January 8, 2003
Volume 5, Issue 1
Midwifery Today E-News
“Pregnancy-Induced Itching”
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THIS WEEK'S ISSUE

Contents:

Send submissions, inquiries, and responses to newsletter items to mtensubmit@midwiferytoday.com.


Midwifery Today Magazine

A 72-page quarterly print publication filled with in depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Subscribe today at www.midwiferytoday.com/products/sub.htm.

Quote of the Week

"Whenever care decisions are based less on the needs of an individual mother and more on the needs of the practitioner, the mother loses."

- Jennifer Rosenberg


The Art of Midwifery: Edema

I had serious edema with my first two pregnancies. With my third, I increased my protein intake, took vitamin B complex throughout pregnancy, and used dandelion and nettle during the last trimester. I also took lots of warm baths and drank lots of water. I had very little swelling and a beautiful homebirth.

- Kathy Midwifery Today forums

All Birth Practitioners: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


News Flashes: Massage for Newborns

Massage may help maintain babies's body temperatures immediately after birth. A prospective observational study of postdelivery care and neonatal body temperature was followed by a randomized controlled intervention study using three simple methods to help maintain the babies' body temperatures. Five hundred infants were monitored in the first study and 300 in the intervention study. In the observation study, 85% of infants had temperatures less than 36 degrees C at 2 hours following the birth, and nearly 50% still had temperatures less than 36 degrees C at 24 hours after the birth. Most of the infants who were cold after 24 hours had initially become cold at the time of delivery (only seven infants had been both well dried and wrapped). In the intervention study, all infants were dried and wrapped before random assignment to one of the three methods: the kangaroo method, traditional oil massage, or a plastic swaddler. All three methods were found to be equally effective. Overall, 38% of the infants had temperatures less than 36 degrees C at 2 hours and less than 18% at 24 hours.

- Acta Paediatr, (Norway) Nov. 1992, 81 (11) pp. 859-63

Itching Skin During Pregnancy

Itching skin during pregnancy can be caused by hormonal changes. Also remember that in later pregnancy your skin must stretch, which also can cause itching. Dry skin can become very irritated, especially during the winter months when forced-air heating aggravates skin discomfort."

To prevent skin irritation, pregnant women (and all people) should avoid mineral oil-based skin care products as well as harsh soap and laundry products. Some women benefit from avoiding soap altogether. Read the labels; most skin products are made with mineral oil. Also rule out irritation from any recent changes in the soap or laundry products you use. Choosing the most natural kind of shampoo, soap, and laundry products is always wise to protect your health and environment. Because you're making a baby, begin treating your own skin like a baby's. Many women have found that applying hexane-free castor oil softens and soothes dry and scaly skin.

Itching can often be alleviated by adding unrefined virgin olive oil to your diet. Also increase your intake of foods that are rich in vitamins A, D, and linolenic acids.

Vitamin A-rich foods:

  • fish liver oil, liver, vegetables, eggs, dairy products

Vitamin D sources:

  • Saltwater fish, sunlight (no tanning - use sunscreen), vitamin D-fortified dairy products, fish liver oil

Linolenic acid sources:

  • Flax seed oil, evening primrose oil, sardines

Between 0.02 and 2.4% of pregnant women are diagnosed with a condition called pruritus gravidarum (also called PUPS), a kind of itching unique to pregnancy. It is related to elevated estrogen and progesterone levels interfering with the liver's efficiency in excreting bile salts. Onset is usually in the third trimester, and the itching is severe. Although this condition is not characterized by lesions, abrasions caused by scratching and contact with clothing can be very painful.

If this happens to you, you should support your liver with the following herbs:

  • Dandelion: a detoxifying herb that supports liver function
  • Yellow dock: relieves heat in the circulatory system and builds iron supply
  • Burdock: dispels toxins by means of diuresis (peeing toxins out)
  • Beet root: nourishing and supportive, promotes elimination, cleanses the liver.

Make sure you are drinking sufficient amounts of water. Ask your health provider about using these herbs during pregnancy.

The worst case of pruritus gravidarum I have seen was treated without antihistamine drugs. The woman's backup physician told her that he could prescribe an antihistamine but preferred that she consult the midwife and look for a natural alternative. This young mother also said, "I've eaten worse in this pregnancy than in my first two. I'm not surprised I developed this skin condition." She was anemic and exhausted because the itching was interfering with her sleep. Within hours of starting herbal therapy to support her liver and increase her iron, she had great relief and slept through the night.

