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THIS WEEK'S ISSUE
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Quote of the Week
"I'm an advocate of truly having your eyes opened and honestly appraising how much power you really have, not pretending that you will have as much power as you desire, just because you really want it. I think that's the essence of informed consent."
- Gretchen Humphries
The Art of Midwifery
While helping one mother breathe through her contractions, I noticed her forehead was very tensed. At the next contraction, I softly told her to relax her forehead. She began to concentrate so much on relaxing her forehead that her contractions did not seem to be so hard to get through. I have tried this during other labors and it really seems to work!
- Courtney Lovell
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Breastfeeding virtually eliminated crying and grimacing in infants undergoing the collection of blood samples from their heels in a recent study. Thirty infants who were held and breastfed by their mothers while undergoing the procedure were compared with 30 who were swaddled and placed in a bassinet. Crying and grimacing were reduced by 91% and 84% respectively among the breastfed babies. The researchers say these findings show that pain relief and stress reduction should be added to the long list of proven benefits of breastfeeding.
- Pediatrics 2002, 109(4), 590-93
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Q: I am following a woman through her pregnancy, and lately she has been unwell with flu-like symptoms, aching joints and a rash. After repeated blood tests, her GP has told her that she has parvo virus! (measles and rubella negative). In Australia, this is something we immunise our dogs against, not ourselves. Her obstetrician was quite evasive as to how she may have contracted the virus and also what the effects on the foetus may be. He mumbled something about congestive cardiac failure. Does anyone know anything about this virus?
A: Parvo virus is also called "fifth's disease" in humans. It is not uncommon in children, but is usually not diagnosed appropriately because of the generic symptoms it causes: fever, aches, etc. Some kids will get a characteristic "slapped cheek" rash that will trigger a provider to run a blood test for antibodies to parvo. Fifth's is not usually serious in adults or older children, but it can make young infants quite ill.
If a woman contracts parvo/fifth's while pregnant, she has a significantly increased chance of miscarriage, stillbirth and birth defects -- including congestive heart failure. I believe the disease attacks the baby's red blood cells and bone marrow. It can cause anemia and hydrops and adversely affect development. This woman should be seen by an OB and/or a perinatologist with experience managing pregnancies complicated by parvo virus. At the very least, she should get ultrasounds for at least 6 weeks post-infection to evaluate growth and look for signs of hydrops. If nothing shows up, she might still be a candidate for midwifery care.
Read the Centers for Disease Control bulletin on parvo virus and pregnancy.
- Melissa Jonas, LM
A: The parvo virus will cause the baby to become anemic and will require intrauterine blood transfusions. Anemia causes fetal hydrops, which is generalized edema. I had a baby (4 months ago) who had severe anemia in utero and after 3 intrauterine blood transfusions she was born healthy, and there were only slight residual effects of the edema she experienced.
- Julie Fuller
A: The following research may be of use, but may also scare the heck out of the woman. Talk with the midwife or your head of midwifery before showing these to the mother.
- P. Mancuso, Cytomegalovirus, parvovirus and rubella infection in pregnant women, Contemporary Clinical Gynecology and Obstetrics 2 (1), March 2002, pp 73-86 (March 2002).
- C.S. von Kaisenberg, W. Jonat, Fetal parvovirus B19 infection, Ultrasound in Obstetrics and Gynecology 18 (3), pp 280-288 (September 2001).
- T. Tolfvenstam, N. Papadogiannakis, O. Norbeck, Frequency of human parvovirus B19 infection in intrauterine fetal death, Lancet 357 (9267), pp 1494-1497 and others, (12 May 2001).
- C. Kailasam, J. Brennand, A.D. Cameron, Congenital parvovirus B19 infection: experience of a recent epidemic, Fetal Diagnosis and Therapy 16 (1), pp 18-22 (January-February 2001).
- Perinatal viral and parasitic infections, Obstetrics and Gynecology 96 (3), 13 pages (insert) ACOG, (September 2000).
- Annemarie, student
A: Many people are immune to it, but some are not, and if passed to the baby it can indeed cause heart failure. Your sister should have an ultrasound to check heart size and possibly cordocentesis to check for anaemia in the baby. It is treatable, but needs early treatment. Contact MIDIRS in the UK for a literature search on the subject: www.midirs.org
- Jane Dolby, ex midwife trainee A/N teacher
A: The only incidence I have come across was a lady at term whose labour was uneventful, but the baby was apnoeic and we were unable to clear the airway as it was continuously occluded by very thick clear fluid. It was extremely hard to ventilate the baby, who eventually died after three hours. Parvovirus B 19 and amnionitis was found at postmortem. The only other thing of note in the postmortem findings were only 2 cord vessels, and a small placenta weighing 290 grams.
- Linda W.
A: This is a very common childhood illness and is usually seen in clusters as one child infects all nonimmune persons around her. If a mom in her first trimester contracts parvovirus (meaning that she didn't have it as a child), her chance of having a miscarriage goes up, but is certainly far from guaranteed. Rarely, in the second half of pregnancy the baby may develop hydrops featalis characterized by anasarca secondary to severe anemia. Generally, nothing happens to the mom or baby.
