January 31, 2001
Volume 3, Issue 5
Midwifery Today E-News
“Apprenticeship, Week 1 of 2”
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THIS WEEK'S ISSUE

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A Message from Ina May Gaskin

If you know of any woman who had a hysterectomy, a fetal or newborn death, or other serious complication after having been given Cytotec for labor induction, please contact me at MidwifeIM@aol.com
or by telephone (931) 964 2394

I am also interested in knowing how to contact the family members of any woman you know of who has died as a result of a Cytotec induction.

Quote of the Week:

"I view my work as a midwife not only as a passionate effort to offer my best possible service to women who need midwifery care, but as an opportunity to learn from each of these women about the immensity of birth."

- Naolí Vinaver


The Art of Midwifery

I have had good success in turning babies in breech position by suggesting to the woman that she take a warm bath to relax muscles and then take pulsatilla 200, two doses two days apart. After taking the pulsatilla the woman can then do the knee-chest position for 20 minutes and can repeat the exercise again that day. This is best done around 35 weeks.

- Julie Watson
New Zealand

Doula tip of the week

I like to bring a hollow Tupperware rolling pin to a birth. I fill it with warm or cold water and apply rolling pressure to mother's lower back.

- Janet Newall
Buffalo NY

Share your midwifery and doula arts with E-News readers! Send your favorite tricks to:


News Flashes

Researchers at the University of Mississippi Medical Center and the Saint Barnabas Medical Center evaluated all neonatal deaths from culture-positive sepsis that occurred over a three-year period at either center. All were of 24 weeks gestation or greater and died within seven days of birth. Total number of deaths evaluated were 35; eight cases of sepsis were caused by ampicillin resistant E. coli and 27 by other organisms.
The babies who died from ampicillin resistant organisms were statistically more likely to have received ampicillin during the antepartum period than those who died of non-ampicillin resistant organisms. They concluded that a relationship exists between neonatal death caused by ampicillin resistant E. coli and prolonged antepartum exposure to ampicillin.

- Amer J of Ob and Gyn, June 1999, Vol. 180 No 6: 1345-8.


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Apprenticeship

Apprenticeship learning involves the whole human being--body, emotions, mind, spirit--and therefore is the most powerful form of learning there is. We all learn to be full members of our cultures through this kind of experiential learning. Pure apprenticeship learning is connection-based, as opposed to didactic learning which can seem to take place in a vacuum, with no apparent connection to anything.... Because birth turns out well most of the time, apprentices attending home and birth center births usually are not exposed early on to pathology, and have the time to build a profound trust in the process of birth and in women's ability to give birth. Their training gives them a much broader experience of the wide range "normal" birth can take when it is not technologically controlled. The establishment of this kind of trust can have a great deal to do with the relationship between the apprentice and her mentor. I have interviewed a number of apprentices and mentors around the country, and am always impressed by the special quality of their relationship. Most mentors care deeply about the apprentices they take on, get to know them intimately, become committed to making sure they obtain the best education possible, and work to bolster the student's trust both in birth and in herself as she learns.

The down side: Apprenticeship learning, because it is so fluid, can be hard to evaluate for efficacy.... Pure apprenticeship is only as excellent as the teacher and the student make it. If the learner is not motivated, the greatest teachers cannot help her. If the teacher is not a good teacher, the learner will be challenged to obtain the needed education. There is the additional risk that the learner may not be able to judge whether she is getting a quality, thorough preparation.
Most experienced direct-entry midwives take very seriously their obligation to mentor the students seeking to follow in their footsteps. But at present there are relatively few experienced direct-entry midwives available to serve as mentors. As their numbers increase, more student options will obviously become available.

