March 17, 2004
Volume 6, Issue 6
Midwifery Today E-News
“Breastfeeding Support”
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In This Week’s Issue:


Quote of the Week

"Birth is a fundamentally successful natural process that turns out well with very little intervention most of the time."

Robbie Davis-Floyd


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The Art of Midwifery

Slippery marshmallow root infusion is a sure way to help alleviate vaginal irritation that results from dryness from hormonal changes of pregnancy. It is best made as a cold infusion: pour lukewarm water over the root pieces rather than hot water, then steep overnight and strain in the morning. It is totally safe for pregnancy. After any infection clears up, try drinking two cups of the infusion each day. Also, adding good fats (essential fatty acids) to the diet can increase the body's overall moisture level.

Adrienne, 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.


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News Flashes

A study of 75 cases of pregnancy-induced hypertension and 25 control pregnancies to determine hypertension's effect on placenta and newborn weight revealed a significantly lower newborn weight in the hypertension group, a correlation that worsened as the degree of hypertension increased. Placenta weight followed the same pattern: as the severity of hypertension increased, placental weight decreased. In turn, a significant increase in the incidence of intrauterine growth retardation and stillbirth correlated with lower weight.

J Anatomical Soc India, 2001 Jun; 50(1): 24–7


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Breastfeeding Support

I speak with many women around the world who plan to breastfeed, try to breastfeed, and then struggle with breastfeeding until they wean to formula. The most common barrier to successful nursing for these women seems to be a lack of support at critical times.

We've known for years that the strongest predictor of nursing success is good advice and support for breastfeeding moms. Today we have more resources, more knowledge, and more support for breastfeeding than we've had for years. Why isn't it enough?

The problem is simple: babies' needs can't be scheduled.

I've told my nursing mothers, "I want you to call if nursing hurts, I want you to call if you're getting frustrated, and I want you to call if you're even thinking about giving your baby a bottle formula." More often than not, I call them when their baby is a few days old and ask them how nursing is going. If they indicate any problems at all, I go to them—not the following day, not three hours later, but within the hour. I rarely spend more than a half hour with them at their houses. When I sit with them and watch them struggle to nurse, I usually need to only help make a small adjustment, pull a lip here, place a hand there, calm the baby down, calm the mom down. Small things. The baby will latch and the mom will see it can be done. This scenario might happen at eleven in the morning, but just as often it happens at ten at night. If it happens during the day, I call a few hours later and ask how it is going. If it happens at night, I call the next morning. I always get one of two answers: either everything is fine (in which case I will call back the next day just to make sure), or there is still a problem. Sometimes I refer my clients to lactation consultants, other times I simply get back in my car and go sit with them.

We have an extraordinary pool of talent and resources to draw on right now. We have doulas, La Leche League, lactation consultants, midwives, childbirth educators, nurses, and postpartum doulas. We have cellular telephones, pagers, e-mail, and the Internet. We also have a growing foundation of scientific and practical knowledge about breastfeeding.

My dream is that a mother learning to nurse her baby will be able to pick up her phone, call someone knowledgeable, talk about what is going on with her and her baby, and have a "milk angel" sitting on her couch to help her through any crisis within forty-five minutes. It would be a form of triage. This on-call crisis breastfeeding support service would be offered by doulas, experienced moms, and La Leche League leaders. For the majority of women, a half hour of assistance would be all that is necessary, as long as it is provided when it is needed. If that crisis visit does not solve the problem, a visit with a lactation consultant would be scheduled for more-intensive help.

A Milk Angels program would be funded by grants, insurance companies, doctors, and hospitals. It should be part of standard care. Clients could have the option of paying on a sliding scale.

