|March 14, 2001|
Volume 3, Issue 11
|Midwifery Today E-News|
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Why OB STARE? In Latin, it means "to be by the side." We are
beside the mother, the father, and of course beside the baby. OB STARE
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Quote of the Week:
"Childbirth is a moment of transformation during which feminine wisdom takes over to connect the birthing woman to all others."
- Mary Rucklos Hampton
The Art of Midwifery
Put comfrey leaves in a blender with some water and whirl the mixture for a few seconds. It makes the comfrey gelatinous and it applies to the perineum quite nicely.
- Midwifery Today Conference Tricks of the Trade Circle
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Researchers provided about 100 premature babies with a 15-minute massage three times a day. An equal number of preemies were given the exact same number of calories and other care, but no massage. The result of this study, conducted in collaboration with the University of Miami Medical School, showed that the massaged babies gained 50% more weight each day and were ready to leave the hospital six days earlier than the control group. The massaged infants were also found to have substantial differences in motor skills and cognitive functioning compared with the controls.
- California Association of Midwives newsletter, Spring 1977
Join us at the Eugene conference with Mexican midwives Naolí Vinaver and Doña Irene Sotelo to learn the techniques and benefits of massage!
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Have you heard of a link between use of Pitocin during labor and subsequent problems with milk supply? I am investigating several mitigating factors that resulted in my inability to nurse my first child. Someone has mentioned to me a possible link between Pitocin use and diminished milk supply. My labor was not augmented with Pitocin, but I did receive a shot of the drug after delivering the placenta, in order to bring bleeding under control. Could either the shot itself have contributed to my problem with supply, or could my need for the shot indicate an oxytocin deficiency?
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Question of the Week Responses
Q: I have recently been supervising a German midwife in Manitoba who uses xylocaine 2% jelly to numb the perineum prior to repairing perineal tears. Is there anything in the literature to back this practice up? I certainly was impressed at the benefit that it provides of not distorting the tissue as does injectable xylocaine and the mom feels no pain. However when I checked it out in our Pharmaceutical Reference book, it instructs us to not apply over broken skin, etc. Do any of you use this jelly? Have there been any negative outcomes? allergic reactions? How much should be applied to the perineum?
- Gisele Fontaine, CPM
A: After the birth of my daughter I had tearing that for various reasons could not be repaired until months after the birth and did not heal in that time. In the interim, the surgeon prescribed xylocaine 2% to help with the pain. I wore reusable gloves and applied only the smallest of smears to each of the open tears. If I used too much xylocaine I would immediately become slightly dizzy. Once I learned how very little was required I was able to use it successfully to eliminate some of the pain as I awaited surgery.
- Mary-Tim Hare
A: I am an Israeli midwife who had to go to Finland for a month to learn to suture because midwives in Israel are not allowed or taught to suture. Since I do homebirths, it was necessary for me to learn this skill. The midwives there at the hospital used a xylocaine spray on all labial tears and before injecting the xylocaine in the perineum for suturing. It seemed to work well enough for the superficial labial tears that needed suturing, and perhaps eased the pain of the needle injection. I don't remember what percent was used.
- Ilana Shemesh
A: I don't know about doing it postpartum, but the nurse midwife who delivered my children (and her physician partner) uses this gel periodically while doing perineal massage when there is time. With my first child I could push but did not feel the burning sensations as strongly as I did the second time when my child came out in 10 pushes or so. She still needed to inject xylocaine to repair tears for my first birth. The gel was not sufficient for me.
- Sarah, RN, monitrice
A: I had my second child at home and due to a bad episiotomy during my first birth, I had a very serious 4th-degree tear that required some major surgery after the second birth. The doctors used xylocaine jelly to numb my very torn perineum while they rubbed off some of the dead tissue. I had no negative outcome or allergic reaction. They used about the same amount of jelly as you would use toothpaste on a toothbrush for lack of a better measurement! I healed better and sooner from the major surgery than I did from the episiotomy. Keep in mind that these were doctors who had no interest in anything natural and were not impressed at my homebirth. When I asked if the same thing would happen with my next birth, their answer was "oh, just have a c-section! That will solve your problem!" I did go on to have another beautiful homebirth with just a small 1st-degree tear.
A: I have not had success using it for repairs, but I have used it to help to decrease the sense of burning of the perineum. It was especially useful for a patient with hemorrhoid pain that did not want to push. Putting the gel on her rectum greatly enhanced her ability to push.
A: We have been using a spray lidocaine (similar to that used in dental offices) for repairs and have found that it works exceedingly well for most women. It has clear advantages: it causes no additional swelling of the perineum, it is easily applied (usually without having to touch the tissues excessively) and it works very quickly. For most tears, it provides excellent numbing action. I have not seen any negative reactions to it, but we always double check to be sure that the woman isn't allergic to any anesthetic (often they have had experience with the spray at their dentists.) Because it is applied topically it can cause a sensation of coldness or stinging, but that quickly subsides. We do carry additional injectible anesthetic, but we haven't needed to use it.
I would think that topical jellies could be used in a similar fashion: I would be more concerned about allergies to the base of the product rather than the actual xylocaine. Obviously checking with the client about past history of anesthetic usage is crucial in any case. A clear disadvantage would be having to physically touch all of the damaged tissues to apply it thoroughly.
- Christina Oertel, DEM, CLC
Q:Does anyone know the story on short umbilical cords? And how short is too short to deliver vaginally? Is it genetic, does it run in families, is it likely to occur more than once, is it nutrition-related, is it avoidable? I've known two ladies to have very short cords and they are afraid to attempt a vaginal delivery again.
