|February 11, 2000|
Volume 2, Issue 6
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"Trust is at the core of the midwife-woman partnership, and the same trust flows to the mother-baby relationship."
- Joy Johnston, midwife
2) The Art of Midwifery
To help prevent hemorrhage, make sure the mother's bladder is empty. If it is full it can impede uterine contraction. When the mother was pregnant, frequent bladder pressure reminded her to go. Once the baby is out, the pressure is off and her bladder can fill without her even knowing it. This displaces the uterus abnormally and can encourage atony. Be sure the bladder is empty, and teach the mother why this is so important.
- Lisa Goldstein, Midwifery Today Issue 48
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3) News Flashes
To identify the link between stress and recurrences of genital herpes, US researchers followed 58 women with a history of genital herpes over six months, taking weekly assessments of stress and mood and monthly assessments of life-change events. They found that transient mood states, short-term forms of stress and life-change events tend not to cause an outbreak of lesions. But persistent stress lasting for longer than a week is more likely to. A moderately stressful experience lasting for more than a week increased the chance of an occurrence the following week by 26%.
- Nursing Times 95: 49, citing Archives of Internal Medicine, 159:13
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4) Supporting Each Other
On Dec. 15, 1999, at Midwifery Today's Conference in Jamaica, the first meeting of the Caribbean Midwives Association (proposed name) was held. The purpose of the association is increased communication, coalition-building and education, especially amongst midwives living and working in and near the Caribbean. Membership is all-inclusive and is open to anyone interested. The group is planning to co-sponsor a conference tied to the International Confederation of Midwives (ICM) Regional Conference and a Midwifery Today Conference, with a proposed date of May 5, 2001, to be held in Trinidad.
The immediate needs of this newly forming association are: membership, responsive contacts in each Caribbean country, funding (i.e. from ICM, PAHO, etc.),a midwives' association in each Caribbean country, women's associations as contacts for networking, multilingual translation of newsletters and at conferences (English, French, Spanish), press releases to all countries in the Caribbean, organizational meetings.
The next international organizational meeting for the midwifery association is tentatively planned for the first weekend in December 2000, or in the spring of 2001 (after carnival).
Plans were initiated for regional organizational meetings to be held amongst midwives in Puerto Rico, at the Autumn School Meeting in Jamaica, with midwifery associations of various countries, and at the Annual Seminar in Trinidad. Progress reports from the regional meetings will be given at the Philadelphia Midwifery Today Conference, the third weekend in March 2000.
One of the most important things that emerged at the Midwifery Today Jamaica conference was the founding meeting of a Caribbean Midwives Association, whose intention is to strengthen and protect midwifery in the Caribbean countries. It is still uncertain how it will be structured, but a much larger group than the twenty-four founding members present at the Midwifery Today conference will discuss it and make decisions. During a rousing exchange about the split between direct entry and nurse midwifery in Jamaica, it was made clear that some of the same problems are going on the world over. According to a midwife from Trinidad-Tobago, however, the midwives' association there includes not only direct entry and nurse midwives but traditional midwives as well. Their ability to bridge the gap is a fine example to all of us.
- Jan Tritten, excerpted from her editorial in the coming issue of Midwifery Today
For the past five years or so I have listened with dismay to direct entry midwives criticizing nurse-midwives as "medwives" and physician extenders" and to nurse-midwives talking about professional direct entry midwives as if they don't know very much, and working in some states to pass exclusionary laws.
Such behavior is a classic feature of oppressed groups who turn on each other instead of concentrating on fighting their oppressors. An oppressed group will tend to want to fight its battle for identity and survival against members of other, often similar, groups. The group that is closer to full cultural integration will want to protect that position, jealously guarding its hard-won toehold in the technocracy, while the more marginalized group will tend to regard the more integrated group as a bunch of traitors who have compromised their ideals and values to get into the system. Both attitudes are exclusionary, and both are counter-productive, because they work to keep apart people with common interests who could benefit from working together in their struggle against the larger system.
For the past several years I have been actively conducting research on midwifery education and politics in the United States and Mexico. ... I found first that most midwives who expressed negative opinions about "that other kind of midwife" had very little or no personal or professional exposure to those other midwives, but rather were forming opinions based on stereotypes or the opinions of others; and second, that every midwife who had positive opinions about "the other kind" of midwife did have direct exposure to those other midwives, personally and professionally, either through watching them practice or through time spent together in monthly potluck dinners, joint conferences, and the like.