- Robbie Davis-Floyd, "Types of Midwifery Training: An Anthropological Overview," in Paths to Becoming a Midwife: Getting an Education, a Midwifery Today Book

The early stages of apprenticing involve a crucial letting go of ego, a taking in, a quiet observing. Letting go implies release. Release requires opening and in opening we become ready to receive. Accept that you may not be at every birth. A couple's choice to have or not have you present is not a personal ego judgment. You may know as much as the next woman, but nothing is gained by talking the most or the loudest. Pregnant intuition will see who you are, anyway. Letting go of fervent desires to "be at the birth" doesn't imply apathy. It does mean an emotional letting go of your ego involvement. Keep yourself directed--study, learn, teach, share--with all your heart, but not your ego.

Spiritual consumerism: "How many births have you attended?" This is a very valid question at times, but it tends to promote a consumer mentality--chalking up births like notches in a belt. The birthing woman is thus depersonalized as an objective to be "won."....The numbers game is also misleading. Most obstetricians have attended hundreds or thousands of births but that doesn't mean I would want one at my birth. It means they have rushed in for the last five or ten minutes of labor of fifteen women a day for the past ten years. A midwife who has attended only fifteen or twenty births may not have the exposure to all the variations and complications labor can present, but I would prefer the intensity and quality of care she may offer.

- Alison Parra, thoughts on the Apprentice's Path, in Paths to Becoming a Midwife: Getting an Education, a Midwifery Today Book


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Midwifery Today's Online Forum

I am 14 and doing a careers project at school. I have chosen midwifery because that is what I want to be when I leave school. Could anyone give me any information about the job or a good email address?

- Kirsty
Go to our forums to share your thoughts and experience.


Question of the Week Responses

Q: Has anyone had a mom who bleeds excessively? This mom has done many herbal/vitamin supplements to build her blood and still has a history of excessive bleeding prior to delivery of the placenta. As her uterus clamps down to deliver the placenta, there is a significant gush of blood. Pitocin has been the only thing her previous midwife used that was effective, but I am looking for an herbal remedy.

- Robe

A: Read Midwifery Today Issue 48--it's the best book on hemorrhage I've ever seen.

- Jan Tritten, Founder/Mother of Midwifery Today

A: When I go to a birth I make a tea for after the birth made of shepherd's purse (Capsella bursa-pastoris), cranesbill root (geranium macalatum), beth-root (trillium erectum) with a touch of cayenne. I mostly don't use it, but I know I have it there in case.

- Kusum

A: Shepherd's purse has been used medicinally since the Middle Ages (Phillips and Foy, 1990). It is valued for its ability to stop bleeding. The Eclectic publication "King's American Dispensatory" refers to the plant's applications for chronic hemorrhages and menorrhagia (Felter and Lloyd, 1992). It is particularly useful for childbirth hemorrhage and excessive menstruation because it stimulates uterine contractions as well as promoting vasoconstriction of the capillaries, stimulating prothrombin production, and tightening tissue structure (Newell et al., 1996). It is also valuable for treating varicose veins (Bartram, 1998) and bleeding hemorrhoids (Belew, 1999). It was used in the First World War to stem hemorrhage when nothing else was available (Blumenthal et al., 2000). The British Herbal Pharmacopoeia (1996) attributes shepherd's purse with the ability to stimulate smooth muscle and treat hemorrhage.

The active constituents of shepherd's purse include diosmin, the flavonoid rutin, oxalic acid, and tannic acid (Duke, 1992a). According to Duke (2000), the organic acids and rutin are hemostatic, and diosmin has been attributed with capillary strengthening and antimetorrhagic properties.

Though shepherd's purse has a long history of use in treating postpartum hemorrhage and excessive menstrual bleeding, clinical studies have not been conducted (Blumenthal et al., 2000). Because of its purported ability to cause uterine contraction, it is contraindicated in pregnancy and labour, and is used only after the placenta is delivered (Belew, 1999; Campion, 1996). Excessive doses can cause heart palpitations (McGuffin et al., 1997). There are no other known contraindications, and frequent dosing is believed to be safe (Belew, 1999).

