|March 28, 2001|
Volume 3, Issue 13
|Midwifery Today E-News|
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THIS WEEK'S ISSUE
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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 is a magazine about Motherhood and Childhood. It is aimed at midwives, parents and institutions. All ideas are welcome.
Quote of the Week:
"The intention and care a society gives to the most precious of all human endeavors, childbearing, is a clear reflection of the healthcare the society is capable of and willing to provide."
- Jim Berg, MD
The Art of Midwifery
DOULA Tip of the Week: When baby's head is malpositioned in the pelvis, try this trick: Put a length of gripper-like shelf liner under mom's belly like a hammock. Dad holds one end of the gripper stuff and I hold the other; we pull up. We hoist the baby slightly up out of the pelvis and hold for about two minutes or so. When we let go the baby tends to settle into a new position.
- Jodie Minniear, C.D., DONA
For hundreds more "tricks," check out Midwifery Today's "Tricks of the Trade" Volumes I & II. Get both volumes for just $40!
Watch for "Tricks of the Trade Volume III," coming this summer!
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Several features on ultrasound scans that doctors thought were warning signs of Down syndrome are almost always harmless, leading many women with normal fetuses to undergo unnecessary amniocentesis, researchers say. The analysis of 56 previous studies casts doubt on the reliability of ultrasound in detecting Down syndrome in the womb. Researchers looked at seven markers sometimes spotted on ultrasound scans that are thought to increase the risk of Down. Only one of those markers--a shaded area suggesting a thickening at the back of the neck--was found to be a reliable indicator. The six other markers were certain brain cysts, shortened thigh and upper-arm bones, bright spots on the bowel or heart, and high fluid levels in the kidneys. About 10 percent to 14 percent of pregnant women have one of these markers, but fewer than 1 percent have Down babies. Ultrasounds that show an obvious structural abnormality, such as heart defects that are common in Down syndrome, should not be discounted.
- AP wire service report, Nov. 23, 2000
STORYTELLING: We are the torchbearers of truth, the tellers of tales of beautiful birth, the weavers of courageous empowering visions to set before the women and families we serve. Our stories must be told often, until they become more compelling and convincing than the horrible "you are weak and effective, prone to failure, need our technology, and might as well give up and give in now" myths people hear all around them.... Share something marvelous at each visit.... Arrange public education sessions. Invite your ladies' relatives and friends to preparatory meetings. Facilitate support groups of women who choose to believe in their power.
- Judy Edmunds, Midwifery Today Issue 52
LISTENING: Good casetaking is more than asking the right questions. It also involves listening and observing skills. A woman who tells you "I can't sleep" in an angry tone while entering the room is different from the one who bursts into tears midway through the prenatal exam sobbing "I can't sleep," which is different from one who shrugs "I can't sleep" in a tiny voice when asked why she is always tired. There is also the subtle art of deciphering the trivial from the meaty in casetaking.... Leave time for the story, the personal, or what may seem a bit of rambling...."Great truths are often said on the doorstep."
WATERBIRTH: Summary of physiological benefits: Increases relaxation, decreases pain, decreases pressure on abdominal muscles and vena cava, increases pelvic diameters, increases buoyancy and mobility, provides a gravity-free environment, increases contractions, increases endorphin and oxytocin production, increases oxygen and blood supply, increases peripheral/muscle and skin temperature, increases velocity of nerve conduction, increases tissue metabolism, relaxes perineal tissue, reduces blood pressure.
- Dianne Garland, "Waterbirth: An Attitude to Care," Books for Midwives Press, 1996
MASSAGE: During the labors I attend I use a lot of touch and massage. As with pregnancy massage, I find that my clients benefit from touch and massage in different ways. One client told me, "Massage eased labor pain in the back immensely. I would have had an epidural without the massage during labor. Massage also gave me something to focus on other than the pain of labor." Another said, "Massage definitely reduced stress and anxiety by helping me focus on each stage and get over it."
- Keri Redding, LMT in Midwifery Today Issue No. 52
CHIROPRACTIC CARE: If the pelvic bones are misaligned, it may cause altered pressure into the uterus and the baby has a more difficult time being head-down. The Webster Breech Technique has been demonstrated to be highly effective. Some studies show it to be more effective than an external version where the baby is forced into a head-down position.
