What Do You Think?
Overland Park, KS., physician Charles Butrick used to deliver babies. Now he
almost exclusively repairs the damage they can cause on their way into the world.
Butrick is among a chorus of physicians and medical researchers who in recent
years have been warning that certain birthing practices are creating needless
damage to new mothers that could result in incontinence, sagging internal organs
or pelvic pain decades down the road.
The campaign for more natural childbirth (and fewer cesarean sections) has contributed
to a huge growth in pelvic floor disorders that weren't very apparent until recently,
according to Butrick, a uro-gynecologist. Doctors have worked hard to decrease
their c-section rates. Nationwide, the average fell from a peak of 24.7%in 1988
to a subsequent low of 20.7% in 1996. It has crept up slightly since then. Compounding
that is the opposition of some pregnant women to any sort of technological intervention,
And yet a growing body of research indicates that although vaginal delivery
is fine in many cases, in some circumstances those deliveries can stretch a woman's
nerves, muscles and ligaments beyond their capacity to rebound. And that can lead
to serious problems that require surgery and physical therapy 20 or 30 years later.
For decades, according to Butrick, obstetricians have suspected that certain
vaginal deliveries cause damage that results decades later in problems. But only
about 10 years ago did the technology develop that enabled physicians to see the
actual damage to muscles, nerves and ligaments.
There is evidence that about 28 percent of vaginal deliveries cause injury to
the mother, 'even though it may not result in symptoms until 20 years later,'
said W. Benson Harer Jr., a gynecologist and president of the American Society
of Obstetricians and Gynecologists.
[Thanks to E-News reader Kathy Jackson, who sent in the above article from the
Lewiston Morning Tribune dated Wednesday, May 23, 2001. Send your comments, evidence,
facts, and experience to E-News. We'll dedicate an issue or two to your discussion.]
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Question of the Week
Q: I am dealing with a bilateral inguinal hernia,
which became apparent at about 24-26 weeks. I am in the eighth month of my third
pregnancy. I am very active and get a significant amount of exercise. I am wearing
a hernia belt, bathing with epsom salts, doing external compresses and trying
to rest regularly and minimize excess lifting. My chief concern is pushing. We
will be birthing at home, probably in water and I don't really expect to push
until I feel a primal urge to (my 8 lb. daughter slid out pretty well on her own,
a few pushes were called for). My midwife is inexperienced with hernias and as
a doula I have never encountered them. Any insight would be gratefully appreciated!
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Question of the Week Responses
Q: I am going to give birth for the second time in
just a few weeks. I've suffered from hemorrhoids since my first baby's birth when
I used that eye-popping Valsalva pushing. I won't do that again! I want to keep
the hemorrhoids from being such a distraction during my labor. Any good ideas,
treatments, positions? Would laboring in water help? I love the squatting position
but it doesn't work well during pregnancy when the hemorrhoids are swollen. I'd
appreciate any advice.
A: Witch hazel compresses can help shrink hemorrhoids before labour starts.
It also may be soothing during second stage. Honey also can be helpful--it's applied
directly too. Avoid any sort of controlled/breath holding/eye-popping pushing
(unless it's involuntary) and try kneeling or all-fours.
A: I have had hemorrhoids since the birth of my second child and I have
eight children, all about two years apart. I have found no difference in my hemorrhoids
whether I had a waterbirth (no. 4 and 7) or when I had land births (no. 1,2,3,5,6,8).
I definitely don't focus on them and the only time they give me trouble is about
three weeks before I give birth, at which time I apply an anti-inflammatory such
as witch hazel and elder leaf salve. I try to keep them extremely clean with a
squirting type of bottle after every bowel movement. They don't usually bother
me after the birth or in the days that follow in the immediate postpartum.
- Jennifer Crowley, CBE, aspiring midwife
A: First, to keep from having to strain, take two capsules of flax seed
oil before bedtime, and drink sufficiently during the day to have soft stools.
If stools are usually hard, one can also take a combination of ground flax seeds,
ground fennel seeds, slippery elm and psyllium seeds in equal measure, one Tbsp
mixed with water or juice followed by a large glass of water, also before bed.
After every bowel movement, gently wash anus with a clean warm cloth, then apply
bottled or fresh lemon juice with a q-tip or cotton ball. It will sting a bit,
but the fast results are worth it. Then apply an herbal salve containing comfrey,
calendula, plantain and yarrow and maybe vitamin E oil. Homeopathic remedy hamamelis
30x can also be useful. Expect to get results in a few days of thorough treatments!
