|April 21, 2000|
Volume 2, Issue 16
|Midwifery Today E-News|
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In This Week's Issue:
1) Quote of the Week
1) Quote of the Week:
"The concept of primary prevention of complications of pregnancy and delivery and prevention of neonatal abnormalities through sound prenatal nutrition has been supplanted by secondary prevention, which consists of elaborate intensive care nurseries which electronically monitor premature babies, many of whom would have been normal size at birth."
- Dr. Tom Brewer
2) The Art of Midwifery
Take time to discuss your client's understanding of the role of sodium in creating a healthy balance for herself and her baby; in addition to the cultural myths that circulate via television and the print media, the firm convictions of grandparents-to-be and other family members can create confusion and hesitancy in your client. After all, she wants what is best for her baby. If *you* do not articulate the sodium question, chances are that *she* will answer any question she has regarding salt from the vantage point of her own understanding, and very likely this will be based on currently popular but unscientific conclusions--to the detriment of the health of her baby.
- Althea Seaver, Sodium in Pregnancy, Midwifery Today Issue 20
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3) News Flashes
Children born very prematurely are more likely than those born at term to have behavioral and cognitive problems in adolescence, U.K. researchers suggest. Their study also shows that more than 50 percent of those born very prematurely (before 33 weeks gestation) have abnormal magnetic resonance imaging (MRI) brain scans when they are in their teens. The researchers tracked the progress of more than 100 children born before 33 weeks gestation. Of 72 of the teenagers, 40 had abnormal scans and 15 had scans that could not be classed as normal. Only one of the controls had an abnormal scan. The children in the study group also showed significantly more reading, adjustment and neurological impairments. (The Lancet; 353 as reported in Nursing Times, Vol. 95, No. 22)
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(Editor's note: E-News readers responded to an inquiry about hypertension and salt restriction posted in Issue 2:15. Following are some interesting and informative responses.)
It is vital that your friend NOT cut out salt! In fact, salt restriction
Your friend's doctor has prescribed the most common medical treatment for high blood pressure in pregnancy, also known as "pregnancy induced hypertension," or PIH. It can be an early symptom of toxemia, but in the well-nourished woman, it seldom is.
Your friend needs to be sure that her diet is indeed adequate for
pregnancy. If not, she may be on the road to the very problems her doctor suspects.
See Dr. Tom Brewer's "Blue Ribbon Baby Pages" at
As for hypertension and salt restriction, here's the scoop:
[The following is adapted from What Every Pregnant Woman Should Know by Gail Sforza Brewer and Thomas Brewer, M.D., Chapter 4.]
Salt is a vital nutrient. No woman, expectant or otherwise, can live without it. Neither can the unborn baby, who receives sodium from his mother's blood stream, through the placenta. Sodium requirements vary widely depending on activity level, environmental conditions, personal health, and many more factors. Pregnancy is one condition where the body actually requires MORE salt in order to remain healthy.
Each person has many finely tuned mechanisms that work in the body to preserve the appropriate concentration of sodium in the tissues and in the bloodstream. In normal pregnancy, the mother's blood volume must expand by more than 40% to meet the metabolic demands of the placenta. Salt is a chief element in maintaining this dramatically expanded blood volume. Salt causes the body to retain fluid, which, under normal conditions, is retained in the bloodstream for use in placental perfusion.
Salt restriction during pregnancy limits the normal expansion of the blood volume, with disastrous consequences. Depending on the degree of sodium restriction and the subsequent blood volume limitation the placenta may: * grow slowly, or not at all,
* develop areas of dead tissue (infarcts) that cannot function,
Under these conditions, the baby's growth, development and even life are imperiled.
Cutting out salt frequently leads to an inadequate diet in other areas as well. Foods such as eggs, milk, cheese and salty meat products are often on the list of restricted foods for a low-salt diet. These foods are sources of essential high-quality protein, necessary for baby's growth, and for prevention of toxemia. It may also mean reduced food intake overall, as food is no longer quite as palatable without salt. Inadequate calorie consumption leads to the body using protein for fuel...protein needed for the baby's growth and development.
Some women live and/or work in conditions that cause their bodies to lose more sodium than is healthful (hot climate, "sweaty" work, aerobic exercise, etc.), and thus boost the body's sodium need. If the mother does not take in more, her depletion will activate temporary sodium-conserving mechanisms in the kidneys and adrenal glands. If salt deprivation continues, these organs can become exhausted, and show signs of degenerative disease.