A Model for Ideal Breastfeeding Support

  • From the beginning, moms need good help getting the baby latched on.
  • When milk comes in, it is important that someone contact moms to make sure they are doing well emotionally and that nursing is going well.
  • If nursing is not going well on the second or third day postpartum (when someone checks in with mom via telephone), a milk angel will be sent to observe the mom breastfeed and provide basic assistance.
  • Breastfeeding help via phone should be available 24 hours per day. If phone help is not enough, a milk angel should be sent to help mom in her home.
  • Lactation consultants will be available for more-intensive help for more-complicated cases.
  • Breastfeeding support groups such as La Leche League and peer-support programs should be available for all women who want them.

Positive Messages for New Breastfeeding Moms

  • You can do this.
  • It gets better.
  • Your baby is learning with you. It's no one's fault.
  • In the next two days or so it will get much easier.
  • It's OK to need help learning to breastfeed.
  • When we figure this out, it will probably get better more quickly than you think is possible.

Excerpted from "Milk Angels," by Jennifer Rosenberg ICCE, CD;
Paths to Becoming a Midwife: Getting an Education, a Midwifery Today book


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Forum Talk

What is the risk factor if a woman had retained placenta after her last birth? She birthed in a hospital, and her cord was pulled on just a few minutes after the birth and it broke. She then had to have a D&C. Does anyone know the percentage of recurrence of retained placenta and if there are any other risks involved?

Katherine


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Question of the Week (Repeated)

Q: I attended a birth for a friend. She had sudden spurts of running a temperature in labor with increased blood pressure for a short period of time (less than 30 minutes), with shakes. She was feeling cold and then hot. It happened twice during labor. The midwife thought about transferring after the second time, but again mom leveled out at perfect vitals soon after. Baby was born at home after a good long labor, but six hours later the temp spiked with chills, and again leveled out. Mom is now taking echinacea/goldenseal, garlic, and zinc. This also occurred the day following the labor, but not as intensely. Mom's temp hit 101 and then returned to normal within 30 minutes. Any ideas? Mom had a wonderful homebirth; baby's doing great and nursing wonderfully.

— NMdoula


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


Question of the Week Responses

Re: Aching pain following intercourse [Issue 5:25]:

A: I believe vaginal varicosity is the correct diagnosis. I have large varicose veins and at the time of pregnancy could feel them around or inside the vagina. However, when having intercourse during pregnancy, especially near term, I experienced pain afterward. A warm bath helped, as did propping pillows between my knees and under my abdomen when lying down to alleviate pressure. Standing or sitting was most painful right after intercourse or even into the next day. Elevating the legs helped; on the days when it was really bad when standing or sitting I wore a maternity girdle. It seemed to ease the pressure in the vagina since it lifted the womb.

— Claudine


Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mgeditor@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


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Feedback

Re: Forestalling Prematurity [Issue 6:5]

Erica, I am delighted to hear that your son is healthy and happy and that the interventions worked to help save him. You can give yourself a great deal of credit for making some tough decisions that were right for your family and circumstances. Sometimes we say thank Goodness for the technology. However, not all applications of technology during birth or prematurity prevention are helpful. We all must weigh the risks versus the potential benefits of interventions or trusting the natural route. Unfortunately not all women are even given the appropriate information with which to make those decisions.

One factor that has not been brought up is nutrition before pregnancy and during pregnancy. This is not a criticism of women, but of the system that does not bother to tell us that nutrition is very important. In my practice, I require my students to record what they eat, giving me a first hand look at the poor quality of their diets during pregnancy. While my students tend to be well-educated professionals, I estimate that more than one-third of the women who come to me for classes have some sort of history of eating disorders, misinformation, and general confusion on the subject.

Adequate nutrition during pregnancy prevents prematurity in many ways: by boosting the immune system to prevent infections that can cause chorioamnionitis and premature rupture of membranes; by supplying adequate hydration to prevent dehydration, a common cause of premature labor; by supplying the liver with adequate protein for the production of albumin, and supporting the expanding blood volume, thus preventing preeclampsia; by supplying the body with enough nutrients for optimal functioning to prevent interuterine growth retardation and support a full-term pregnancy. There are many peer-reviewed references of these benefits.

