June 13, 2001
Volume 3, Issue 24
Midwifery Today E-News
“Vaginal vs. Cesarean Birth”
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THIS WEEK'S ISSUE

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Quote of the Week:

"Honesty and humility are two of the most important qualities a midwife can possess, and during your early years of practice they will be tested, tried, and strengthened again and again."

- Lois Wilson


The Art of Midwifery

As a doula, when I have my first meeting with a client I always end it with a foot rub using lavender-scented almond oil. This gives me a chance to touch mom. I then meet with her at least once a week starting at 38 weeks for a foot massage. It serves many purposes, but most importantly, no matter what, during labor I can rub her feet and help her relax between contractions. Massage also gets mom used to being touched and lets me know how comfortable she is with others touching her. The intimacy we create easily carries over to birth and postpartum.

- Chantel Haynes

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News Flashes

Monitoring increases in ambulatory blood pressure at work can help identify women at risk of developing hypertension in late pregnancy, according to an Australian study. The study showed that pregnant women's blood pressure is significantly higher on work days than on nonwork days. The absolute magnitude of work-related increases was predictive of hypertension later in pregnancy.

- Obstet-Gynecol 2001 87:361-365

What Do You Think?

Editor's note: In this and the next issue of E-News, we will include responses to a news item [Issue 3:23] about an American obstetrician who believes vaginal birth creates "needless" pelvic floor disorders later in a woman's life. The news story appeared to favor cesarean section as an acceptable alternative.

I think Dr. Charles Butrick, along with other OBs, is trying to create panic and hysteria in a time when vanity, narcissism, and the willingness to go under the knife are at an all-time high. Because the doctor is foremost a surgeon (OBs are surgeons first), and because a lot of the birthing dollars are going to midwives and "natural," less costly vaginal births, he's upset. The doctor is an opportunist and is seeking to continue making money in his trade by offering his repair via the knife, after birth, while at the same time trying to urge the public to see c-sections as safe and needed. (Income from surgery twice in a woman's life is quite a boon. And let's not forget that 90% of hysterectomies are unnecessary--that would make it three income-producing surgeries per woman!)

If he's now repairing women whom he claims were damaged 20-30 years ago, weren't they more likely to have delivered in hospitals and by c-sections? Could it be possible that forceps and vacuum extraction and unnatural--lying on the back--delivery positions with mom numb and unable to work her muscles during labor are the real cause for pelvic floor damage? Could it be that the most common, medically sanctioned, female genital mutilation operation for women during that time--episiotomy--could be the cause of "pelvic damage"?

- Asiila, aspiring midwife
San Diego, CA

Did I miss something, or are they trying to say that a c-section will save you from damage? Have they forgotten that a c-sec is major abdominal surgery--that it IS damage? It is so typical of male OB/GYNs to think they will fix us if they just interfere more. I am appalled. In all the births I have been at or even heard of, I can think of no major perineal damage in the homebirths or even hospital midwife deliveries. However, I have been at countless hospital doctor-attended deliveries where the woman tore extensively. Last Feb a woman had a 5-pound baby and had a second-degree perineal tear because she could no longer feel the biofeedback of the burning at her perineum because the doc had lidocained her in anticipation of cutting an episiotomy, all against her wishes. In fact the woman and I caught the baby together as the doc turned around to reach for his scissors. Disgusting. I've seen an episiotomy and forceps on a 7-pounder, reconstructive surgery after a fourth-degree tear for a 6-pounder with a nuchal hand, and I've seen more lithotomy, stirrups births with 7-lb babies and subsequent second-degree tears to last me a lifetime.

All these are examples of how the medical model handles things. It is no wonder women are showing up with major trauma and problems. I just don't get doctors, who insist we are the ones broken when it is really they who are breaking us.

- Augustine Daniels, CBE and doula

Notice how they say damage to nerves, muscles and ligaments, yet they say absolutely nothing about the decrease in outdoor activity in the last 20+ years. I'd love to see a study on the amount of women who have "women problems" and how sedentary lifestyle worsens these conditions. Let's face it, most of us barely exercise. We used to walk, garden, play with our children. Now we spend time on the computer, drive to the mailbox, and our children watch TV instead of being outside.

