October 10, 2001
Volume 3, Issue 41
Midwifery Today E-News
“Perineal Health”
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Midwifery Today Conference News

SEE YOU IN TWO WEEKS at Midwifery Today's international conference in Paris, France, 18-22 October 2001! Ina May Gaskin, Michel Odent, Beatrijs Smulders, Naoli Vinaver, Suzanne Colson, and Marina Alzugaray are just a few of the numerous knowledgeable, talented, dedicated teachers.


TRICKS OF THE TRADE IN HOSPITAL BIRTH (taught by Valerie El Halta) is just one of the many classes offered at the next Midwifery Today U.S. conference, scheduled to be held in Philadelphia, Pennsylvania March 21-25, 2002.



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Birth Center For Sale

Birth center and homebirth practice for sale in Eugene, Oregon. Beautiful, three-story, fully renovated, 100-year-old house, four blocks from the hospital. Decorated with antiques and birth art. Buy the practice (with its five year lease) or buy the practice and the building. Contact daphne@oregonmidwifery.org for more details.

Quote of the Week:

"As guardians of the birth rite, we can show women that birth doesn't have to be scary, dangerous, or even painful."

- Laurie Fremgen

The Art of Midwifery

For vaginal yeast infection, dilute tea tree oil with warm water and use it as a douche, or mix the oil with olive oil and soak a tampon with the mixture; insert for one to two hours. If it is not diluted, the tea tree oil can be very irritating, like alcohol on an open wound.

- Midwifery Today Forums

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News Flashes

High levels of glucose in nondiabetic pregnant women are associated with a greater risk of pregnancy complications, including cesarean section and clinical chorioamnionitis, a University of Medicine and Dentistry of New Jersey study of 1157 women suggests. Women whose plasma glucose concentrations were <99 mg/dl were compared with other participants. The comparison indicated that birth weights were approximately 50 g higher (p < 0.05) for gravidas whose glucose concentrations were 99 to 130 mg/dl and 200 g higher (p < 0.005) for those with glucose concentrations of >130 mg/dl. Increased maternal glucose concentration also correlated with a greater risk of large-for-gestation fetuses (p < 0.001). Length of gestation was inversely associated with glucose level, being significantly shortened by 2 to 5 days when concentrations of glucose were high. Furthermore, high glucose concentrations resulted in a twofold increased risk of maternal complications, including cesarean section and clinical chorioamnionitis. Chorioamnionitis combined with a high maternal glucose concentration resulted in a nearly 12-fold increased risk of very preterm delivery.

- Am J Epidemiol 2001;154:514-520

Perineal Health

The following herbs and essential oils can be used topically to help speed recovery to the perineum following bruising, stretching, and possibly stitching following birth:

Comfrey - Cell proliferant, vulnerary
Yarrow - Astringent, antiseptic
Rosemary - Astringent, antiseptic
Goldenseal - Antimicrobial, astringent
Witch hazel - Anti-inflammatory, vulnerary, astringent
Thyme - Antimicrobial, antispasmodic
Lavender - Antispasmodic, antimicrobial
Calendula - Anti-inflammatory, antimicrobial
Myrrh - Antimicrobial, astringent
Tea tree Essential Oil - Antiseptic, antimicrobial
Lavender Essential Oil - Antimicrobial, antispasmodic
Aloe vera - Vulnerary, antibacterial, analgesic

Make an Infusion
Bring 2 cups water to a boil; remove from heat and allow to cool slightly. Pour over two heaping teaspoons of the desired combination of herbs and cover tightly. Allow the mixture to steep for at least 1/2 hour (overnight is best), then strain well. Keep refrigerated for up to 3 days.


  • Spritz bottle: Put the undiluted mixture into a clean glass spray bottle and keep next to the toilet. Spray as needed, especially after urination.
  • Sitz bath: Soak the perineal area in a basin of water with the full 2 cups of tea added to an additional 6-10 cups of clean water. Use cold water if there is inflammation or swelling. Once that has subsided, experiment with warmer water until comfortable.
  • Regular Bath: Add the full 2 cups of tea to bath water.
  • Peri Bottle: This is a plastic squirt bottle (a water bottle with a pop-up top works) that can be used to irrigate the perineal area. Greatly reduces stinging if used during urination. With clean water, dilute the tea by half and fill the bottle.
  • Compress: Soak a clean cloth in the cooled mixture and apply to the sore area. Try freezing the cloth ahead of time for a cold compress.

