July 30, 1999
Volume 1, Issue 31
Midwifery Today E-News
“Ultrasound”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Risks of Ultrasound Scanning
5) Question of the Week
6) Switchboard
7) My Story: A Thankful VBAC
8) Coming E-News Themes

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1) Quote of the Week:

" I would not let anybody get near my infant's head with a transducer unless I knew what the output was." Dr . Taylor, Professor of Diagnostic Radiology and Chief of the Ultrasound Section at Yale University School of Medicine, in New Scientist 1476, 1999

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2) The Art of Midwifery

If fathers want to catch their babies, I hand them a flashlight to shine on the perineum. This shows me how steady their hands are. How steadily he is able to train the beam indicates whether or not a father will need assistance. And he will accept help more readily if he can see for himself how nervous his hands are.

- Midwifery Today Tricks of the Trade Vol. I

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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. Please mention Code 940.

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Visit the multiple award-winning WATERBIRTH WEBSITE for the most complete waterbirth information available on the net!
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3) News Flashes

Women have commonly been denied trials of labor if their first cesarean section was performed for failure to progress or cephalopelvic disproportion, the most common indications for primary cesarean. In a 1987 study published in the American Journal of Public Health, the largest percentage of women attempting VBAC had cephalopelvic disproportion or failure to progress cited as the primary indication for their initial cesarean. Of these women, 65 percent, or almost two-thirds, went on to have normal births. Many of the babies were much larger than the baby for whom the original cesarean section had been performed.

- ICAN Clarion, September 1997

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4) Risks of Ultrasound Scanning by Beverley Beech

Saari Kemppainen: 20 miscarriages after 16-20 weeks, none in the control group. Davies: 16 perinatal deaths compared with 4 perinatal deaths in the control group.

Lorenz: Preterm labour was more than doubled in the ultrasound group--52% compared with 25% in the controls.

Taskinen: A significant increased risk of spontaneous abortion amongst physiotherapists who use ultrasound for at least 20 hours a week and deep heat therapies for more than 5 hours a week.

Apart from the last two studies the others are randon controlled trials. For more information and discussion about the risks of scanning see Ultrasound Unsound? which Jean Robinson and I wrote about the risks. Copies available from AIMS Publications, 2 Bacon Lane, Hayling Island, Hants, PO11 ODN. (#6.25 for orders outside the UK; #5.75 for orders within the UK).

I do not agree with the statement that "a lot of embryos have been exposed to ultrasound over the last 25 years with no documented ill effects." Lieberskind's research indicated changes in cell structure that persisted over 10 generations and although researchers attempted to rubbish the research it was repeated by other researchers, and now we have research from Ireland that also shows affected cells.

There is a widespread assumption that ultrasound is beneficial, yet there is no evidence that infant outcomes have been improved by routine ultrasound examinations. Researchers have enthusiastically focused on what ultrasound could find but have paid little or no attention to the potential adverse long-term effects. As a result, despite ultrasound being enthusiastically used over the last 30 years, there is no good research that addresses the anxieties that ultrasound may be responsible for dyslexia, learning difficulties and behavioural problems.

The Saari Kempaainen study revealed that 150 women were diagnosed as having placenta praevia; when they got to term only 4 women actually had it. In the control arm the women who were not exposed to ultrasound also had 4 women whose placenta praevias were discovered when they went into labour. Both sets of women had caesarean sections and there was no difference in outcomes. The researchers did not investigate the amount of stress a diagnosis of placenta praevia could have caused in the 146 misdiagnosed women. This research shows that early diagnosis of placenta praevia is irrelevant and a complete waste of time, yet doctors and midwives persist in telling women they have low lying placentas.

A study by Jahn revealed that out of 2,378 pregnancies, only 58 of 183 growth retarded babies were diagnosed before birth, and 45 fetuses were wrongly diagnosed as being growth retarded when they were not. Only 28 of the 72 severely growth-retarded babies were detected before birth. Furthermore, the diagnosed babies were more likely to be delivered by caesarean section (44.4%) compared with 17.4% for the babies who were not small for dates. If a baby actually had IUGR the section rate varied hugely according to whether it was diagnosed before birth (73.1% sectioned) or not (30.4%). Preterm delivery was 5 times more frequent in those whose IUGR was diagnosed before birth than those who were not.

The average diagnosed pregnancy was 2.3 weeks shorter than the undiagnosed one. The admission rate to intensive care was 3 times higher for the diagnosed babies. This important study provides further evidence that scans are not benefiting babies or those mothers who were subjected to caesarean sections.