- Dr. C. Karl Krantz, Midwifery Today Issue 52
AROMATHERAPY: The use of essential oils as massage agents, additives to baths, or a few drops on a tissue used as an inhalant can be effective for relaxation and stress reduction, decreasing pain and discomfort in labor, augmenting labor contractions and facilitating healing and reduction of perineal discomfort during postpartum. A six-month pilot study in English maternity wards showed lavender, clary sage, peppermint and eucalyptus to be among some of the most helpful essential oils studied.
- Mary Bove, ND, LM "Herbs for use in Pregnancy, Birth and Postpartum," The Birthkit newsletter Issue 20, a Midwifery Today publication
HOMEBIRTH: In a hospital environment, women often produce the hormone adrenaline in response to subconscious or conscious fear. This inhibits the release of the hormone oxytocin, and labour may well slow down. Although this slowing of labour is a natural safety mechanism designed to let the woman know she needs to find another environment, it is interpreted by many medical professionals as "failure (of the body) to progress." Rather than suggest that the woman talk about her fears or find a different environment, they will turn instead to drugs to "speed up" the labour. This drug (usually Pitocin or Syntocinon) can cause distress in the baby, among other effects, and often itself leads to a "cascade of intervention" which may result in an instrumental delivery or a cesarean.
- Sara Wickham, "Homebirth: What Are the Issues?", in The Heart and Science of Homebirth, a Midwifery Today book
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Add a new dimension to your practice. Learn to teach hypnotic fear release and profound relaxation methods to eliminate the "fear-tension-pain syndrome" and create calm, comfortable birthings.
UVA URSI: When edema is coupled with elevated blood pressure, I thoroughly inform a woman about the course of preeclampsia. I then suggest deep relaxation, mild exercise, increasing protein to 125 grams per day, calcium to 2000 grams per day, and water to three quarts. I then suggest one cup of uva ursi tea per day. Method: Place one handful of uva ursi leaves in a jar, add 2 cups of boiling water, cover and steep for eight hours. Have her drink one cup per day. In severe cases, she should drink one cup every 12 hours. Recheck blood pressure and edema in three days. Refer to an allopath/homeopath if the condition is not responding to treatment.
- Alison Osborne, Midwifery Today Tricks of the Trade Vol. I
ANTI-HEMORRHOID SALVE: 2 cups dried plantain leaves, 2 cups coconut oil, 1/2 cup dried yarrow flowers and leaves. Mix and put into a nonmetal, covered container. Put in oven at 120 degrees for six hours. You may need to leave the oven door open a bit. Strain while warm through cheese cloth. Put in a clean wide-mouth jar and store in a cool place. Use this salve whenever hemorrhoids are irritating.
- Daphne Singingtree, Midwifery Today Issue 26
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International Cesarean Awareness Network (ICAN)
International Cesarean Awareness Network (ICAN) presents its 2001 conference: Celebrating the Gift of Birth: Empowering, Embracing, Acknowledging
Check It Out!
HAVING A BABY TODAY: Midwifery Today's new publication! From preconception to the first birthday, this newsletter will help parents and parents-to-be learn how to have a healthy and happy baby and mother.
From the premiere issue of our newest newsletter, Having a Baby Today:
TRICKS OF THE TRADE VOL. 1 excerpts can be found on our web site!
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Yvonne Cryns Legal Defense Fund
Yvonne Cryns (CPM) was indicted by an Illinois grand jury on two counts of involuntary manslaughter. Each count carries a potential sentence of 2 to 5 years in prison. Legal fees are mounting. Please contact Jan Caliendo at email@example.com to help Yvonne and her family with a donation or contact Yvonne Cryns Legal Defense Fund, 5703 Hillcrest, Richmond, IL 60071.
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Midwifery Today's Online Forum
During the 15 years I have been practicing as a midwife, I have always done vaginal exams (VE) on labouring women to assess progress, as I was taught to do and as is the protocol with the health authorities I have worked for. However, I have recently cared for women and have found myself questioning the value of VEs, and look at them more of an invasion of privacy and unnecessary. If I am confident that the vertex is presenting and I can feel descent on abdominal palpation, I have not done a VE at all. Is there anyone who knows of any research which suggests that VEs are unnecessary?
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Question of the Week
I have a client (gravid 5) who has come to us with the history of retained placenta three times in the last three births. Is there something to do to prevent it?