The best way for any pregnant woman to be assured of meeting her body's (and her baby's) need for sodium is to follow the wisdom of her body and salt her food to taste throughout pregnancy. The body's simplest salt-regulating mechanism, the taste buds, are the most reliable guides to salt intake management.
The low-salt diet doesn't work because it overlooks the body's physiologic self-conserving mechanism and brings about the very conditions it was designed to prevent:
* High blood pressure--when salt is restricted below body requirements, the kidney reacts by releasing a hormone, renin, into the bloodstream. Renin influences other hormones which, in turn, cause the arterioles to constrict. The effect is to raise the blood pressure since the same amount of blood is being pumped with the same force through a smaller opening. The obstetrician worries about high blood pressure since it often accompanies one of the most dangerous pregnancy diseases, toxemia. By putting the mother on a low-salt diet he can *cause* hypertension where there was none before.
* Low protein intake--the low-salt provision sharply reduces the mother's range of food choices, and makes the permitted foods less palatable. Her appetite wanes, so she will probably eat less than she should. She will then be even more severely malnourished than a first look at the low-salt diet indicates. As her intake of protein falls, her liver becomes less able to manufacture circulating serum proteins, such as albumin, and albumin levels start to fall. As a result, water is lost from her bloodstream in the the area surrounding the cells (interstitial space) and it appears that other substances in the blood, such as iron, are present in adequate levels (true anemia resulting from the diet is masked). Fluid lost from the bloodstream shows up as generalized swelling of tissues (edema). Edema caused by this fall in albumin levels is abnormal, a sign of the disease of metabolic toxemia.
* "Excess" weight gain--the edema will increase as long as the woman's body is malnourished. Her kidneys excrete less water in the urine as they scramble to keep salt and water in the body within normal limits; the reabsorbed water cannot be held in the bloodstream since albumin levels are too low, so it leaks out into the tissues. Result: added swelling and added pounds. [end excerpt]
It is not unusual for obstetricians to make a reflex diagnosis of toxemia whenever one or more of the "classic" symptoms are present: swelling of the hands and face, excess weight gain, protein in the urine or elevated blood pressure. Your friend is fortunate to have been only diagnosed as "borderline hypertensive," but her treatment may still CAUSE her to develop toxemia, because she is being treated for a problem she may not actually have. Her blood pressure should be rechecked several times before making a diagnosis, and her diet must not be ignored. Her BP may be high because she's not eating well--not having enough salt, fluids or protein to expand her blood volume as needed for pregnancy. Again, see the Blue Ribbon Baby web site for more on this.
[Quoting again from Brewer, p. 82] Elevated blood pressure (hypertension) may result from many different causes. "Anxiety" hypertension is engendered by emotional stress of any sort. Many women become anxious during physical examinations or during laboratory testing. Women whose blood pressure has been normal throughout pregnancy may develop hypertension at the time of admission to the hospital for labor and birth. These mothers do not have MTLP; the liver is functioning normally and the blood volume is expanded.
"Essential," chronic, or benign hypertension is most common in women over thirty years of age. However, many black teenagers have already developed the condition and will continue to have it the rest of their lives. These mothers require exactly the same diet as mothers with normal blood pressures--including the use of salt to taste--since their blood volumes must expand, too, as pregnancy advances.
Sodium deficiency can trigger hypertension, as mentioned previously.
Obese women are often incorrectly diagnosed as hypertensive when a
Pheochromocytoma, an exceedingly rare tumor of the adrenal gland, also causes hypertension.
Kidney diseases also result in high blood pressure. [end quote]
There is so much more I could share with you. Please check out Dr. Brewer's web site, http://www.BlueRibbonBaby.org for more information. Also, I have been working with Gail (Brewer) Krebs (excerpted above) on publishing both of her books on prenatal nutrition online. She is working on updated versions of them, but it is taking longer than expected. Visitors to the web site can click a button to be notified when the books are available. I hope it will be soon!
To reach Dr. Brewer personally:
(Note: I'm not getting personal benefit from promoting Dr. Brewer's web site. It's truly a labor of love because I believe in his work, and have seen too many benefits from it to let it be ignored. If you have suggestions for the site, please let me know. I will be putting the above information on the site, so you may refer other clients to it as well.)