- Robin Lim, from her soon-to-be published book,
"Eating Wisely: Recipes for Pregnant and Breastfeeding Women"


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CONFERENCE AUDIOTAPES FOR THIS WEEK'S THEME

Itches, Rashes and STDs

Potential Pathology

Obstetric Anatomy & Physiology of Pregnancy


Forum Talk: Nuchal Hand

Do midwives find a nuchal hand slows down emergence of the baby's head? Can it be detected by just looking for a bulge next to the head, or would you need to be more invasive to figure out what was going on? A midwife I know says you just sweep the hand across and out - across the baby's anterior (face?).

- Adrienne

Go to our forums to share your thoughts and experience.


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Question of the Week: Rectocele

Q: Have you successfully delivered a baby when the mother has a rectocele? I have a mild rectocele and am expecting my ninth baby. I am interested if there is a way to prevent it from worsening during pregnancy and especially during delivery.

- S.K.

Send your responses to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line.


Question of the Week Responses: Pregnancy-Induced Itching

Q: I am nearly 9 months pregnant (first babe). Terrible itching plagues me. I have tried acupuncture, Chinese herbs, and oatmeal baths. The medical suggestion is to take Benedryl, which I haven't done because it seems focused on allergic-type responses which I don't think is the problem. The itching started at 32 weeks and worsens at night. It is worse on my palms, feet, ankles, back, breasts, at especially at joints. The rest of my body also itches (except my head and face) but is not as bad. It is a deep itch and is only temporarily relieved by scratching. I wake up itching several times a night. Any answers?

- Marissa


Editor's Note 1/7/2005: Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a benign itchy condition, cause unknown, not associated with preeclampsia, autoimmune disorders, hormonal abnormalities or fetal abnormalities. Treatment is usually for relief of symptoms. Intrahepatic Cholestasis of Pregnancy (ICP), however, refers to a specific liver condition in which the normal flow of bile is impaired in a woman's body resulting in severe itching and, more rarely, jaundice. ICP is diagnosed by blood tests showing elevated levels of bile acids and certain liver enzymes. ICP is associated with an increased risk for infant stillbirth, premature labor, fetal distress and hemorrhaging in both mother and child.


A: The condition you are describing is called PUPS - toxification of the liver from the high dose of pregnancy hormones. A midwife I know recommends drinking a whole 16-oz container of chlorophyll and then 5 tablespoons a day until the end of your pregnancy. Make sure that it is plain (not mint) and drink 3 qts of water per day. This treatment will either alleviate the condition or at least make it bearable until you give birth. The chlorophyll will also increase your iron.

- Sara Fariss Krivanec, postpartum doula


A: Try dandelion capsules to help strengthen and cleanse the liver. It also purifies the circulatory system.

- Norma


A: It sounds like classic symptoms of obstetric cholestasis. You should see your caregiver immediately and arrange to have a blood test to assess liver function. There is no cure except delivering the baby. There is also an association with stillbirth.

- Jane Dolby,ex-midwife,antenatal teacher student


A: We had a good discussion of this at the MANA conference in October. Extreme itching during the final weeks of pregnancy is not uncommon. It is called pruritis and can be related to a condition of the liver called cholestasis. But the consensus among the midwives there was that there's no difinitive evidence that cholestasis really has anything to do with pregnancy outcomes. My suggestion is to focus on relieving the symptoms and supporting your liver. Dandelion root tincture, 15 drops 3–4 times/day seems to help, as does milk thistle (same dose). Eliminating any other stressors to your liver (medications, food additives, smoking, alcohol, etc.) is important. Sting Stop, a homeopathic ointment applied topically is helpful, as is Weleda Calendula cream. Birthing your baby will cure it.

- Merilynne Rush


A: This is called the rash of pregnancy. It is very common and is easily gotten rid of by taking 4 capsules of John Christopher's slippery elm bark tea capsules 3 times a day until the condition is gone. If she has difficulty swallowing capsules she can open the capsules and make a tea. It will require honey. She will need to use the 4 capsules for each of the teas she makes.