In analyzing the research of Dr. Thomas Brewer and others, I have found that specific diet modifications can reduce prematurity rates. Dr. Brewer achieved a prematurity rate less than 2% in the populations in which he worked. (Metabolic Toxemia of Late Pregnancy, 1982, p. 90)

Following are some examples of the latest research on the subject:

  1. "Women who don't eat well have a 30% increase in risk of delivering prematurely. A study undertaken at the University of North Carolina examined the association between frequency of eating and preterm delivery in more than 2000 women enrolled in a study from August 1995 to December 1998. All women were asked about their frequency of eating during the second trimester of pregnancy and were followed through delivery.

    "The vast majority of women met current Institute of Medicine recommendations for eating three meals plus two snacks each day during pregnancy. Women who fell short of these guidelines had a 30% increase in risk of delivering prematurely than the others. Women who ate less often than recommended were also slightly heavier prior to conception, were older and had lower total energy intakes than the other women in the cohort.

    "Research in animals suggests that skipping meals could result in elevated levels of stress hormones implicated in the events leading to preterm delivery. Some studies in humans also support this mechanism of action."
    [Am J Epidemiol 2001;153:647–652.]

  2. "Even modest restrictions in a mother's diet around the time they conceive can increase the risk of premature birth, according to a study by New Zealand scientists."
    ["Premature deliveries linked with poor maternal diet at conception." Leatherhead Food International Editorial: Friday, April 25, 2003. www.newscientist.com/news/]

It's time to stop placing blame and just treating the problem, and start working on preventing prematurity! To do that, women must be educated before they get pregnant in the importance of proper nutrition and avoidance of harmful substances!

Amy V. Haas, BCCE


I am an RN working in labor and delivery at an inner-city hospital in Northeastern United States. We get a lot of high-risk patients who go through the same process that Erica described in an attempt to give their babies an opportunity to mature in the womb. I would give a month's paycheck to have educated patients who would comply with an effective natural prenatal program. Unfortunately, the reality of inner-city healthcare these days is that you're happy if the patient makes it to more than five prenatal clinic visits and gives up tobacco.

As ugly as the side effects of magnesium sulfate therapy are for the mother and the baby, it does provide us with an opportunity to educate these patients and perhaps reach them in a way no one else could. The sad fact is that these people do not generally have the financial situation, educational opportunities, or social support to even be aware of the possibility of a positive birthing experience.

Too often it feels like much of your material is focused at the already well-educated upper class "Boomer" population, to the exclusion of the underserved working poor without healthcare insurance who make up the majority of the child-bearing population.

Please remember that not every healthcare practitioner in allopathic medical institutions is part of some grand conspiracy to suppress women. We consider it more like subversion from within the monolith. Alternative positive information will go further to improve the situation for all OB-GYN patients and alternative practitioners than negative and disparaging commentary.

Joseph M. Adams, RN


I am a critical-care RN working in a designated heart hospital in central Virginia in the CCU. My goal is to become a CNM. I know and use magnesium frequently for cardiac arrythmia stabilization, particularly SVT management. However, elevated mag. levels are notorious for depressing cardiac function, and on odd occasions (we normally catch issues well before this point) can cause rather significant brady arrythmias. I was wondering if and how well mag. sulfate for treating preeclampsia has been studied for any effects/contributions to fetal or neonatal bradycardia, especially given the doses used. I know it is listed as a category A drug, but all the information I have found simply said not to give it less than two hours before delivery.