- Marci O'Daffer, CCE
5) From Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition By Dr. Tom Brewer
In the last fifteen years obstetricians have narrowly focused on the blood pressure of the pregnant woman as being of central concern regardless of her nutritional metabolic status, liver function, blood volume and placental function. If the diastolic blood pressure rises 15 or 20 mm Hg or the systolic rises 20-30 mm Hg, a diagnosis of "pregnancy-induced hypertension" (PIH) is made. All "PIH" is then "managed" the same as if every hypertensive pregnant woman were in jeopardy of convulsions, brain hemorrhage, abruption of the placenta, fetal death, etc. This is simply not true; *most hypertension in human pregnancy is physiological or benign, not related to MTLP at all.*
British investigators Mathews et al. have shown the benign nature of hypertension in the well-fed pregnant woman. (British Medical Journal, vol. 2, p. 623, 1978) When these workers abandoned the traditional "therapies" for hypertension in pregnancy, bed rest, low calorie, low salt diets, sodium diuretics, sedatives, pre-term induction, for women with "non-albuminic hypertension" as they termed it, they found that their hypertensive patients achieved *the same outcome of pregnancy* as in women with normal blood pressures attending their prenatal clinics. Their recommendation for those with hypertension not attributable to any medical disease is simply to refrain from aggressive therapies and have [the patient's] case followed by the district midwife. In the United States this would translate to having her continue to be followed by her chosen care provider, not to be referred to a "high-risk" perinatal specialist.
6) More Approaches to Elevated Blood Pressure
I would recommend taking blood pressure at another location than the doctor's office. During my second pregnancy, I was seeing an OB for backup in case of an emergency. My blood pressure was always high at the doctor's office, but normal at my midwife's house. The doctor's office made me tense and nervous and was causing the change. This may not be the reason for borderline high blood pressure, but it might be worthwhile to consider it. My doctor would have probably suggested inducing me, if I hadn't been planning a homebirth.
- Lauren Poindexter
Your hypertensive client may benefit greatly from massage. I am a certified doula and work mostly in the hospital. I found that massage lowers the BP and promotes general well being. I use it prenatally, but especially during labor. Possibly, you could go with her to a massage therapist and learn a few strokes and tips from the therapist. Loving hands, good breathing technique (both you and client!) and some soothing music or a quiet room can work true wonders!
- Alex Wagner
A very effective way to quickly reduce high blood pressure is with vegetable juices. I have seen a friend with high blood pressure due to preeclampsia respond the same day to 16 oz of carrot (8 oz.), cucumber (4-5 oz.), beet (2-3 oz.), lemon (1 oz.) and garlic juice (3-4 cloves). Drink the juice in 3-4 serving through the day. This can be repeated daily as long as desired. Susun Weed, in her herbal for the child bearing years also has a chapter on herbs and food to correct high blood pressure.
Certain forms of yoga are clinically proven to reduce blood pressure. I believe yoga in general is effective in lowering BP.
..Salt is one of the essential components of a cell, and to reproduce cells one must have some salt in the diet. Salt to taste....Salt is also needed to regulate fluid levels throughout the body and amniotic fluid, which recycles itself every 8 hours or so, also contains salt, as does the expanded volume of blood.
We all know what sitting on one's behind does for pregnancy, labor, and postpartum. My first inclination would be to record diet for 3 or 5 days and check her protein and calorie levels. If she is in the early stages of toxemia, then a protein intake of 100g per day may help, calories need to be 2500 per day, calcium is important also.
How are your friend's stress levels? Is she in a stressful situation at home? Is she a coffee or other caffinated beverage drinker? As for herbs, I like to start with food and progress to herbs from there. Beet juice, cucumbers, and lemon juice all help (see Susun Weed's 'Herbal for the Childbearing Year), then hops, passionflower, skullcap, and dandelion in addition to the usual raspberry leaves and nettles.
Your friend could try taking hawthorn berry tincture, 20-30 drops three times per day. Hawthorn is a gentle normalizer and toner of the entire circulatory system and can lower high blood pressure. Interestingly it can also normalize low blood pressure. If the blood pressure reading shows an elevated diastole (the bottom number), she may also add passionflower, a sedative to the arteries. You could try 20 drops hawthorn and 10 drops passionflower together, in a little water, three times per day. I don't know how long these herbs take to show an effect. They are both gentle enough to be used during pregnancy.
- Adrienne Leeds
I had borderline p/e (called PIH) during my pregnancy, and my midwives suggested going to a pool every day to use the water pressure to drain fluids from my tissues. It not only worked, it did wonders for my heavy, tired pregnant body--I was weightless for a little while. Your friend will pee quite a bit more after she gets out of the pool (she needs to be in for at least 15 minutes submerged up to her neck constantly--1/2 hour would be optimal).