- Chantel Haynes
Tucson AZ

This kind of vague, statistics-based misinformation is hurting women. I wonder why these doctors don't put their obviously ardent energy into creating statistics that support women, that support our natural birth processes? I'm going to choose to believe that the real reason this growing body of "doctors and researchers" is seeking out this type of misinformation is that we as a society have an inherent fear of the natural, of death, of the lack of control we have on the world, of the inherent power that lies in a woman's body.

Vaginal deliveries can stretch a woman's nerves--hah! This article stretched *my* nerves more than five vaginal deliveries ever could!

- Anon.

Don't underestimate the contribution of the techniques of the careprovider during pushing and crowning. Forced, extreme pushing, combined with not allowing enough time for the head to mold or the tissues to stretch, can seriously contribute to additional perineal trauma. Allowing a woman to push to the point of comfort, in her own time, and gradually ease the baby out can go a long way toward protecting tissues.

- Amy V. Haas, BCCE
Fairport, NY

Learn about Cesarean Prevention and VBAC with Midwifery Today issue 57

In "Choosing Cesarean Section" Marsden Wagner, MD, tells us that the risk/benefit factors of c-sections depend on the reason for doing them: "Where the baby is not in trouble, the risks to the baby still exist, meaning that the woman who chooses CS puts her baby in unnecessary danger."

Read more informational articles by Robin Lim, Judy Edmunds, Gloria Lemay, Nancy Wainer and many more!

Click here for the full table of contents


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Question of the Week

Q: While listening to fetal heart tones late in labor (when heard right above the pubic bone) it seems at times I hear cord sounds. This usually happens when the baby comes with a nuchal cord. I now prepare myself for a nuchal cord when I hear a cord pulsing at a woman's pubic bone, and I must say, it is nice to anticipate this fairly unexpected event. Have any other midwives found this to be true?

- Dawn

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Question of the Week Responses

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!

- Anon.

A: During my last trimester, I developed an umbilical hernia. I received acupuncture surrounding the hernia (very superficially) and at other places in my body. I was also informed to moxa (charcoaled mugwort that you heat and hold above the skin) every day. Within three weeks the pain and the hernia were both gone and never came back.

- Anon.

More on hemorrhoids [Issue 3:23]

I have found lemon juice to be absolutely marvelous. Every time you use the bathroom, wipe your bottom with a piece of fresh lemon. You will find the hemorrhoids will heal from the outside in. When you first apply the lemon the area will itch because the lemon is shrinking the hemorrhoids.

I also suggest doing pelvic rocks before bed and resting during the day with your feet up to relieve the pressure on your body.

- Robe

Many good herbal and homeopathic remedies that can be used prenatally are available to strengthen your vessels. For labor and birth, lying on the side opposite your hemorrhoids is an excellent position. Also have your midwife keep some 4x4s or washcloths soaking in a bowl of ice water (with a squirt of antibacterial). This can be used to provide you with counter-pressure during pushing. Most women find the cool pressure nice against the "ring of fire" and the cold/pressure reduces and prevents the hemorrhoids from coming out, along with the reduced pressure of being on your side.

Borion makes a great combination homeopathic for hemorrhoids that can be used postpartum, if necessary, and the standby trick of soaking pads with witch hazel, putting them in the freezer, and applying them as needed also works great.

- Christina Di Eno, midwife


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 editorial@midwiferytoday.com


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International Connections

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EDITOR'S NOTE: Only letters sent to the E-News official email address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER email addresses will be NOT be considered.

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E-News asked "What are the essential elements in prenatal care?" Readers should know that the latest issue of The Lancet has a paper from WHO (first author Jose Villar) that reports on a very large study of prenatal care in a number of countries as well as another article, also from WHO, that reviews the scientific literature of prenatal care.

The results of this study and review of the literature is that the usual schedule for prenatal visits is excessive and not productive. They found that half as many visits--around a total of six rather than around 12--gave just as good results in terms of the health of the baby and woman during and after birth. So we need to take a long hard look at the way we do routine prenatal care in the U.S.

Of course, these studies focused on the medical outcomes and had little to say about the emotional and social support prenatal care can give. In the U.S. having surgical specialists (obstetricians) give routine prenatal care is unnecessary and foolish. In the rest of the world, it is midwives who give routine prenatal care and that is the way it should be here. But these WHO studies do have implications for prenatal care in that they show you don't need to do the medical part of prenatal care nearly as often as thought.

I urge those interested in prenatal care to read these articles in The Lancet.

