later at the hospital I birthed my son through my belly in the middle of the night, dealt with the grief and physical pain, and still was a happy, happy mother. Nothing could steal my ecstasy away!

Fast forward five more years: I was pregnant again, this time at age forty. Herpes had finally settled down in those intervening five years, and I was ready for a VBAC--at home. I knew I didn't want to run the hospital's gauntlet and risk another c-section. But who would be my midwife? My friend and midwife I'd had for my first pregnancy had pretty much retired; she agreed to attend my birth but not as primary. But this was Eugene, Oregon, one of the more liberal birthing environments in the country, and I was confident I'd find someone. Into the spotlight stepped brave Jill Cohen, lay midwife extraordinaire, who when I first met her looked me silently and squarely in the eyes as if she were assessing something on her private scale, then said something like "Sure, we can do a home VBAC. Let's do a little research first, then we'll have your first prenatal in a couple months."

Jill had never done a home VBAC, but she was undaunted. I think she truly believed it wouldn't be much different from any other of the hundreds of homebirths she'd already attended. I rallied round the confidence in normal birth she portrayed and the apparent faith she had in me. We did our research, and proceeded as if this were any other homebirth. I took good care of myself with excellent nutrition, rest, a daily walk, positive self-talk, meditation, celebration. I watched funny movies and read positive birth stories. I didn't tell anyone, not even my parents, that I was planning a homebirth so I could stay clear of negative or overly concerned questions or talk. For a month before my due date I kept my life as quiet as possible--no work, no dates, no visitors, no stress. I pretty much hung a "do not disturb" sign on my life. Again I loved being pregnant. Best of all, I was infused with Jill's hardy confidence, even though I'd had a couple of bouts of herpes through the pregnancy.

Darned if during the week of my due date, I had a small lesion. When she saw my confidence flagging, Jill matter-of-factly said "We'll just deal with this one day at a time. You've already had a c-section--you know what it's like and that you can do it. Let's just be calm and see how this turns out." I awoke before daybreak one April morning with light contractions every ten minutes. As I sat alone by candlelight, I simply let go of my expectations, sadness and fears. Two hours later the contractions stopped, and my body and my baby gave me two more days to heal from the lesion. On Earth Day, my strapping daughter was born at home after fourteen hours of labor, a nuchal hand (I always say she "elbowed her way out"), and my son announcing her gender. Jill to this day talks about how I laughed through much of my labor.

Laughter is indeed good medicine. So is the positive attitude a confident midwife who has faith in birth can convey. My daughter and I were truly blessed to have been on the receiving end of good midwifery care. So be strong for your birthing women, muster you confidence, stay calm, believe in birth, yourself and the women you serve, and try the matter-of-fact approach. You too can midwife women through VBAC births and into feeling fully confident that no matter why they'd had a cesarean, they can also successfully accomplish a vaginal birth.

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6) Working With VBAC Moms

I like to talk to my moms about their previous cesareans. I'll look at the hospital records first, then ask them to tell me what they think happened. They tell me what they think and I tell them what the records say. Almost always, they were given Pitocin, or they had more drugs than they knew, so there were possibly some reasons for that failure to progress, and that's very important for them to know.

VBAC women do labor differently than other women. They have to be tentative, they have to dip their toes in the cold water, then come back and dip again. Some of them go in and out of labor five or six times. They want to know if you're really going to be there, if your words really are true. They're going to test you to see if you mean it. And you really have to be there and say it's OK, I'm here. And each time the labor goes on a little longer.

I've had women who love me and know I love them, and they say they couldn't totally trust me. You have to help heal the hurt. It's very important to let your actions speak for you because you never know if something you say is similar to what a previous doctor said, and will trigger a negative response. You have to let her know you're there for her and you love her. Help her connect. (Mary Cooper, Midwifery Today Issue No. 23)

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7) Quick VBAC Facts

- Rupture of the unscarred uterus occurs more often and does more harm than rupture of the scarred uterus (Martin, M et al., Vaginal birth after cesarean section: the demise of routine repeat abdominal delivery, "Ob Gyn Clin North Am, Vol 15, No. 4 1988, pp. 719-736).

- The scar that has remained intact up to the threshold of labor is very likely to remain intact through the birth (Macafee, C, Irish J. of Med Science, Vol 38, 1958, p. 81).