- Robbie Davis-Floyd, Ph.D., Midwifery Today Issue 49
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6) Question of the Week
I would like more information on hypertension during pregnancy, both straight PIH as well as hypertension as a sign of impending toxemia. I am a Bradley instructor who had a student lose complete control of the birth she wanted due to high blood pressure (BP), hospitalization, mag sulfate w/ Cervadil, Pitocin and ensuing epidural.
What are the differences in hypertension that shows up at 30 weeks vs. 39 weeks? What about a BP that stays up no matter how you take it vs. a BP that is much lower when taken in a side-lying position?. Can hypertension ever be considered normal for some women during their pregnancies--their body needs it for some reason--or is it always an ominous sign that means an automatic high-risk handover to a medication-happy OB?
What else can you do for a hypertensive woman who is at term besides mag sulfate?
It seems that once on mag sulfate the muscles are sabotaged yet they need to do the hardest work of their lives; a woman is usually given Cervadil or something similar, then Pitocin is added to counteract the mag sulfate.
Do women in this situation have to throw their hopes & dreams out the window when this occurs?
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perinatal psychology, her presentations include: Millennium Babies-Restoring Soul to Childbirth.
7) Question of the Week Responses
In reference to a question asked about deep squatting in late pregnancy and its effect on baby's position:
This is not something I have heard but it seems to make good sense. I think it could be something that I would think about with posterior babies who have not engaged and talk to this baby's mother about. Don't encourage the baby into the pelvis in a posterior position.
- Sally Westbury
Deep squatting can cause fetal compromise in an OP baby. One way to show this, if necessary, is to monitor the baby's heart rate before and during a squat. When the baby is OP, the heart rate drops. Conversely, this is an indication of OP.
- Beth Germano
I have never known of a deep squat with an OP baby to cause fetal compromise. However, an OP baby's heart rate will often decelerate temporarily when it's rotating. This brief deceleration does not cause fetal distress. Maybe the contributor heard decelerations with an OP baby in a deep squat because the baby was rotating, or trying to. Of course every labor must be treated individually. In a baby who is OP and also not fitting well, it might have fhr decelerations when it tries to rotate in a deep squat. Keeping up with the position without progress could of course lead to fetal distress; any deceleration will if it is persistent, not temporary.
- Marion Toepke McLean
And more comments on the Rh factor:
Sure, the Rh has to be tested and tested again in parents. False positive and negative results are not rare.
- Francoise Railhet
To be Rh neg you *have* to homozygous for the negative gene.
- Phil Watters
Rh is not a dominant vs. recessive gene but a case of an existing vs. non-existing characteristic. An Rh negative mom does not have an Rh positive gene which is masked by a "dominant" gene. She has *only* Rh neg. genes.
An Rh pos. mom could have a positive baby. She could have a negative baby if both she and her husband are heterozygous or if her mate is Rh neg. But if both parents were Rh neg. the child *must* be Rh neg. unless there is a genetic mutation. These mutations do rather occur (I've heard estimates of approx. 1/30,000).
It's also possible there could be a lab error that erroneously shows an Rh pos. child born to Rh neg. parents. Either the baby is actually Rh neg. or one of the parents is Rh pos. instead of neg. as they thought.
- Gail Hart
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A very important CIMS (Coalition to Improve Maternity Services) working session at the end of February in Washington DC relates to the future of the CIMS' Mother Friendly Initiative and other work to manifest real changes in birthing practices and midwifery in this country. I need to be there with Jan Tritten (from Midwifery Today), Ina May Gaskin, Peggy O'Mara (Mothering magazine). We have some important brainstorming to do at this meeting. Many, if not most, of the working group of CIMS manage to get their organization to pay their costs. I have no such backing. I've managed to finance myself going to several of the past CIMS working sessions. This time I can only go if I'm able to raise the money or get free air travel, such as by using someone's mileage for a ticket. Can anyone help? I'm in Durango, Colorado.
- Suzanne Arms
Please note: From Issue 2:4, my advice about evening primrose oil tablets--they are for use from 36 weeks onward!
- Amy D.
Last week's circumcision question drew some practical as well as impassioned responses. Excerpts follow.
There are still mohels who just take the tip of the foreskin off. We are Messianic Jews and have a mohel come on the 8th day to do it. Two of my sons have this type of circ and it takes all of 2 minutes.