References:
Davies JA et al. (1992, Nov). Randomised controlled trial of Doppler ultrasound screening of placental perfusion during pregnancy The Lancet, Vol.340: 1299-1303
Jahn A et al. (1998). Routine screening for intrauterine growth retardation in Germany: low sensitivity and questionable benefit for diagnosed cases. Acta Obstet Gynae Scand. 77: 643-689
Liebeskind DE et al. (1979a). Diagnostic ultrasound: effects on the DNA growth patterns of animal cells, Radiology, 131: 177-184
Lorenz RP et al. (1990, June). Randomised prospective trial comparing ultrasonography and pelvic examination for preterm labor surveillance. Am.
J. Obstet. Gynecol: 1603-1610
Olsen O and Clausen JE. (1997, Nov). Routine ultrasound dating has not been shown to be more accurate than the calendar method. British Journal of Obstetrics and Gynaecology, Vol 104: 1221-1222
Saari-Kemppainen et al. (1990). Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy,
The Lancet, Vol 336: 387-391
Taskinen H et al. (1990). Effects of ultrasound, shortwaves, and physical exertion on pregnancy outcome in physiotherapists J. of Epidemiology and Community Health, 44: 196-201

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Ultrasound? Unsound is also available from Midwifery Today at a cost of $12 plus $2.50 S&H in the United States, $3.00 S&H to Canada and Mexico, and $3.25 S&H (ground) to all other international addresses. Call 1-800-743-0974 to order. Mention code 940.

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Learn more from these Midwifery Today issues:
No. 24, Caring for the Unborn (Regular price, $7.00)
No. 30, Ethics (Regular price: $7.00)
No. 37, Threat of Technology (Regular price: $7.00)
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Wise Woman Way of Birth, a 5 Day Intensive Skills Workshop in Langley, B.C. Canada Aug. 9-13, l999. Designed for doulas, student midwives, birth assistants and childbirth educators. Increase skills, improve outcomes; hands-on focus. Instructor Gloria Lemay. $150 before Aug l; $175 from Aug 2-7. (604) 882 9488, jnusche@intergate.bc.ca (604) 530 5394 kevin2@uniserve.com

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5) Question of the Week: What steps do you take in your practice to avoid postpartum hemorrhage? (repeated)

Send your responses or submit a Question of the Week to mtensubmit@midwiferytoday.com

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6) Switchboard

In response to Joy who had a terrible experience with Prostin induction [Issue 29]: I am an RN who works in a labor and delivery unit in the Midwest. Both midwives and doctors deliver with us. I have experienced inductions on my patients using Cerividil (Prepidil), Prostin, Cytotec (both vaginally and orally), Pitocin, and artificial rupture of membranes.

Most people may be surprised to know that the majority of drugs used in labor and delivery are not approved for that use by the FDA, but are used as such all over the country. Cytotec for instance is an anti-ulcer drug but is very effective in ripening a cervix for induction. All these medications are safe if used correctly with appropriate monitoring.

I am deeply sorrowed that Joy had such a terrible experience with her labor. But who is to say this would not have happened if she had gone into labor on her own? Generally it is not the drug that causes fetal distress, it is an underlying problem such as a nuchal cord, placental insufficiency, etc., that leads to emergency cesareans.

As for the use of Clindamycin leading to enterocolitis and her other problems, in our volume of births (1000 per year average) I have rarely seen any complications such as these and generally they are caused by other mitigating factors such as an underlying infection.

- M. Farney, RN

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Studies going back to the early 1980s attest to the efficacy and safety of Prostaglandin E2 either as pessary or Gel (Prostin Gel/Upjohn). The standard starting dose is 2mg pv for primips and 1mg for multips but as with all inductions for whatever reason (and I've spent more time talking women out of than into induction in the last 20 years), each mother needs to have a careful assessment of her cervix and position of the presenting part before Prostin is used. It is recognised that hyperstimulus may develop. That's why close (but not necessarily continuous electronic) monitoring is very important.

Joy seems to have suffered an unfortunate "cascade" of things going wrong whereas Prostin used judiciously should promote a "natural" cascade of events leading to labour. It does not cause contractions directly. I'm curious as to the original indication(s) for induction and at what stage of labour the c-section occurred.

- Phil Watters, OB/GYN, Hobart, Australia

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The media and medical personnel tell of the "safety" of drugs and the "necessity" of interventions. At an in service I did at a local clinic, I accidentally stepped on toes when I implied that some cesareans are not necessary--ouch! The nurses were not impressed because it made them look bad. The doctor on the other hand agreed with me and that kept the nurses quieter (after one lambasted me because I had "terrorized" a group I was speaking to when I told them that one in four in this room would have a cesarean birth and explained to them how to avoid a cesarean...so the truth hurts?!).

Yet I am called more and more about my classes, my doula services and for VBAC information. My newsletter is making inroads in my community and doulas are welcome at the hospital. The nurses are slowly, begrudgingly changing and the newer doctors are embracing alternatives.

But most importantly, one woman at a time is learning she has alternatives. That drugs, any drugs do affect her baby. She has a choice in caregivers (especially here in Canada) and can choose wisely, if she wishes. Education is the key.

- Connie Banack, CD, CBE

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In reply to Gemma on the subject of eczema [Issue 30]: I have eczema off and on too and although it doesn't affect my hands, I have had a lot of great and immediate relief with a natural product called Dermeze. It's called a "cortisone alternative" and was developed in Germany recently. The U.S. distributor is in Eugene, Oregon (541)687-7212. The ingredients are: water, glycerin, borage oil, evening primrose, cetyl alcohol, vitamins A ,E and P, Fumaria officialis and Calendula officialis. It costs about $15 an ounce but is well worth it. Only a tiny dot at a time is necessary, so it goes a long way. I've been to lots of dermatologists in my life and this is by far the best and safest cream ever.