Shepherd's purse is a popular herb in contemporary midwifery. When discussing postpartum hemorrhage, the authors of some articles prescribe shepherd's purse and Pitocin (oxytocin) interchangeably (McLean, 1998; Toepke, 1998). Apparently, it is a matter of personal preference on the part of the midwife. Goldstein (1995) notes that shepherd's purse is gentler than Pitocin, resulting in less postpartum cramping. Pitocin is not hemostatic; it stems postpartum bleeding by encouraging the uterus to clamp down.

Most herbalists recommend a tea or tincture made from the whole fresh plants, including the flowers and seeds. The tincture loses its potency after a year or two (Belew, 1999). A typical dose is two drops of tincture under the tongue or one dropperful (about 1 mL) in 30 mL of water as needed (Goldstein, 1995). Its action is very quick; Susun Weed (1986) reports that a dropperful of tincture under the tongue can stop postpartum hemorrhage in five to thirty seconds.

References
Bartram T. Bartram's Encyclopedia of Herbal Medicine.UK: Robinson, 1998.
Belew C. "Herbs and the childbearing woman." Journal of Nurse Midwifery 1999; 44:231-252.
Blumenthal M, Goldberg A, Brinckmann J, editors. Herbal Medicine- Expanded Commission E Monographs. Texas: American Botanical Council, 2000.
British Herbal Pharmacopoeia. British Herbal Medicine Association, 1996.
Campion K. Holistic Herbal for Mother and Baby. London: Bloomsbury, 1996.
Duke JA. Dr. Duke's Phytochemical and Ethnobotanical Databases (www.ars-grin.gov/cgi-bin/duke). Agricultural Research Service: USA, 2000.
Duke JA. Handbook of Phytochemical Constituents of GRAS Herbs and Other Economic Plants. Florida: CRC Press, 1992a.
Felter HW, Lloyd JU. King's American Dispensatory, 1898 version. Oregon: Eclectic Medical Publications, 1992.
Goldstein L. "Remedies. to file for future reference." Birthkit, Dec 1, 1995.
McGuffin M, Hobbs C, Upton R, Goldberg A. Botanical Safety Handbook. Boca Raton: CRC Press, 1997.
McLean MT. "Hemorrhage during pregnancy and childbirth." Midwifery Today 1998; December 1.
Newell CA, Anderson LA, Phillipson JD. Herbal Medicines; A Guide for Health Care Professionals. London: Pharmaceutical Press, 1996.
Phillips R, Foy N. The Random House Book of Herbs. New York: Random House, 1990.
USDA, NRCS. The PLANTS Database (http://plants.usda.gov/plants). National Plant Data Center: Baton Rouge, 1999.
Weed S. Wise Woman Herbal for the Childbearing Year. New York: Ash Tree Publishing, 1986.


Coming E-News Themes

1. INTERNATIONAL MIDWIVES: Tell us about your practice, birth customs and culture in your country, arts and techniques for the birthing year, your struggles and triumphs!

2. CHARTING CAN BE AS UNIQUE AS EACH MIDWIFE'S CARE. Do you have charting methods you would like to share with E-News readers?

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Know a strong woman? Helping empower one? If you haven't already done so, please forward this issue of Midwifery Today E-News to one or two of your friends or business associates. Thanks so much!


QUESTION OF THE QUARTER for Midwifery Today magazine

Mamatoto: Motherbaby

How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?

Deadline: March 31, 2001

Send your response to:


Switchboard

More on transverse lie [Issue 3:4]: After ruling out physical symptoms, I would inquire why is this baby not ready to be born? My preferred way is for the woman to go deep inside to find the answer by asking the question and waiting for the answer in the silence.