In case the hemorrhoids are bothersome at the time of the birth, side-lying with
a supported leg might be an optimal position. Do not push forcefully but trust
your uterus to do the job!
- Shanu, doula, herbal and natural health practitioner
A: Certainly water for labor should be tried since water seems to alleviate
so many discomforts. A remedy to try to decrease the hemorrhoids before labor
would include whittling suppositories of potato and inserting them into the rectum.
Recently a nutritional healing specialist suggested that 10,000 mg of bioflavonoids
taken in divided doses daily for a month is therapeutic for hemorrhoids and varicosities.
I do not have information about whether this is allowable for pregnant women.
So I answer this question with another question: does anyone out there know
if there are contraindications to such high doses of bioflavonoids in pregnancy?
- Karen Ehrlich, CPM, LM
A: Shredded raw potato placed directly on them makes them go away and
feels wonderfully cool on a postpartum perineum. During labor with my second child,
my midwife fully supported my anus during the last of the pushing phase (when
it feels like it's inside out). I didn't have near the hemorrhoids I had after
my first birth experience.
Question of the Quarter for Midwifery Today Magazine
Theme for Issue No. 59: Prenatal
Question(s) of the Quarter: What are the essential elements of good prenatal
care? How does prenatal care create better birth? As a midwife/doula, what do
you hope to accomplish in the prenatal period with a pregnant woman?
Please submit your response by June 30, 2001 to firstname.lastname@example.org
In Celebration of Doulas
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To Melanie & Lisa, student midwives from England [Issue 3:22]:
I went to an "alternate birthing center" for four weeks at the end
of my BN program. I suggest you browse through the ads in midwifery journals.
You will need to have goals and objectives approved by the folks at both the university
you attend and wherever you go for this experience.
- Sylvia L. Nicholson, RN, BN, MHSA, MS, CNM
There is a wonderful teaching clinic in Zululand, South Africa. They are willing
to take people eager to experience different cultures. The person to contact is
Colin Pfaff: email@example.com
As well as being a great cultural experience, it is probably one of the most beautiful
places in the world! It is just south of Mozambique on the east coast of Africa.
[Ed. Note: Melanie/Lisa, please contact E-News at firstname.lastname@example.org]
I would love to hear from anyone about becoming a midwife. I have been thinking
very hard about the idea, doing as much reading as I can on the topic, exploring
internet sites etc, but nothing beats "spoken" word with those in the
know! I'd love to hear about any aspects of midwifery from both a personal and
practical perspective, especially from those of you in different parts of the
globe (I'm down under in New Zealand!) Perhaps you have an opinion on the different
types of training paths--nurse-midwifery vs. direct entry--which could give me
some more to think about.
Reply to: email@example.com
To the woman with the friend in Geneva, Switzerland:
I live in Basel, and don't know much about resources in the French Swiss part,
but in the German part there are many birth centers committed to natural births,
with excellent midwives. I gave birth in the center just outside Basel, Geburtstatte
Muttenz, attended by the co-leader of the center. The midwives there also provide
homebirths if you are ok'd for one. The website for muttenz is: www.geburtstatte.ch.
If she wants more info, she can contact them direct at: +41 061.461.4711.
More on evening primrose oil:
Evening primrose oil (EPO), borage oil, and black currant oil, like salmon oil
and flax seeds, although chemically slightly different, are all essential fatty
acids. Essential fatty acids are essential nutrients in the human diet.
Essential fatty acids are found in breastmilk and appear to be building blocks
for brain growth and development in the infant. Europeans have been adding essential
fatty acids to their artificial infant milks for years. U.S. formula companies
feel that before they can add it they must undergo rigorous testing, which may
be proving to be too expensive.
The "Lawerence Review of Natural Products Facts and Comparisons,"
maybe the pharmacist's bible when it comes to alternative phytochemicals, i.e.
Essental fatty acids are safe for pregnancy. They have been studied up to 8000
mg with no adverse effect. (Not one side effect was reported).
In addition, the standard six 500 mg capsules per day a pregnant woman is taking
by the 42nd week is only 3000 mg, well below the studied 8000 mg. Upon occasion,
when I have had a client go past 42 weeks, I have them increase the dosage, especially
if there is very little cervical ripening apparent. I have VBACs ingest this nutrient
during labor to soften the cervix. Several clients have melted a capsule in their
vagina at night to "soften things up," and they have not torn. They
attribute their intact perineums to the EPO. I attribute it to waterbirth or the
slow pushing and panting as the fetal head emerges.