Also, she should ask her doc, but taking more calcium/magnesium tablets (with a 2 to 1 calcium/magnesium ratio) will greatly help bring her b/p down. It is exactly what they give moms with hbp (magnesium sulfate). It's terrible to receive during labor because it makes one woozy and one tends to forget most of what's going on. I had this and wished I would have educated myself then.
As with anything free, seek professional medical advice before following any of this info!
- Kristine Owens
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8) Question of the Week
If the waters break during pushing and there is thick meconium, is it better to try to get the baby out quickly or allow it to stay inside mom?
- Belinda, apprentice
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9) Question of the Week Responses
Q: I just had a client receive a second c-section. She had 24 hours of back labor, contractions 2 minutes apart from 2 cm on. The doctor commented when he was repairing her that she had massive amounts of scar tissue from her previous section and we all concluded that the scarring may have played a factor in the baby being persistent posterior and unable to fully engage. She's very hopeful of attempting another VBAC homebirth next time around and would like further advice on reducing scar tissue. Any suggestions?
- Amy Jones
A: I have just come across information about a physical therapy/ massage group in Florida that is using "site specific" massage to treat pelvic pain and adhesions in the reproductive tract. Women who had been previously infertile due to adhesions, blocked tubes, etc. were getting pregnant after being treated. The web site for more information is www.clearpassage.com. They will respond to email questions and send out more information. I wish I had heard of it before going through in vitro. Sounds like a non-invasive alternative worth looking into.
A: First, in regard to the scar tissue, good quality, abundant nutrients are needed for her body to heal all the traumatized tissues. That should come from whole foods and/or whole food supplements. You will most probably not get the results you are looking for from processed, incomplete vitamin/mineral preparations and foods.
Second, the back labor and persistent malposition of the baby may be due to distortions
in the pelvis and/or low back. When that bony support system isn't correct, it
may cause baby to prefer a certain position. Plus, those distortions may very
well be interfering with the proper function of the nerve system, which is absolutely
essential for mom's body to do its job properly during labor. Having a well adjusted
spine and pelvis is very important.
A: Apply comfrey salve directly to the incision site. Comfrey has long been known in indigenous cultures as "Bone Knit." It rapidly heals tissue on acellular level. With calendula, lavender and echinacea added, it will reduce scar tissue and heal the site quickly.
- Kelli J.
A: To improve scar tissue, therapies like deep massage, rolfing or best, osteopathy, give really good results.
- Marypascal Beauregard
A: Vitamin E has been shown to have excellent results on scar tissue, even old scars. (Use topically and orally) Also, adequate essential fatty acids such as evening primrose oil help soften such tissue, especially in the reproductive category.
A: Licensed massage therapists (LMT) trained in neuro-muscular therapy (NMT) ar trained to do organ massages, which can, if done right, reduce scar tissue. Not all LMTs are trained in NMT, so you need to ask if they are, and what method they have been trained in. To find one in your area you can call (888) NMT-HEAL or (800) 232-4NMT.
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I was diagnosed with gestational diabetes during my first pregnancy. It was controlled with diet until the ninth month, when I took a very small amount of insulin each morning. My OB talked me into an induction one day after my due date with a "better safe than sorry." Semiweekly NSTs were perfect. Even though I had already dilated to 3 cm, she agreed to start with Cervadil to see whether it would start labor because I was very against the use of Pitocin unless absolutely necessary. My goal was a natural birth, and aside from the use of Cervadil, we were successful. My son was born after 7 hours of back labor (finally turned at the last minute), with one hour of pushing. He was perfectly healthy, 6 lb 15 oz, no problems with sugars for either of us. Although I had gone to the hospital ready for a fight to keep interventions to a minimum, everything turned out great and I felt ecstatic.
I would LOVE to have a homebirth with my next baby, but I am wondering whether anyone will attend me at home if I am diagnosed with GD again. Or even if I'm not, will having had the diagnosis before make me an automatic "high-risk"? I know there is also some controversy about the GD diagnosis itself. I am wondering if it would be irresponsible of me to try a homebirth. With my last pregnancy and birth, I took very good care of myself and always felt my baby was fine and that the birth would be fine. I don't want to put my next baby at any unnecessary risk, but I don't want to be "scared" into a hospital birth if there is no real need.
Special thanks to Stacy from Montana for ordering Paths to Becoming a Midwife and Life of a Midwife (both from Midwifery Today Books) to donate to her local library for International Midwives Day, May 5th! Great idea to spread the word! You go, girlfriend!
- Midwifery Today staff
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