To contact people and info you're looking for try: Jewish Assoc. of CRC, PO Box 232, Boston, MA 02133, http://www.circumcision.org; or Alternative Bris Support and Ceremonies, Brooklyn, NY, SAMMOSH@juno.com
Please read Questioning Circumcision: A Jewish Perspective, and Circumcision: the Hidden Trauma by famed Jewish psychologist, Dr. Ronald Goldman, of Boston. His web site, also very helpful, is www.circumcision.org.
The highest density of nerve endings in the penis is in the "ridged band," in
exactly the part of the foreskin you propose to cut off. This was
scientifically discovered and first reported in the British Journal of
Urology, Vol. 77, 1996, by medical researchers Taylor, Lockwood, and
Taylor. The article itself can be found on the web at
No matter what Hal's understanding or misunderstanding of his own religion may be, he does not have the moral or ethical right to destroy these nerves given by God to your son. Only your son has that right. Refuse to allow anyone to sexually mutilate your son for life. Respect his body and mind. Your son's freedom of religion, and equally important his health, are more important than placating your husband.
Would either of you allow it if it were your daughter and you were married to an African who would freak out if you refused [to have her circumcised]? Stand up equally for your son. When he is 17 he and you will be proud and happy that you did.
You cannot give informed consent...let your son make it for himself. Circumcision can always be done later if your son wants to be circumcised for any reason, religious or otherwise. He can *never* be uncircumcised!
- Van Lewis
"Trauma is an emotional shock from an overwhelming event. Certainly, having part of the penis cut off by force qualifies. The fact that the whole society participates in perpetuating this trauma requires that people deny the reality of what is happening."
- Ronald Goldman, Ph.D., Circumcision Resource Center, www.circumcision.org
This baby has another parent who is not from a circumcised group. Should the baby not have the right to resemble his mother's ethnic group? Especially since circumcision is now known medically as an amputative injury having life-long ill effects on health, including progressive desensitization leading to rougher sexual intercourse of a nature that routinely causes vaginitis.
The "floppy tip" does not exist on the newborn and develops later in life with normal dilation which occurs over time. The prepuce has not fully evolved at the time of birth: a tight narrow tube is usual in the neonate. It contains the greater proportion of ultimately precious specialized sensory nerves. The "fusion" of the foreskin to the glans is normal too. Separation occurs naturally over a few years through shedding of cells from both glans surface and interior mucous membrane lining of the prepuce. When the foreskin is ripped from the glans before destruction by amputation at circumcision, often the surface of the glans is sacrificed as well. Chunks are often torn out of it, the entire surface is torn off and the glans never develops properly if it is deformed at birth in this way. I hope it is evident that this is not a humane way to treat the genitalia of anyone of any age.
It was one of the few things I had the wisdom to set out as a condition of marriage: that none of our sons would be mutilated. I know my mother's heart would still be sorrowing now, 32 years since his birth. Often when I counsel parents thus, I feel they think I am taking their baby's side against them. But really it is for everyone, parents too, that this information is crucial. Some of the worst grief I have had to deal with in my nursing career is from parents who wish they had known enough about circumcision to say no to doctors who choose to earn their living this way.
- Maurene White
A baby born to a non-Jewish mother is not considered Jewish under Halacha (Jewish Law). While his decision to circumcise a son may be admirable to some, there is no such thing as a bris milah on a non-Jewish baby. No respectable mohel would even perform such a procedure. Therefore, the question of circ. becomes a moot point. Your husband can relax, and you can protect your baby.
This link might help with your circ. dilemma:
A child is "Jewish" within the terms of Judaic law if his mother is Jewish.
The "floppy tip" contains the ridged bands--very erogenous tissue which, in addition to everything else, allows the foreskin to taper at the end as it is supposed to. [Removing the floppy tip] should still be viewed as intolerable. If I may give an example from the "violence against women" theatre: If I only strike you across the face with an open hand, as opposed to with my fist, is that acceptable? Why would you even consider a presumably "minor" excision of a part of your son's birthright as acceptable? "Minimal circumcision" is tantamount to a "minimal rape."
Your son will never thank you for only cutting off part of his penis no matter how small the amputation...but he will thank you for not forcing him to undergo this androphobic indignity which has not a single benefit associated with it.
- Brian A. Waldman
Editor's Note: In last week's issue, A. Terrell's email address was listed incorrectly. Following is her question repeated, with the correct address:
How, as midwives, do we advise a woman who contracts cytomegalovirus (CMV) for the first time during her pregnancy? What are all the options for her and the baby? Do we continue to care for her? Is it medically sound to advise abortion for this seemingly rare complication?]