I encourage all of my mothers to continue taking EPO (or whatever their dietary
choice has been) even after delivery so their milk is higher in this nutrient.
Infant brain growth is the most rapid in the first year of life (and the third
trimester). In this day and age with margarine and shortening contaminating most
fast foods, crackers, and grain products, the EFAs a body attempts to make, or
ingests in dietary form (oatmeal, spirulina) are used up fighting the "bad"
saturated fatty acids and transfatty acids.
Two publications in U.S. medical libraries are dedicated to studying EFAs (their
names escape me). I first saw them at the UCSD library in San Diego. I saw one
of the publications in Tyler, Texas at the UT hospital library. I was thoroughly
convinced of this nutrient's safety. There were numerous studies about infants,
brain growth, placentas, etc. packed in the two or three issues I was blessed
to stumble across. I'll bet with just a little online research or a jaunt to a
medical library you can find these journals and find some articles you can share
- Sandra Stine, CNM
For the woman looking to add EFAs to her diet during pregnancy: she should try
pumpkin seeds! There is a seasoned prepared version known as Pumpkorn. They are
very tasty and can be found in most health stores.
- Amy V. Haas, BCCE
To Andrea, who wishes to become a midwife but doesn't want children:
I am also 22, an aspiring midwife, and I plan to have children in my late 20s.
I have found many warm hearts so far that have encouraged me onward, but I have
also found many doubters and mothers/doulas/doctors who have made me feel like
I am second rate. But midwifery is changing in so many miraculous ways and it's
becoming possible to be part of a profession that was once strictly for experienced
birthers. On the other hand, midwifery is about experienced women bringing their
knowledge to laboring mothers. How can we empathize with these women if we have
not been through it ourselves? Is there some kind of deeper spring of knowledge
that we may tap into? Will we seem like fakes?
If you are dedicated and feel a spiritual calling to help women through labor,
you should follow that calling and see where it leads you. Pass up the doubters
and embrace those who make you feel like you are doing something worthwhile and
- Mindy Herron,
I would encourage you not to see your childlessness as a liability. I just gave
birth 15 months ago with the assistance of the "queen mother" of NE
Ohio midwives, the one who trains so many of the others and is so in demand that
she has to squeeze everybody into her very full schedule. Everyone is absolutely
in awe of her. Initially, I wondered how she could know how to best serve a client
when she didn't have children; however, so many of my friends had used her with
excellent, rave reviews, that I took the plunge. She quickly won my total confidence.
Beyond a shadow of a doubt, she was the one of three midwives I've used who
was the most intuitively understanding of my needs and the best in handling my
painful back labor. A spirit of peace and purposefulness and gentle humility permeated
the room, as well as awe of this important event. She took care of my spirit as
well as my body and my baby. My other children were treated with the most love
and care by her than by the earlier midwives. I shudder to think how awful the
world would be had she elected not to become a midwife.
She told us the reason she never married and bore children was that she felt
God had called her to be a full-time midwife and not to be hindered by a family
also in need of her attention. After she said that, I felt so important and valued
to be assisted by one so devoted to her art and ministry of midwifery.
You may need to initially set rather low prices to get enough clients to build
a reputation. Soon you may find that people appreciate the extra availability
you can accord them by not having a family to care for.
You would be an ideal midwife because you would not have your own family to
have to worry about. It also would be difficult to sympathize with a woman--"I
know it hurts"-when you've never experienced it. It's a two-edged sword.
If you found a good midwife to practice under for a while, or maybe even join
a group setting, you could gain a lot of respect. The more you age will help too.
I think "book knowledge" has a lot of influence these days, even in
this field. My first two OBs had never had kids, and of course there are tons
of men OBs!
I first began studying birth in 1973, and I have been a midwife since 1975.
I am now 54 years old and have never had a child. There is certainly a feeling
among many midwives and mothers that no one who has not given birth should become
a midwife. This is an issue that I and a small number of midwives have had to
deal with ever since the renaissance of homebirth and midwifery.
While I understand that feeling, obviously I disagree. Even though I cannot
truly "get" the profound depths of pregnancy and birth and postpartum,
even though I am floating on the surface of an incredibly vast body of experience,
I do have breasts and a uterus, I bled and cramped for 40 years, and I am a loving
human being who cares mightily for mothers and babies and families.