- Amy Jones
A: I would also like to know the answer to this question. I recently had a cord snap at birth in a pool. It measured 31 cm (about 12 inches) from navel to placenta. The literature suggests 50 cm as an average length. This still seems very short. I have now started measuring those that are especially long or short. The longest so far is 100cm (about 3 foot 5 inches).
The one that snapped appeared to go into "spasm" and blood loss was minimal. Apparently, 30 ml loss to a baby is the equivalent of a 600 ml postpartum hemorrhage in an adult. This particular baby was clinically well, feeding and we were some miles from the nearest "baby unit" with paediatricians available. We observed the baby closely, and the following day sent capillary blood samples in for various tests. All were within the realms of normality. Mother and baby continued to do well.
This particular woman was a mature multip who did not appear to be "unhealthy" or nutritionally deficient in any way. She was a well-educated woman, and neither of her previous two babies had had short cords.
- Lynn G Walcott, RM
A: My midwifery partner has had two children: the first with a very short cord (complicated by several wraps around his neck) who ultimately was born by c-section. Her second child had an extremely long cord which was wrapped around the baby's shoulder, neck, abdomen and leg and who was a VBAC at home without problems. She had severe morning sickness with both pregnancies and ate whatever would stay down, often in very odd combinations or quantities. She focused on protein with the second pregnancy, having read somewhere that it would help make a longer cord.
As far as too short for a vaginal delivery, it depends on all of the variables involved with each mom and baby. I don't know that there is a way to predict whether or not it's "too short" until they are in labor. Over time I think you'd expect to see a huge variety in both the length of cords and what works in birth.
What was the situation with the two ladies you know? Was the problem with descent or with birth? Did they deliver vaginally? Were the babies okay or did they need help getting started? Each woman needs to be evaluated for where she's at. I don't think that there is an easy answer, but the possibility of having a short cord shouldn't be the only criteria for avoiding a vaginal birth.
- Christina Oertel, DEM, CLC
A: I recently cared for a primip woman in labour who had a really straightforward quick first stage of labour. In the second stage of labour she pushed involuntarily for over two hours, with the head almost crowning for at least an hour and a half. Eventually the baby was born with the cord so short that the baby could not be placed farther up then the symphysis-pubis. (She wanted a physiological third stage). The placenta did not want to appear either, and after an hour we opted for active management and it delivered with no problem. I can only think that the pressure applied on the placenta by the short cord during the birth of the baby disturbed the normal physiological process of placental separation. There were no signs of distress from the baby during the second stage by intermittent auscultation, and she scored well at birth. However, I also think if there had been restrictions on the length of second stage and she had ended up with an instrumental delivery, then the short cord would have been cited as an abnormality. As it was she had a normal birth, albeit a bit longer than usual. Are we making a fuss about something that is not abnormal?
- Pauline McGill
A: I just doula-ed for a couple with twins and one died at 39+ weeks. Doctor's initial comment was that baby had a very short cord--approx. 5 inches. Don't know the details or have the pathology or ME findings yet, but he indicated that the short cord was a symptom of underlying difficulties. If I remember my education correctly, cords are supposed to be between 10 and 22 inches. I'll be glad to hear what others know.
A: I am interested in hearing how a definitive diagnosis of "short cord" can be made prior to the actual delivery. Though I am aware that short cords do indeed cause legitimate problems, I have never attended a delivery where a short cord prevented vaginal delivery. Most interesting to me is the statement at the end of the question--that two mothers are afraid to attempt vaginal deliveries for fear of repeat short cords? The only alternative to vaginal delivery that I am aware of is cesarean section. I sincerely hope that no one would advocate a c-section for this purpose.
- Kim Ray, L.M.
QUESTION OF THE QUARTER for Midwifery Today magazine
Issue No. 58
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001
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In response to the question about blood types [Issue 3:9]:
I am O+ and my husband A+. Both our children are B+ and experienced jaundice before or around 24 hours after birth. My first child was born in the hospital and had a level of 13 around 12 hours. She was immediately put under phototherapy lights in the nursery. After two days I was allowed to take her home and continue phototherapy with a biliblanket. My son was born at home and was taken to the pediatrician after 48 hours. The doctor also recommended phototherapy and wanted to hospitalize him. Fortunately, we were able to keep him home with the home unit.
For both births the cord was not cut until it had stopped pulsing. With the second birth, my midwife recommended alfalfa a few weeks before birth. After birth she gave me a liver cleanser. Could any of these procedures/herbs have helped or hindered cleansing of the bilirubin from the blood? I would like another child in the future, but the ABO incompatibility jaundice and a possible blood transfusion is a scary thought. What are the accepted levels at different times? Are there any more alternative therapies? (Both children were born in November when there is not an abundance of sunlight to put them in.)
- Claudine (firstname.lastname@example.org)
I also have O+ blood with my husband being A-. Of my 7 children only one has experienced problems with severe jaundice related to and diagnosed as direct ABO incompatibility. As it was explained to me by our pediatrician the key to reducing the severity of the jaundice is to produce milk as quickly as you can. We know that breastmilk helps break down the bilirubin. I also used phototherapy. This child did have to have regular blood tests for the first six weeks of her life. Although there is a possibility of other children having this condition it is not likely as the condition is very rare. Subsequent children tested for this incompatibility have not had this problem. I am expecting my eighth and I am not worried. My advice to you is to do the appropriate tests when your babe is born. Then embark on an aggressive milk production program which may require extra stimulation as these babes tend to be sleepy. Take alfalfa capsules now and continue this for at least six weeks postpartum. Chances are everything will be fine!!
The pharmacy department at the hospital where I work contacted the manufacturers of prostaglandin gel who stated that prostaglandin gel is not derived from pig semen. [This was in response to the query in E-News in Issue 3:9.]
- Christine Holliday, midwife
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