- Amelia Terrell
I am seeking information regarding the use of warm soapy water versus Betadine or other surgical soaps being used to wash the perineum prior to birth of the baby. I strongly feel the use of harsh soaps is an outdated and unnecessary ritual still being used in the hospital where I am doing clinicals and where I plan to work after school. My preceptor supports changing this ritual, but told me I need journal articles to support this change. I have searched Medline, PubMed, GratefulMed and MedScape. I have Enkin's book that summarizes the Cochran database; no luck. I have found studies that document that Betadine is unsafe for babies, but nothing on just washing with warm soapy water. Many midwives and CNMs have told me that they use nothing, but I don't think that big of a change would be acceptable at this institution.
I would like to see Betadine go the way of shaving and enemas. It is disturbing to see every woman's delicate labial tissues, perineum, and legs painted with Betadine and the continuation of the myth that women's bodies are dirty and in need of surgical cleansing.
- Delphine Thomas
In response to the question of "naturalizing" fertility treatments [Issue 2:5]:
I was 41 when I conceived my second after 1 year and 2 miscarriages and much frustration. My husband was found to have a low sperm count, but all my tests came back normal. I had also been seeing an acupuncturist/Chinese herbalist throughout the year but it was after she started treating my husband with Chinese herbs that we got pregnant within 2 months!
You might want to try a chiropractor and acupuncturist. My practitioner told me about a client who had come to her for back trouble, then confessed she'd been trying for 2 1/2 yrs to conceive and done all the fertility drugs and procedures, etc., to no avail. The chiropractor addressed the back problem but within a week of her first adjustment, the woman conceived! It's a more natural approach with no guarantees, but you'll definitely feel better from the back adjustment and the energy balance afforded by acupuncture.
- April Stirling
Making sure your husband and you work together as a team with your doctor will help make the process seem more personal--"helping" him collect his sperm, having him present for the insemination, seated by your head stroking your arm or hair and talking sweetly helps create a spcial moment for conception to occur. You will have time after the insemination where you are left alone to lie still for a while and during this time you and your spouse can spend some private time together. You may even want to try bringing a nightlight or some quiet music from home to create a "softer" atmosphere for your wait time after the procedure. I have also heard from woman that getting a foot or body massage right after an IUI helped relax them and center them.
- Amy Jurskis
I have read about turning a breech baby by lying on your back with your rear propped up with a couple of pillows. Have you ever heard of this and how would one do it? I am 36 weeks and the baby has not turned. This is my eighth baby and I have never had this problem before.
- Chautona Havig
Every night my wife has to use a bulb to remove the stuff in our baby's nose because the baby's nose stops up at night. She does the same in the early morning. Do you know of anything that may relieve this situation?
Here in Scotland (& in the UK as a whole) we don't refer to "stripping" the membranes, but to "sweeping" them. We are more likely to say we have "given a woman a sweep" which sounds rather like what is done to a lum--that's the Scottish word for chimney. Words certainly DO make a difference!
- Sue Chadney, midwife
Only a LLL leader can start a LLL support group, but anyone interested can start a breastfeeding support group. You might want to purchase information materials from LLLI to have available as a resource.
LLLI welcomes all mothers to seek information, support and coaching in breastfeeding matters. Women who apply for leadership are required to have a broad personal experience in breastfeeding a child throughout his/her first year of life, have sufficient oral and written communication skills and have a positive understanding of the LLL philosophy, showing this in the way they nurture their child(dren). The accreditation procedure takes place in written form. The time involved in becoming a leader depends on things like access to a group to learn from observation, geographical settings, correspondence rate.
There is also the possibility of being trained as a peer counselor, which
does not require the recognition of LLL philosophy. You can find more
information on becoming a LLL leader at the LLLI website:
- Gonneke van Veldhuizen
In California there is a group called Nursing Mothers Council that is a voluntary program with experience and reading requirements. This was an awesome group back in 1994. I met up with them through Dominican Hospital in Santa Cruz, CA.--call them for a number. This is a group you could start in your community!
Have you thought about starting a mother's support group? I got lots of support from the informal relationships formed in the sub-groups I belonged to. I am still friends with several of these families almost 20 years later and so are our children! You don't have to be accredited to start a support group--run it like a play group or babysitting co-op where everyone contributes time and energy.
- Mary Kay Smith
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