- Claudia Souther, RN


A: I have had similar itching at all of my joints. The inflammation lasted for several months. I am not pregnant. I do not have psoriasis, eczema, or ringworm - I am gluten intolerant. I analyzed my diet to make sure I was not getting any hidden glutens, used Neems soap only in the shower, and eventually used some topical steroid or cortisone cream twice a day for a week and a half. It is much better, but the relief by these means is only masking the symptom, not curing the cause.

- Traci B. Mueller


A: I am surprised that acupuncture has not helped. Have they tried colon 11 to reduce your body heat? I found women sometimes had some relief from a lavender-oil bath. Sometimes drinking more water helped too.

- Sue


A: The homeopathic remedy Dolichos is for "pregnancy: intolerable itching all over body in pregnant women, worse at night, preventing sleep, worse from scratching, no perceptible eruption on skin." Try it in a 30-c potency twice a day or as needed until improvement occurs, then stop taking the remedy until you notice your symptoms starting to return again.

- Jennie Walsh


A: Try Aveda's Beautifying Composition with jojoba wax and oil as well as other moisturizing agents or the All-Sensitive Composition, which contains jojoba oil and 11 Indian herbs to calm the skin. Jojoba oil is the best moisturizer because it is closest to the skin's own sebum.

- Hannah Louisville, KY


A: Two responses, based on the research I've done so far:

  1. Drink plenty of water - drinking approx. 6 litres every day while I was pregnant and sometimes even 8 made the itching go away whenever it returned in mild form. Evian is a good water because it seems to be low in sodium. Some mineral waters made me feel thirstier and did nothing for the itching.
  2. Accept the usual conventional treatment for obstetric cholestasis if the itching continues - especially hands and feet - because cholestasis is a risk factor for stillbirth. The treatment that seems to work is ursodeoxycholic acid.

- Sylvie


A: It might be scabies, which you can get from contact or even trying on clothes in a store. The itching is worse on the hands, feet, and back. Scabies almost never affect the face or head. If you do have scabies you have to treat the condition like head lice, including treating your furniture, washing all fabrics, cleaning very well, and using a topical lotion after showering. See a dermatologist.

- A.


A: I had the same terrible itching. After birth I discovered my baby had thrush, which inspired me to do a lot of reading. I found that what I had was probably candida overgrowth. I did not have vaginal yeast infections. I eliminated all sugar and only got my carbohydrates from fresh veggies, whole grain breads that were freshly baked f rom freshly ground grains, ate a lot of organic meat, chicken and fish. As long as I stuck to these eating habits my baby's thrush went away, and so did the rashes that doctors told me were just dermatitis and the headaches that plagued me. Fermented foods should also be avoided (e.g., cheeses, pickles, soy sauce, etc.

- Calista


A: Persistent itching in pregnancy (pruritus gravidarum) can result from altered liver function, possibly due to maternal hypertension (high blood pressure) or the accumulation of bile in the liver (intrahepatic cholestasis). Any history of this or any other previous illness (such as hepatitis) that may have affected your liver? A routine liver panel (blood test) can hopefully rule out questions about a stressed liver. Topical hydrocortisone preparations purchased over the counter may be appropriate (consult a pharmacist about its safety in pregnancy) but only for small areas of the skin.

- Kari Michalski, BSN


A:I recommend finding a homeopath to help you. The National Center for Homeopathy has a listing of practitioners on their website. They can also direct you to a homeopathic study group that may know of a homeopath who isn't a member of the National Center.

- Jane Ann Sears


A: Contact your care provider to order labwork to check serum bile acid salts, alkaline phosphatase, and bilirubin. Do you notice any yellow discoloration to your skin or eyes?

- Rose Fife CNM


A: I wonder if it is stretching of the fascia as her body expands.

- Anon.

EDITOR'S NOTE: Responses to any Question of the Week may be sent to E-News at any time. Please indicate the topic of discussion in the subject line or in the message.


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Midwifery Today magazine Question of the Quarter

Theme for Issue No. 66: Birth Environment

Question of the Quarter
What do you do to create a positive birth environment? In your experience, what have you seen that disturbed or facilitated the birth environment?

Please submit your response by March 1, 2003 to mgeditor@midwiferytoday.com.
(All responses subject to editing for space and style.)