Although it is perhaps harder for those who have never had a baby to understand
the depth of what women go through in labor and in parenting, it doesn't mean
that we can't have the requisite sensitivity, empathy, caring, skill, ethics,
knowledge and ability. My clients have let me know over all these years that I
am able to relate well to them, give them the information they need, support them,
and be a good midwife for most of them. Certainly if any pregnant woman doubts
that she can be cared for properly by a childfree midwife, then I should not be
that woman's midwife, and I will happily refer her to some of the other wonderful
midwives who are also mothers. I take no offense at the hesitation or reluctance
to have a childfree midwife.
Cross culturally, probably the more common pattern is for older women, after
having completed their families and having raised their babies past dependency,
and perhaps after having raised them to adulthood, to then launch into their later-in-life
callings as midwives. However, this is not universal. In some cultures, young
women are trained as midwives who then devote their lives to this work; some of them do not ever go on to have children of their own. In others, indeed it is
women of childbearing age who become skilled at helping their peers in birth and
continue their work into older age. So the wisdom of the ages cannot help us determine
what is the best age and experience for welcoming our callings as midwives.
In 1974, a childbirth educator who was helping me sit in on birth preparation
classes had her first baby after having taught for about five years. She told
me, almost two years after her daughter was born, that she was a much better childbirth
educator before she became a mother. When she had not given birth, she told me,
she had hundreds of experiences to draw on when she taught her classes. Since
she had given birth, she now only had one experience.
To place a requirement on having gone through the experience oneself in order to be able to minister to another person going through that experience would ultimately
mean that no one can tend to anyone--because only a midwife who has had her own
baby die could be a midwife for a woman whose baby will die, except that only
rarely can we know ahead of time whose baby will die. A midwife who has had a
cesarean would not be able to tend to any woman who expects to give birth vaginally.
No midwife who has not had a VBAC would be able to tend to a woman who wants a
Clearly, in my opinion, there is no absolute requirement either way. I urge
Andrea to go ahead and follow her heart and calling. If no children find their
way through her body, she can still be a wonderful and credible midwife.
- Karen Ehrlich, CPM, LM
First, congratulations! I am 23 and due with my second baby in mid-October.
My midwife has no children of her own and is not married. I take her seriously
because she knows what she's talking about. Even if you don't have kids of your
own, you can still be a fine midwife! The care I receive from Kara is great. She's
very warm and personable, laid-back and easy-going. And it doesn't bother my husband
or me that she doesn't have children. You'll do fine!
San Antonio, TX
In response to the question about working with teen mothers/adoption [Issue
I was fifteen when I gave my baby up for adoption. I had had a lengthy stay at
the hospital before the birth because of preterm labor so the staff knew me well
and understood my situation. They were very supportive. My adoption was handled
by an agency, so a lot of the needed support was there. The adoptive family paid
for counseling and we exchanged pictures and letters. Having this kind of semi-open
adoption was very helpful. I was able to let go easier knowing my baby was okay.
The hardest day for me was the last day I was at the hospital. The hospital staff
offered me a lock of my baby's hair, a hospital birth certificate, and help with
pumping my milk. I had decided to pump and the adoption agency transported the
frozen milk for me (the family lived in the area).
Now, as a doula, I have not yet been privileged to accompany a mother planning
to release for adoption, but I have a few suggestions. Each mother is different:
One may want all the contact she can get and pictures and such; another may not
want to see the baby at all. One may want medication during the labor (as much
for pain as for emotion); another may feel tremendous accomplishment in doing
it naturally. You should not label and pre-decide how it will be. Be flexible
and don't come to the birth trying to accomplish any of your own goals. It is
hard enough for the mother without any judgment being passed.
Make sure the hospital staff knows her situation and that they will be supportive.
She needs to hear over and over that she is doing the right thing, that she is
strong and brave, and she can get through it. You can't praise her enough for
her decision. Over time this need will subside.
Once the birth is over she will need someone to confide in and talk with. Be
available for that--it is essential to her healing. Giving up a baby feels the
same to the mother as if her child had died. She has to grieve. Be her support
and her sounding board. It is not unusual for the mother to feel as though the
world wants her to forget. It seems unacceptable to talk about the baby to her
friends or even clergy and family. You can be her friend and let her remember
her baby with you. She will never forget and this experience will change her forever.
Helping her make the appropriate contacts in the community is necessary, especially
if she is not working through an agency. Counseling is a must.
Consider it a great opportunity if you get the chance to help one of these mothers.
- Laura Grout, CD (DONA), aspiring midwife
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