A: It is easy for children to tolerate, but adults have a harder time with it. It took 6 weeks for me and my 3 kids to clear it out of our house completely. They each looked scary for a week, but I was feverish for 2 days with no symptoms, followed by itchy extremities and arthritic knees and fingers on the following day. My husband must have had it as a child because he never caught it from us.
- -Evelyn Walker, AAHCC
Midwives for Midwives
Antigua, Guatemala: Midwifery-run, non-profit, model women's health and birth center looking for dedicated, experienced midwife to provide quality, full-scope midwifery care to women of diverse backgrounds, consult and provide support to traditional midwives, oversee apprenticeship program. CNM/CM with 5+ years experience providing full scope care, proficient/fluent in Spanish a must. Generous salary and benefits.
To learn more or apply, visit our Web site or send CV and letter to firstname.lastname@example.org.
Check It Out!
A Web Site Update for E-News Readers
CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME
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Offer expires July 24, 2002.
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The Birthsong Midwifery Workbook: Are you an aspiring midwife attending school or on a self-study course? This workbook-study guide is just what you need!
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INTERNATIONAL ALLIANCE OF MIDWIVES
Midwifery Today's Web-based organization that networks international midwives.
Midwifery Today's Online Forums: Anemia
I have a client who is about 30 weeks pregnant. She is very anemic. She tried a few things like Floradix with iron, eating beans and nuts. She doesn't eat beef, however. She is taking a high dose of iron supplement prescribed by her GP. She also takes folic acid, B vitamins, and vitamin C. Any ideas what could cause the anemia and what else she can do?
To share your thoughts and experience, go to Midwifery Today's Forums.
Lamaze International Conference
September 27-29, 2002
Join us as we advocate for a world of confident women choosing normal birth at It's Not Your Ma's Lamaze Anymore! Conference at the Hilton Pittsburgh and Towers. The early bird registration fee is $285 and the deadline is August 9. Visit our conference Web page for more information or call 800-368-4404.
Question of the Week (Repeated): LGA Babies
Q: I have two boys who were large for gestational age (LGA) babies. First baby was born 2 days before his EDD, 10 lb 13 oz, 21 1/2 " long, hospital birth with episiotomy, 4th degree tear, vacuum. Second baby was born on his EDD, 11 lb 4 oz, 23" long, waterbirth at home, no episiotomy, tiny tear with no stitches. I tested negative on the GTT both pregnancies. Besides shoulder dystocia and possible blood sugar problems (which didn't happen with either of my kids) what, if any, are the medical risks for LGA babies/moms? Most of the clients I teach or provide labor support for choose hospital births with OBs, and I'd like to be able to give them some evidence that they don't necessarily need to be induced or sectioned if their babies look "too big" on ultrasound, etc.
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The BirthLove Web site has helped many women grow trust in birth and in their bodies. It has helped women resist Cytotec, find good midwives and stop believing everything their doctors say. There are hundreds of homebirth stories: unassisted VBAC, fathers' stories, twin (and triplet home VBAC!) stories, breech stories -- for things that people get sectioned for daily, there are homebirth stories on the site. Marsden Wagner, MD is a contributing expert, as are Sarah Buckley, MD, Gloria Lemay and Gretchen Humphries. BirthLove has changed and saved lives through education, communication and love. Become a member of BirthLove today and be inspired!
Question of the Quarter, Midwifery Today magazine
Issue 63, Interventions
What is the worst case of interventions-gone-awry that you know of?
Please submit your response by June 30, 2002 to email@example.com.
Issue 64, Unity
Is unity possible in this diverse midwifery community? Can we stand up for and support one another when there is such a range of philosophical approaches to training and practice?
Please submit your response by Sept. 30, 2002 to firstname.lastname@example.org.
All responses subject to editing for content and style. Sorry, but we cannot reply to each individual submission.
by Gloria Lemay, compiled by Leilah McCracken
Using Castor Oil (and other methods of home induction) with Caution
Inducing with castor oil is not without hazard. The action of this harsh substance is that once swallowed the castor oil is hydrolized by intestinal lipases to recinoleic acid, which stimulates intestinal secretion, decreases glucose absorption, and increases intestinal motility. My question to a midwife who says castor oil is not absorbed is "Would you please provide me with references for that statement?" I worry about women taking castor oil because they also give their babies castor oil as it passes through the gut. This means the baby may pass meconium, too. If the midwife always transports for meconium in the amniotic fluid, this could cost the woman her planned homebirth and lead to aggressive suctioning of the newborn.
When a woman is hurried into the birth process in any way (membrane stripping, cohosh tinctures/teas, nipple stimulation, castor oil, etc.), the flow of the birth will be disturbed. One of my concerns about home inductions is that the birth that is stimulated by outside forces can result in erratic birth processes that stop and start and are difficult to complete.