For essential oils recommended above:

  • Sitz baths: Add up to 5 drops
  • Spray bottle: add 10-15 drops
  • Peri bottle: Add 5 drops per 500 ml

Caution: Many essential oils, if used undiluted, can cause serious damage to tissues. Be sure to use only those that have been recommended by a professional for undiluted use. Both lavender and tea tree oils are safe when used as directed in this article.

- Stacelynn Caughlan, ClN, CH, The Birthkit No. 30


THE BIRTHKIT, Midwifery Today's between-issues newsletter, is full of helpful articles, commentary, stories, herbal lore, and art.


Perineal Exercise

Vaginal muscle awareness and control are essential for avoiding vaginal/perineal tears. If the expectant mother can learn the difference between contracted and relaxed states of her vagina and perineum, she will be able to create either at will. Encourage her to do some exploring; have her place her fingers inside and contract her muscles around them in order to learn which motions work for her.

My favorite exercise is the classic "elevator." In this exercise, the pelvic floor muscles are pulled up like an elevator ascending to the first floor, second floor, third floor, fourth floor, fifth floor, then are held for 30 seconds and let down slowly to the fourth floor, third floor, second floor, first floor and finally to the basement--the place from which we give birth.

Yet another exercise that imparts control of the internal muscle most likely to tear at birth (the bulbocavernosus) is a quick, snapping movement lower down in the vagina, near the introitus.

- Elizabeth Davis, Heart & Hands, Celestial Arts 1997


Place the birthing woman's hand on her baby's head while it is emerging. The woman feels her baby crowning past the "ring of fire" and will slow down her pushing so she can birth without tearing.
- Midwifery Today Issue No. 33

Prenatally, a well-balanced diet of enough proteins, fresh fruits, and vegetables and very little refined foods is critical to the integrity of the perineal muscles and tissues. Well-hydrated and oxygenated tissues promote elasticity and quick healing. Women should drink a minimum of 8 glasses of filtered water a day. Adequate fat intake is also important for skin suppleness and elasticity. Supplemental alfalfa tablets contain vitamins A, B-12, D, calcium and phosphorus. Vitamin E (200-400 IU) taken daily with foods or drink containing fat will help absorption. Daily intake of vitamin C (1000-2000 mg) will help circulation and tissue elasticity. Red raspberry tea is wonderful for relaxing and helping the entire pubococcygeal area to be supple, especially toward the end of pregnancy.

Greater oxygenation of tissues is not only accomplished by diet, but also with exercise by increasing circulation. Walking, squatting, duck walking, pelvic rocks, tailor sitting, kegels, and swimming all are useful exercises.

- Renee Stein, Midwifery Today Issue 33

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Check It Out!

A Web Site Update for E-News Readers

CROWNING EARRINGS: A Midwifery Today favorite for years! Sterling silver, designed by Russel Wray.

TEAR PREVENTION and Alternatives to Suturing: Midwifery Today conference audiotape; teacher is Jill Cohen, lay midwife.

BREECH BIRTH: WOMAN-WISE: A straightforward book that covers incidence and types of breech, reasons for breech presentation, diagnosis, concerns regarding breech, birth planning, positions for labor, assisting breech birth, and the follow-up.

Midwifery Today's Online Forum

I am about to attend my first birth as a doula to a good friend. It is her first baby, and while her husband is there, he will not be able to touch her. I would appreciate any advice you might be able to give.

- Jennifer

Go to our forums to share your thoughts and experience.

Question of the Week


  1. What is the longest you have waited for a placenta after the birth of the baby? What was the outcome?
  2. While I was at the conference in NY the midwife covering for me attended one of my women. She was dilated fully at 5 am and had no urge to push. Six hours later, after trying several things, including AROM, they transported to the hospital and the woman was given Pitocin and an epidural - she was sectioned four hours later for failure to progress. Heart tones were fine all through and mother, although tired, did not want to be sectioned. The mother now believes that if they had simply waited, not broken her water, and trusted, the baby would have been born vaginally. What is the longest you have seen from full dilation to the beginning of pushing - or to the birth of a baby? What were the outcomes?

- Nancy Wainer

(Editor's Note: Please be as succinct and as helpful as possible when answering Nancy's question--avoid lengthy birth stories--E-News can't accommodate them!)


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Question of the Week Responses

Q: Has anyone had experience with pertussis contracted during pregnancy? I have searched all the textbooks I have, many from the local medical library, and the Internet with no significant results. My common sense tells me it could cause PROM, fetal and maternal hypoxia, and very possibly preterm labor. Any information?