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Question of the Week Responses
Q: Considering that a primigravida usually has a longer labour than a multip, the reason often being that the muscles are tighter and stronger, does anyone think primips should be encouraged to stop their pubo-coxygeal, pelvic floor exercises [kegels] at about week 34?
A: Kegels should continue for the entire length of pregnancy. The pressure a lot of mothers feel toward the last few weeks creates a sort of stagnation in the pelvic sling. In the yogic tradition kegels are called root lock (mula bandha). The purpose of this exercise is to allow fresh blood flow and life force (prana) to flood the area, bringing in oxygen and nutrients which will be helpful to heal possible stitches and/or hemorrhoids after birth. The benefits go beyond the physical to the energetic connection a mother possessed with her "root." The root chakra deals with basic survival, an instinct mothers need to access during birth. Moreover, some mothers aren't acquainted with their yonis in a healthy way and the kegel/mula bandha brings awareness to that region of the body so that the perineum and baby's head can be felt during labor, drawing an energetic bond from mom to babe.
- Nicole Gauthier-Schatz, yoga teacher, birth doula
A: I seem to recall that longer labours of primigravidas is more attributable to denser collagen in the cervix and the slower response time for that to soften, than the musculature of the vaginal wall and perineal floor that the tightening exercises addresses. I understood that the most variable portion of labour is the time for cervix to soften, stretch and dilate? The exercises would help create better blood flow and more conscious control of muscles.
- Julei Busch, midwifery student, doula
QUESTION OF THE QUARTER for Midwifery Today magazine
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001.
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Fenugreek and comfrey are two herbs that have long been thought to benefit nursing mothers. However, these herbal remedies pose health risks to the breastfed infant and should not be used.
Dr. Ruth A. Lawrence of the University of Rochester, New York, reviewed the use of herbs by nursing mothers in a presentation at the annual meeting of the American Academy of Pediatrics. According to Dr. Lawrence, nursing mothers will take fenugreek believing that the herb helps increase milk supply. It is important for nursing mothers to know that this benefit has not been documented. Furthermore, there is data confirming that fenugreek poses certain health risks. Fenugreek is known to cause hypoglycemia and high blood pressure in the mother. It is also is associated with increased colic and diarrhea in the nursing infant.
Comfrey is another herb that should be avoided. This herb is rubbed on the nipples of nursing women to prevent cracking and dryness. According to Dr. Lawrence, it does pass to the nursing child and is associated with hepatic veno-occlusive disease in infants.
A nursing mother who is encountering postpartum depression may reach for St. John's Wort as a way to feel better. Though studies have shown some success in treating depression with St. John's Wort, the studies were done in men, not in women. St. John's Wort contains a seratonin reuptake inhibitor and there is no way to tell how much is being passed to the infant through breastmilk.
Since the FDA does not regulate herbs, Dr. Lawrence advises staying away from most herbs while nursing. She concluded her remarks by listing some herbal teas the nursing mother can enjoy. She recommends chicory, peppermint, red bush and rosehip teas.
- Jennifer Rosenberg
Re. the red raspberry question: Indeed, my herbal books all indicate the ideaus form of red raspberry for pregnancy. I use this form with my women and can tell a great difference in shortened, more straightforward labors. Many of my moms who have had long labors before have cut their labors in half by drinking a quart a day beginning at five months. I also have less hemorrhage and postpartum bleeding in these same moms. An Amish midwife from this state who has delivered a few thousand babies taught me this about eight years ago, in answer to my quest for help with my grand multips who were having trouble with dysfunctional labors. It has brought a marvelous difference to my practice.
- R. W.
In E-News Issues 3:1 and 3:2 the remedy of cabbage applied to engorged breasts was offered and then later disputed. I have been a labour support and postpartum doula for over three years with the majority of my clients breastfeeding (at least 90%). In my experience, cabbage applied to engorged and tender breasts at intervals greatly relieves the discomfort with no evidence of reduced milk production. I always inform my clients that it CAN reduce and ultimately dry up milk supply if used on a continual basis for over 24 hrs, in addition to no feeding.
When breasts are red and hard, cabbage offers immediate relief. When nipples are sore and even cracked I recommend warm salt water soaks (shot glasses work best) three times a day for about five minutes, in conjunction with applied colostrum and later, breastmilk. Colostrum/breastmilk is another miracle worker (in addition to making sure baby has proper latch, tongue forward and no lips over gum and all, if not almost all, of the areola in the mouth}.