- Lis Worceter, San Francisco

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Does anyone have any information on the psychological, sociological and sexual aspects of co-sleeping? I am aware of all of the physical benefits but have a presentation and essay to do on the other side of the coin.

- Kathryn Weymouth, student midwife in the UK KHWeymouth@aol.com

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Speaking of breastfeeding and feminism [Issue No. 27], I was perusing an issue of Sesame Street magazine and came across an advertisement for artificial breastmilk, and the company was none other than Nestle. I find this unacceptable in this magazine, which I expect to have children and families' interests in mind, not those of corporations. I also find it distressing that the program shows bottle feeding, but no breastfeeding.

- Jennifer Moore

(Editor's note: Write to Sesame Street magazine, PO Box 7688, Red Oak, IA 51591-0688)

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A midwife colleague who works in Sydney, Australia will be visiting family in the USA from 10 August till first week of September and is looking for workshops/conferences on midwifery (anywhere in US is feasible) or birth centres to visit.

And does anyone know of workshops/meetings in London UK, 2-9 August? Please respond to Jan Cornfoot capers@gil.com.au

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Online Birth Center News, a free birth activist newsletter, has a section where people who are _looking for_ a midwife may have their request listed for a few weeks. Email your location and needs to djz@efn.org with OBCNEWS ITEM in the subject. If you'd like to subscribe to the OBCNEWS, write to the same address and ask to be added to the subscription list.

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Share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com

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7) My Story: A Thankful VBAC by Shel Franco

My first pregnancy ended with a 10 lb. 6 oz. baby delivered by cesarean section. Two years later, I was pregnant with my second child. Although I did not know much about my choices in childbirth, I knew I didn't want another cesarean.

Early in my firstborn's infancy, I was introduced to parenting books by William and Martha Sears. I decided pregnancy and birth books by the same authors would be a solid beginning point. They introduced me to concepts I had never thought of as possibilities. Those concepts led me to deeper research. Eventually I found Midwifery Today E-News and Online Birth Center News.

My deepest thank you to all who participate in these newsletters. These publications imparted the greatest amount of information. Through them I was able to gain access to a world that had been foreign to me. I was introduced to normalcy in pregnancy and childbirth, something that eluded my first pregnancy, and that I feared would be denied me in a VBAC attempt. In believing in the normalcy, I was given courage I did not know existed within my heart.

I went on to hire a midwife and an excellent doula. Using tips from these two online publications, I was able to take an active role, and most importantly, competent responsibility for myself, my pregnancy, my birth and my child. The outcome was miraculous.

On a humid Midwest Thursday evening, I awoke with labor sensations. They were not painful, but strong and undeniable. I sat in the dark calm of my living room, my company Jay Leno and a bowl of cereal. In that serene environment, I labored on my own terms for nearly an hour and a half.

As the clock neared Wednesday morning, I needed the companionship of my husband. My sensations were even stronger, but manageable. While I walked and talked through each contraction, my husband timed. Even though the sensations were coming every 5 minutes or less and lasted at least 60 seconds, I would not allow myself to believe I was in active labor.

Because I was feeling rectal pressure, I asked my doula to meet us at the hospital. I decided that anything less than 5 cm would necessitate my return home. Imagine my surprise when I was 9.5 cm dilated--nearly perfect timing! After 55 minutes of pushing on all fours, I birthed my second son, Luc. He weighed 8 pounds 5 ounces. The euphoria still lingers.

I am often confronted by people who hear my story and proclaim how "lucky" I was. I have come to a different appreciation: it has little to do with luck. The information I gathered while I was pregnant prepared me for childbirth. The power was in the knowledge that gave me confidence and courage to let go. When I turned the reins over to my body, my child was born on his terms. And his terms were much kinder and more efficient than most of the obstetrical medicine practiced today.

My many thanks to the contributors of these newsletters. In a very real sense, your information enabled me to birth my son like I had always dreamed.

In telling this story, my hopes are twofold. Perhaps someone in the many professions within pregnancy and childbirth has a tiring passion, a flame that will rekindle when they hear how important their work truly is to women and their unborn children. Perhaps a woman with a history of cesarean birth will read this story and have the courage to reach out, explore herself, and gain the courage I did.

My birth was an epiphany. I feel I owe all the women who have had cesarean sections. I owe them the hope that was taken when our children were taken out of our wombs. Thank you for allowing me to accomplish some of that.

(Editor's note: Readers, continue to share your knowledge, experience and insight. Join us at the Switchboard, write on the coming themes, ask a question, answer a question, write about any aspect of your work, or share research. Take an active part in E-News-who knows, today you may influence someone's life forever!)

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8) 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:

- Premature labor (Aug. 6)
- International Midwifery (Aug. 13)
- Postpartum Hemorrhage (Aug. 20)
- Herpes (Aug. 27)

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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