I attended a coroner's inquest in Vancouver, BC, into the death of a full-term baby girl who was born at home. The midwife stripped membranes because of pressure from her licensing body to not have the mother go more than 10 days past her due date. The first-time mom began having birth sensations right after her membranes were stripped by the midwife, and she dilated to 10 cm quite quickly -- but she then had no urge to push. She was in second stage a long time and then, when the baby's head was visible, her perineum wouldn't stretch. The midwives cut an episiotomy to get the baby out. Baby had bleeding in the brain and only breathed on life support. Later, after transport of baby and mother to the hospital, mom's placenta had to be manually removed because it wouldn't come out. It seemed to me that this woman's body wasn't ready to give birth and that the membrane stripping had caused an emergency response in her body that produced dilation but then didn't complete the birth smoothly.
The risk/benefit rationale of any type of induction must be carefully weighed. The old maxim "First, do no harm" should guide any decision to meddle with Mother Nature's plan for birth. Gail Hart, a respected midwife from Portland, Oregon, says to think of the all the factors that begin a birth naturally as a combination lock. Just as with a combination lock you need to have all the numbers lined up in exactly the right order for the lock to release, so does a woman/baby combination have to have all their "numbers" lined up perfectly for a smooth, flowing birth to ensue. We do not know what all these factors are, and that is why inductions of any kind are so fraught with poor outcomes for the mamatoto. Being patient is the midwife's best birth tool.
Gloria Lemay is a private birth attendant in Vancouver, BC, and is a contributing expert at BirthLove.
Read Gloria's article "Pushing for First-Time Moms" on Midwifery Today's Web site.
Note: This article is also published online in French and Spanish.
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!
Re: side-lying for birth [Issue 4:25]: As far as pushing on the side resulting in less lacerations, the head descent is slower and is more controlled. It is an excellent position for 3rd or 4th kids if mom has a history of precipitous deliveries. It's also useful for vulvar varicosities.
One of my pet peeves is seeing a woman told to lay flat on her back to push! All I can tell you about side lying in second stage is my own personal experience. I delivered my 5th child in the hospital VBAC. When my membranes were ruptured I felt an incredible contraction and immediate urge to push. I was 6 cm. I rolled onto my left side and started to blow, blow, blow. Next thing I knew my 9 lb 21 1/2 inch persistent posterior daughter made her entrance. She was 3 lb bigger than her older sister and it had been 4 1/2 years. My second stage lasted 2 to 3 minutes and I had no tears. I had the pleasure of having an "unassisted hospital birth" in that I delivered her into my own hands, guiding her out of my own body because the doctor and the nurse were not available. I don't recall ever bearing down to push her out -- my body just did it. I had delivered 2 babies vaginally and had a c-section with transverse twins. Her birth was as smooth and easy as one can be with such a short time between 6 cm and delivery. I think the position had a lot to do with that.
- Amy K. Reay, doula, CBE, BSP
A client who is 11 weeks pregnant and works at a petrol station pumping gas asked me if this work could be harmful to her baby. My response to her was that I would not continue that line of work but that she should ring the occupational safety and health service for their advice. She made the call and the OSHS personnel were not helpful at all. What is known about petrol fumes and their effects on pregnancy? Is it teratogenic?
- Anneke Knegtmans,
More about inverted nipples [Issue 4:25]: The best product on the market is the Avent Nipplette, but with the red tape it took to get through FDA it ended up with a price tag of $100. But it works great! The next best is the Nipple Enhancer and wearing good ol' Swedish milk cup type breast shells. If you start early enough it can be fixed before birth.
- PJ Jacobsen, IBCLC
My sister had dry and sore nipples with her first four nurslings (all nursed into toddlerhood). Latch on was correct, used lanolin and all that. With her fifth baby she took an omega-3 supplement and says as a result she had ample lubrication from her tubercles and had no nipple dryness or soreness for the first time. I have read about other benefits of omega-3 fatty acids for pregnant women, but has anyone else heard of this secondary effect before?
- Lisa Bushman, CBE
Re: PROM and potential prevention [Issue 4:24]: As I a midwife for 26 yrs+ I have read somewhere that an increase in calcium and possibly zinc makes the membranes stronger and also that it seems to help bring about more-efficient labour. I have used this advice with my clients who have had previous episode of PROM and they did not have another episode. I also suggest to those who have PROM to take some minerals but also concentrate on a good diet high in them. Garlic and vitamin C is also recommended.
- Terry Stockdale, independent midwife,
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The ARKANSAS MIDWIVES SCHOOL AND SERVICES is currently accepting applications for Fall 2002, both full- and part-time students welcome. For more information call (479) 571-BABY or go to our Web site, http://www.midwifearmss.org.
A thriving midwifery birth center in Juneau, Alaska has employment opportunities for direct-entry midwives, certified nurse midwives and/or midwife-friendly MDs. Must qualify for Alaska licensure. We also have internships for student midwives. 907-586-1203 or http://www.juneau.com/birthcenter
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