With Woman: Vitamins in Pregnancy, by Gloria Lemay

Most people think that vitamins are always good for you and the more the better. Pregnant women should use caution with vitamins A, C, and D in higher doses than the recommended daily allowances. Synthetic vitamin A in some drugs used for acne and psoriasis can cause birth defects in the developing fetus. The concern with toxicity of vitamin D in pregnancy is calcification of the placenta and other soft tissues. The mother is also more prone to developing kidney stones. Vitamin C taken in extra large doses is thought to cause miscarriage in the early weeks of pregnancy and can cause harm to the baby after birth. Anne Frye has this to say about megadoses of vitamin C in pregnancy:

"High doses of any water-soluble vitamin may, in some cases, produce marked symptoms of deficiency in the newborn because of the rapid drop in blood levels once the baby is not being supplied with nutrients via the umbilical cord. For example, a baby whose mother takes more than 5 grams of vitamin C daily throughout pregnancy may develop scurvy (vitamin C deficiency disease) shortly after birth." [Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth Practice Vol. l, Care During Pregnancy, l995 Labrys Press, p. 252]

Go to www.midwiferytoday.com/enews/enews0501.asp for Holistic Midwifery for your practice. Gloria Lemay is a private birth attendant in Vancouver, BC, and is a contributing expert at BirthLove, http://www.birthlove.com. Read more from Gloria on Midwifery Today's website: "Pushing for First-Time Moms"

Note: This article is also published online in French and Spanish.


Exclusively on the BirthLove site: Gloria Lemay, celebrated midwife and teacher, is offering advanced online doula education. She covers a vast amount of topics that today's doulas and student midwives need to know: herpes simplex II, medical terminology, pediatric exam of the newborn, prenatal diagnostic tests, business and professionalism, pregnancy-induced hypertension, gestational diabetes and so much more. The course is free for all BirthLove members. Check it out! http://www.birthlove.com/glo_doula.html


Feedback

A prenatal support belt eases the symptoms of pubic symphysis (PS) pain [Issue 4:38] but in some women the problem is caused by a misalignment of the pelvis and the PS joint in particular. For these women, wearing a support belt may actually make the problem worse and make them more uncomfortable. For others, it may be a "band-aid" for the symptoms without treating the cause. Many women find more relief by treating a possible source of the problem - misalignment of the pelvis - by seeing a chiropractor who specializes in treating pregnant women. Be sure not only the sacroiliac joints and the back, but also the PS joint itself, are checked and aligned. Many women with PS pain have reported great relief with proper chiropractic treatment.Alternatively, classical osteopaths who are knowledgeable about manipulation for the pelvic area may also help alleviate pelvic misalignments (or "pubic shear" in their terminology). Women experiencing very strong PS pain are at increased risk for long-term damage to the PS area during birth and must be carefully handled to avoid permanent injury. For more information: http://www.plus-size-pregnancy.org/pubicpain.htm.

- Pamela Vireday

The pubic symphisis pain is most likely caused by pelvic subluxation. The pelvis is a ring, so if one of the joints misaligns and is fixated, the others will undergo more and unusual stresses. The production of the hormone relaxin during pregnancy loosens the normally taught ligaments of the sacroiliac joints, allowing them to subluxate easier and more frequently. Wearing a trochanter belt will restrict the motion into the PS which will, in turn, reduce the pain, but it does nothing to restore the motion to the joints of the pelvis that will be so important during the delivery process. Nor does it allow for proper alignment of the pelvis to maximize the size and shape of the birth canal. Even more important, leaving the subluxation uncorrected means that the interference being caused to the mother's nervous system remains, possibly affecting the development and growth of her baby. This situation is easily correctable by visiting a chiropractor. The International Chiropractic Pediatric Association's website, http://www.icpa4kids.com, can direct you to a chiropractor in your area who has the proper certification.

- Steve Ranicki, DC, FICPA

I am expecting in the next few weeks and hoping for an unmedicated VBAC. I ended up with a c-section previously because I didn't progress past 5 cm. I do not want oxytocin my OB (in Malaysia where I am an expat) is worried about uterine rupture. Is it safe to take the homeopathic remedy caulophyllum, or is it too strong so that it might increase the risk of uterine rupture? A friend took small doses from 3 weeks before her due date, and she has had fast but efficient labours each time.

- Deanna Stein


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