- Susan Padilla

A: I have only worked with one case of pertussis during pregnancy. The mother was very uncomfortable with coughing frequently and excess mucous production. Often she would cough continuously to the point of vomiting. This put a lot of stress on abdominal muscles. However, she did carry to term and had no problems with delivery. The baby was healthy and has done well in spite of mom's discomfort during pregnancy.

- Judy


More about breastfeeding challenges as the result of large breasts and flat nipples (Issue 3:40):

In the case of an uninterested baby combined with nipples that are hard to latch onto, I recommend that moms pump their milk to keep up with milk production and to avoid engorgement (which makes nipples even flatter). The pumping can also help draw out the nipple. Then, with a person holding a container with the milk below breast level and a narrow tube (#8) leading out of the container, put the baby to the breast -- as best as possible get the baby on the nipple. Slide the end of the tube into baby's mouth so that it's entering over the top of the mom's nipple. Let baby suck on tube/mother's nipple. Usually babies are pretty good at drawing milk through the tube. It seems to be the reward of milk that eventually stimulates the uninterested baby. They get used to the flow of milk and soon the tube can be discarded (within a few days to a week). It might be necessary to finger feed with the tube for a few minutes before the feed to get the baby accustomed to the reward of milk for sucking, but don't get in the habit of only finger feeding.

To help baby get on flat nipples, show the mom how to compress her breast to make a "ledge" which the baby can latch onto. With the reward of milk, baby will soon become an expert at attaching to this ledge. If baby fusses, remove him/her from the breast. Don't force the issue--take a short break, wait for fussing to end, then try again. You don't want to set up being close to the breasts as a negative thing. Eventually, even with very flat nipples, babies figure out their own individual latch for their own mother.

Make sure the pumping is done with a high-quality electric double pump. Anything less is quite inefficient and mom may get the impression she isn't capable of producing good quantities of milk.

- Terra Reindl, Kelowna


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!


Regarding a question about counseling couples about infertility (Issue 3:40): Whenever someone asks me about infertility problems, the first thing I look for is possible low thyroid. In our part of the USA, thyroid problems are rampant. I have found that low thyroid is one of the most frequent causes of infertility as well as frequent repeated miscarriages. I ask them about a list of symptoms: feeling tired all the time, feeling cold, dry skin, brittle hair, chocolate cravings, fuzzy thinking, sometimes weight gain or inability to lose weight after a previous pregnancy, history of postpartum depression, any menstrual irregularities. If they answer yes to a majority of the questions, they are probably low thyroid. If you are unsure, have them chart their basal body temperature (same time every morning before rising) and coordinate it with their menstrual cycle. Low thyroid will actually cause a low basal body temperature. I give these women natural food products from Standard Process, Thytrophin PMG and Iodomere. It is amazing how quickly their body can heal itself and they often become pregnant. If they wish to go to a physician, make sure they do the complete thyroid panel work-up not just the initial thyroid level, or they will miss it. The conventional medical treatment would be to put them on thyroid. This works but does not really help the thyroid to heal.

- Judy


I learned of the RAMP technique in midwifery school but have never seen it done and I don't know anyone who has used it. It involves making a "ramp" with your dominant hand to slide the baby under the pubic bone. The hand is stiff with the fingers angled up toward the umbilicus. This supposedly prevents the baby's anterior shoulder from becoming lodged against the bone and allows it to slide down the hand into the birth canal. This is done if a shoulder dystocia is anticipated, and we all know this is very difficult to predict. Personally, I cannot imagine doing this even in anticipation of a large baby. Perhaps others have tried it and can comment.

- Kathleen Mulkern, CNM


In response to a question about tubal ligation (Issue 3:40): I would suggest to your sister to check the possibility of vasectomy for her partner. I would not choose BTL because women who have had this done [may] have early onset of menopause. Doctors forget to say so. My last pregnancy was while I was using the pill, so after the baby was born I got an IUD. Again I became pregnant. I decided to have an abortion and BTL, which seemed to me the only way not to become pregnant again. Vasectomy was out of the question because my partner was against it ("One never knows"). Today, with sperm banks, that problem is easily solved. Seven years after the BTL I found myself in the middle of menopause. Since than I have to use hormone replacement therapy (HRT) because life became very unpleasant without estrogen. Today I am 50 and have been using HRT for over 10 years, which puts me at a higher risk for breast cancer. I thought 20 years ago that I had no other options, but today you have and I do hope you will check all the possibilities before acting.

- Nellie Kahania Herman


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