Should pain persist, it's time to see if thrush is the culprit and consult a lactation consultant to assess if there are other undetected conditions. Many women who I see have a) hospital births and receive mixed messages from hospital staff, and b) see breasts as objects of aesthetics not necessarily bounty of life. It takes a moment for them to transition, but when they do the discomfort seems to decrease rapidly.
- Jennifer, doula
My stretch marks are horrendous! Angry purple marks on thighs, hips, belly, sides, and breasts have appeared in spite of being treated with pure vitamin E oil twice daily since the third month. And I'm not overweight!
Now the good news:
- Beka Joy Anast
I am 16 weeks pregnant with my fourth child. I have always had horrible all-day morning sickness for 60-70 days beginning at 6 weeks. I feel the all-day nausea has passed, but every time I eat I get sick to my stomach and feel like I have a small lead weight sitting there. I eat six small meals instead of three. I try to keep food and drink separate. If I throw up my food, (I've only thrown up five times because I don't feel better after and I'd rather fight it than violently throw up for 10 minutes), it looks barely digested after even four hours.
Only a family practice doctor is available to me. There are no midwives in my area. I feel anemic (but haven't been tested; my next appointment is in two weeks) and am taking a prenatal vitamin, yellow dock, nettle and raspberry tea. I notice no difference whether I take them or not. I haven't told my doctor I'm taking these. I am desperate for some help.
- Kalli Johnson
I need information about what a pregnant woman can do to reduce swelling during pregnancy? Herbal remedies or otherwise?
Re. The question about using nettles to prevent postpartum hemorrhage [Issue 3:12]: Nettle infusion teas are a good source of vitamin K, a natural aid for blood clotting. However, the frequency and the potency of the tea is another matter. A good herbalist should be well versed enough to give advice on the subject. Other sources of vitamin K include cayenne pepper and alfalfa. Always seek sound advice before taking any herbal remedy for ailments as many are contraindicated in pregnancy.
- Mel Radford, student midwife
I have attended two births that involved short cords. One was with a primip with some subtle decels at 3-4 cm. We transported to the hospital. She continued to labor in knee-chest position until full dilation. Then she turned over and pushed her baby out as quickly as she could with the help of fundal pressure. The cord was just shy of 12 inches. All was perfect with the baby.
The other was a case of a multip whose water broke at 2-3 cm, followed by a premature urge to push. We worked with every contraction to minimize any pushing. The contractions were very frequent. We had some interesting FHT variables, and some very light bleeding (are you getting worried yet?). This was a mom who didn't want to go to the hospital unless she or the baby was about to die. At one point we had a bit more bleeding, and it did have the smell of blood that comes with the placenta. The bleeding decreased to just less than a tablespoon when she could not keep from pushing. As she was not progressing very quickly, I had to advise transporting. The doctor who took over her care insisted on a cesarean. The baby had an 8 in. cord that was wrapped around her neck and arm. She was just fine.
So, a few inches and entanglement can make a big difference in outcome. I would not advise any new or unseasoned midwives to stay at home with a client with a situation such as the second case. I have been a midwife for a very long time.
- E.T., CPM, LM
I recently began work with a young woman who conceived her child when she was taking Ritalin; she used the drug for the entire first trimester. Where do I go for information about the effects of the drug on mother, embryo, fetus and baby? What direct experience do midwives have with this? What does she need to know or be prepared to think about?
- Kathy Berry
I was reminded today that worldwide, one million women die during pregnancy or in labour due to pregnancy-associated causes. I think this would be a good topic for discussion, especially among the privileged "first world" readership.
- Phil Watters
More on breech:
I was curious that your section on breech didn't mention the recent international Term Breech Trial. Any reflections from participants would be welcome(the outcome was quite the opposite to Henci Goers').
How was breech birth handled 100 years ago? Any ideas where to find such information?
I'll be 27 weeks pregnant in two days and my midwife just measured my uterus at 31 cm. At my last visit two weeks ago, I was almost 25 weeks and measured 28 cm. I'm scheduled for a sonogram for fetal growth tomorrow morning--the prescription says "size>date". Of course I'm concerned about the effects of ultrasound (my only other one was at 21 weeks and things were fine then) but I realize that this is not a routine sonogram; it's for a medical purpose.
I just had the gestational diabetes screen today, and last night dreamed I
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