Maureen E. Huizinga, RN


Reading "whatever works for you is better than having a premature baby," an alarm went off in my head. I have learned through experience that premature babies can be perfectly all right. My last two were born at home six and seven weeks early, weighing 5 lb 12 oz, and 5 lb. I am so glad I did not have cerclage or magnesium sulfate to keep these two in longer. My friends urged me to go to the hospital with my second premie because we're all so scared and uninformed about caring for small babies. Then I remembered seeing a documentary about Yanomamo people whose babies were born smaller and earlier than mine but they knew how to keep their babies warm and take care of the mothers. My husband's uncle was a premie and they kept him in a shoebox on the radiator to keep him nice and warm, and he turned out great. So don't freak if the baby's early, keep that baby warm and breathing. Watch over it constantly. Take care of the mother so she can focus on the baby. We should do the same for any new mother and baby, but it's a little more important with a premie.

A.N.


March 2, 2004, the Canadian Society of Obs and Gyns made a news announcement reminding us they are still behind the times. The latest decision to offer the "option" of elective c-sections under guise of "client choice" runs counter to evidence-based research that cautions about both short- and long-term effects of unnecessary c-sections, the associated interventions and medications on mom's and babe's health and breastfeeding relationship. Particularly galling was the News Flash [Issue 6:5] quoting a four-year-old article from ACOG that shows how the definition of c-section criteria plays out at the local levels.

As an active member of the birth and postpartum doula profession here in Toronto, a long-standing women's health advocate and private healthcare provider, and former student in the regulated midwifery training in Ontario, I have seen tremendous variation in interpretation of professional guidelines, even in the same medical practice.

I am resigned to the lack of context and "uncritical" presentation of the announcement. Not surprising in a climate of risk-aversive active management of pregnancy and the usual skewed media reporting. Where are reporters asking Henci Goer and Marsden Wagner for their informed critique? Funny how key watchdogs get no media attention nor public rebuttals.

As we strive to become "proactive consumers" of our own health and then to educate our children, I suggest:

*building healthy informed skepticism. Stay alert to the fact that most service professions do not adequately train for informed choice discussions, critical analysis of research, nor self location (ability to understand personal biases in providing services). If you find those caregivers, celebrate them! Tell them exactly what they do that empower you! Refer to them!

*be aware of the impact risk aversion built in a liability insurance climate has on which data are presented. Note that that is not a conscious process, rather an insidious by-product of professionalism—that is, privatizing information in process of creating a set of regulated "professionals." Fear mongering is never conducive to decision making. Balancing all information means you have the right to make a different decision than your caregiver might. It is your health!

*examine conflicts of interest in the funding and production of research, media and reporters. Notice the links between funders and products offered as "solutions." Conflicts are only just beginning to be declared—British Medical Journal being one positive agent for change. Use a range of established credible and ethical resources. Establish credibility not by media popularity, but funding sources, longevity in field, breadth of reporting and skill at balanced presentation. Corporate Watch and Multinational Monitor are useful resources when tracking pharmaceuticals funding.

Of course, what I am suggesting is not news, but if said at regular intervals, those ready to hear it will think again and put the power back in their own hands. At least, that is my hope! Pass it on!

J. Busch


International Cesarean Awareness Network, Inc. (ICAN), has declared April 2004 as Cesarean Awareness Month. Several mayors and governors across the United States will be making formal proclamations to that effect as well. Once this is accomplished, we will be contacting the Department of Health and Human Services to have it put on the National Health Observance Calendar.

ICAN has adopted an inverted burgundy ribbon as the symbol of cesarean awareness. The rich reddish color of burgundy symbolizes the power of birth, while wearing it inverted is a sign of distress and/or protest. (It also looks like little pregnant belly with outstretched arms!)

With the donated talents of birth photographer Patti Ramos and graphic designer Laura Maples, ICAN has adopted a beautiful poster that is available to the public through our Web site. We also have adopted an Internet "banner" that we are asking interested Web sites and E-publications to publish.

ICAN would appreciate any nod you could give to our efforts across North America to raise awareness of the risks of cesareans, at least half of which are preventable. If you are interested in collaborating in another manner, please contact me. There is strength in numbers!

Tonya Jamois, President, ICAN
www.ican-online.org


Editor's Note: Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


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