- Marsden Wagner, MD, MSPH

To read full-length articles by Dr. Marsden Wagner, go to Midwifery Today's web site!

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More on kidney disease [Issue 3:22]:

As an herbalist, I would avoid any vitamin supplements in preference to herbs that will benefit the kidneys and urinary tract and strengthen the uterus. My favorites for this are, in order, nettles, urva ursi and raspberry. The only one of these that requires care in dosage during pregnancy is urva ursi because it's quite strong and should only be taken as symptoms persist. Red raspberry and nettles should be taken throughout and on their own could more likely solve the problem. I would also add some dandelion leaf to the tea to help with toxins elimination and to assist the liver. Add 3 parts to a pot of water (liberally--2 tbsp. each), bring to a boil, simmer 5 minutes, strain and enjoy. Continue 2 times per day.

- Tessa Neilson, DTCM

I would like to echo Jill Cohen's call for revamping the language of birth so it appropriately reflects the kinds of births that midwives are regularly seeking and seeing [Issue 3:21]. When medical language is being used regularly, it's difficult to ask a mom to expect anything different from the kind of experience her friends are having in medicalized hospital birth. Being a hypnotherapist, I find it very disconcerting to hear the words "multip" and "primip" in the middle of a paragraph that is describing beautiful, gentle birth. In England and Australia, midwives refer to this woman, whether she has birthed or not, as the "mom." I did a workshop in Australia recently and was quite taken with the way the nurses and midwives refer to birthing mothers as "a woman I was caring for," and, "one of the moms I was looking after."

Could we at least get away from the word "deliver"? Pizzas and packages are delivered--on time and charted and voluminously documented. Babies are birthed. And can the person attending the birth receive the baby and not "catch" it? No one is throwing the baby. Actually, in the best of circumstances, shouldn't it be the mother who receives the baby? After all, isn't birth a celebration of life and, indeed, a reception for the baby?

- Marie Mickey Mongan
Avondale, Arizona

Re: neonatal seizures and cardiac arrest and their relation to "high tech births" [Issue 3:22]:

I have seen research relating external fetal monitoring to an increase in neonatal seizures but the research says there is no difference at one year. (I think we're supposed to find that comforting!) I haven't seen anything about cardiac arrest.

- Susan Mooney

I have worked in OB in hospitals for 13 years and seizures and arrests in neonates are very rare under normal circumstances. The only times I have seen this is with a catastrophic event leading to prolonged fetal hypoxia such as an abruption, bleeds, maternal seizures or codes, etc. Babies with other underlying disorders who have had some kind of prenatal insult or who are in withdrawal from their mom's drug use may seize.

Incompetent practitioners (both in and out of the hospital) may mismanage a delivery, but in my experience this is thankfully very rare. I have a lot of respect for the vast majority of midwives, nurses and doctors I have known over the years. There is a place for both homebirth and hospital births in our spectrum of care, a place for high-tech and low-tech based on a mom's preference and medical needs. Everyone's goal is a healthy, happy mom, babe and family, whether we work with homebirths or hospital births.

- Tracey Ledel, RNC

Do you know if there is a common thread in their births or postnatal care? Have these babies received vaccinations? You may want to read up on the effects of vaccinations. So many factors are being investigated--ultrasounds, Pitocin, and vaccinations being the main ones I am aware of, but I'm sure any invasive procedure could potentially be causing it. Every baby is different and will react differently to different assaults.

- Colleen Morris

Re: use of oregano oil for yeast infection [Issue 3:22]: Anyone who practices the use of aromatherapy or has read about it knows that internal use of essential oils is forbidden because it can cause tissue damage. Furthermore, the use of this oil is forbidden during pregnancy for it can cause uterine contractions!

- Zaramati Caroline, R.N. midwife

I am contemplating a third pregnancy. I have had 2 c-sections and have met with much apprehension upon my request for a natural and peaceful birth. I dearly want a midwife to care for me during this time, but feel I would be unwise not to have the backup of a specialist OB in case of a problem. The few who respect my feelings keep stating one thing: it is essential for dilation not to occur too slowly. I have been told that in the later part of dilation, 1 cm every three hours is not enough (which is what happened previously)--they would want 1 cm per hour or similar. I am well educated in birthing matters, but can find no real reason why slow dilation, without feotal distress and an active/well mother, causes such a problem. Their answer is that "something" must be wrong. Can anyone explain this reasoning?

- Anon.


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