- Kusum

I would like feedback from other U.S. midwives who live in states where licensure is required. I live in a state that does not require licensure. A midwife in the community did some "illegal" activities and now the state may pass legislation. This is the first case in the history of my state. Midwives have practiced traditionally without any problems for hundreds of years. This midwife injected meds that were illegal in my state. I would rather practice legally without regulations than go for licensure. I would like to hear pros and cons. I have never talked to a midwife who supports her particular state's legislation. I am concerned about traditional midwifery and wonder at times what is happening that we have to be licensed to catch a baby. Does everyone use drugs out there?

- Anon.

Nona [Issue 3:4], I feel like the most fortunate woman on the planet when I think of my mother delivering all of my children. I cannot imagine doing it any other way. There is nothing more special or more soothing and reassuring than having my very own mother there for me and for my baby. What a gift she gives me and gives the kids each time she comes to help walk us through our labor. It's a beautiful thing seeing her hold and cuddle the babies after the check-up. Your daughter is really lucky to have you.

- Allie

I had two very successful VBACs, totally natural. I wonder what is going on with this sudden fear of rupture? It seems that inductions and Pitocin play a huge role, and many, many, women are subject to these interventions. Also, a midwife friend of mine said that doctors are not sewing up the incision as well to save time and that they rupture easier. She works in a hospital and has first-hand knowledge. Has anyone else run into this? If ruptures are happening because the doctor doesn't sew up the incision as well, it just becomes a vicious circle of more cesareans! Do doctors realize they are sabotaging future VBAC births by being rushed or sloppy surgeons?

- Mary A. Owens
Richmond, IN

I'm 36 in March, have a four-year-old daughter born via c-sec (first pregnancy, no prior history of miscarriages). We've been trying to conceive a second child for the last six months with no luck (although I am pretty sure I was pregnant for about a week, and then had a very early miscarriage).{Regarding the study reported in E-News in Issue 3:4] I am concerned that the original c-section is causing me to have difficulty conceiving and to have had that miscarriage. I'd like to know if your readers have any experience with c-sections causing these problems. I am also interested in any ideas for herbal/nutritional/lifestyle support for these issues.

Another concern: I exercise regularly and wonder how much truth there is to the belief that pregnant women should avoid exercising heavily because they might raise their body temperature and damage the fetus. My naturopath seems to think it would be pretty hard to raise your core body temperature enough to cause damage or miscarriage. But I get really hot when I exercise, even moderately, and the one miscarriage I had occurred while I was at the gym. I would like to know where I can find more information on this topic.

- Sharon Cooper

Midwifery Today Issue 57, Spring 2001, is due out in mid-March, and it will be packed with information about VBAC birth and cesarean prevention. The issue includes articles by childbirth activist, filmmaker and photographer Suzanne Arms; Nancy Wainer, the midwife who coined the term VBAC; CPM Judy Edmunds, who describes seven ways to prevent VBAC; Dr. Marsden Wagner, who writes about ethics and cesarean choice; Dr. Heidi Rinehart, who delves into technical issues of VBAC; surgical veterinarian Gretchen Humphries, who writes about suturing a cesarean wound; CPM Robin Lim, who addresses what happens to the baby in a cesarean birth; CNMs Marion Toepke McLean and Sharon Glass Jonquil who write about women's choice, and many others.

Non-subscribers can purchase the issue for $12.50 plus shipping of $4.00.

====

I would like a minute by minute video of the actual birth of a child until the cord stops pulsating and has completed its transfusion of blood into the rightful owner, the infant.

I would also like to have a video of any delivery that has had the approval of the mother to do immediate cord clamping, even before the baby was breathing, if that can be approved by a court order and a trust fund is in place for the risk of compromise to the infant, in the event the parents are seeking to bank the infant's cord blood for the sake of the infant to have that same blood, sometime in the future, should the infant get sick in that time.

Can anyone tell me the amount of blood in ounces that the newborn infant is most likely deprived of due to immediate cord clamping?

- Donna Young
Reply to: Box 504, Dawson Creek, BC V1G 4H4, tel/fax: 250-782-9223, email dyoung@pris.bc.ca


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