- The possibility of other unforeseen events occurring which may necessitate transport such as intrapartum hemorrhage, fetal distress, or cord prolapse is about 2.7 percent, roughly ten times the rate of rupture during labor (Enkin, M. et al., "Effective Care During Pregnancy and Birth, New York: Oxford U. Press, 1989).

- In her literature review, Henci Goer ("Obstetric Myths Versus Research Realities" p. 42) found reference to only 46 ruptures during 15,154 labors, a rate of 0.3 percent (benign scar separations are a more common occurrence).

- thanks to Anne Frye and her book, Holistic Midwifery Volume 1, Labrys Press 1995

Holistic Midwifery, Volume I: Care During Pregnancy by Anne Frye can be purchased through Midwifery Today. $69 plus $10 S&H (U.S. only, others inquire for shipping costs); over 1,100 pages. Call today to order: 800-743-0974. Or email inquiries@midwiferytoday.com. Please mention code 940.

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8) Book Review

Natural Birth After Cesarean, by Karis Crawford and Johanne C. Walters, begins with each author's birth stories: each have had two cesarean births and two VBACs. After describing the medical history of cesarean section, the book then answers the question, "What are my chances?" by addressing twenty concerns women commonly have about VBAC. This provides a good opportunity for pregnant moms to address various factors and fears and get them out of the way before attempting a VBAC.

Sections on pregnancy and on labor carefully prepare the reader physically, emotionally and otherwise for a positive VBAC experience. Included is a wonderful chapter on the positive effects of visualization. Techniques for labor and answers to common questions, interspersed with inspiring stories, lend encouragement and a "can-do" attitude. The book concludes with a chapter on repeat cesarean and a chapter on sorting things out after birth. (Jill Cohen, reviewer)

Natural Birth After Cesarean, by Karis Crawford, PhD and Johanne C. Walters, RN, 1996. (Blackwell Science, Cambridge, MA, 248 pages, soft cover)

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9) Letters

I love your Midwifery Today E-News. After the article on B6 you had in Issue 2, I was wondering if you can point me to any studies of the effect of B6 on morning sickness. I'm a doula in nursing school (working toward CNM), and I have a client whose doctor and nurse have specifically asked for any such material so they can recommend it to other patients. (I recommended it to my client and it is working great, along with ginger root tea. She mentioned it to the doctor, and now he wants information.) Any studies you can point out would be great. I'm pointing him, in the meantime, to "Heart and Hands," [by Elizabeth Davis] which makes the recommendation. Thanks for your help. I hope to hear from you.

- Jen Taylor

Readers, can you help Jen out? Send your responses to Send yourmtensubmit@midwiferytoday.com

I just love your newsletter. What I love most is that the whole issue is devoted to one topic, with several variations on that topic. I can save this document in one file specific to the topic, then it will be there when I need/want it. Please continue this trend. Thanks !!

- Pat Sonnenstuhl

I just wanted to let you know how delighted and impressed I am with your new email newsletter. If your first issue is an example of the exciting information that will appear in my computer mailbox regularly, all of us who responded to your generous invitation are indeed blessed!

Thank you all for all the unbelievably hard work that must have been required to birth this joyous and helpful creation. I will certainly respond by subscribing to your journal "Midwifery Today," as soon as I recover from holiday bills.

Congratulations and welcome to the world!

- Patti Warren, CNM
Davis, CA

I have enjoyed receiving and reading your WONDERFUL cyber-newsletter! It is such a joy to get it in my email! Thanks for your commitment to birthing women and the midwifery model of care! With Gratitude...

- Kim Mosny, CPM candidate
Memphis, TN

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10) Coming E-News Themes

Coming issues of Midwifery Today E-News will carry the following themes. You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to these themes:

- breech birth
- placenta previa
- infections
- ultrasound
- epidurals
- breastfeeding
- waterbirth
- posterior labor
- postpartum depression
- meconium aspiration
- tear prevention

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.

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Cascade Health Care Products
Birth & Life Bookstore
Moonflower Natural Products

We offer a complete line of products for midwives, birth centers,
childbirth educators, lacation consultants and expectant parents.

Visit us at www.1cascade.com
or call 1-800-443-9942.


Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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