April 28, 2004
Volume 6, Issue 9
Midwifery Today E-News
“Occiput Posterior Presentation, Part 2”
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In This Week’s Issue:

Quote of the Week

"When women's lives are busy, their money and work paramount, they come into birth with the same expectations as their trips to a convenience store: they want to get in and get out with what they came for. But natural birth requires preparation, emotional and physical."

Connee Pike-Urlacher

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The Art of Midwifery

I have been a midwife since 1979, and in all these years I think the best help for a mom with a posterior-positioned baby is to have her sit on the toilet backward with her feet flat on the floor. Sometimes I apply pressure to her back with my hand or apply heat with a warmed-up rice bag.

Linda Thorpe, CNM, Fort Edward NY

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

A Danish cohort study of 4169 male and 3943 female babies born between 1959 and 1961 to mothers who had smoked cigarettes during the third trimester of pregnancy showed a correlation between fetal nicotine exposure and later adult criminal and psychiatric hospitalization for substance abuse outcomes. The degree to which these outcomes occurred were dose-response related (the amount of maternal smoking during pregnancy correlated to the rate of criminal arrest and psychiatric hospitalization for substance abuse in male and female offspring).

Am J Psychiatry 2002 Jan 1;159(1):48–54

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Homeopathy for Occiput Posterior Presentation, Part II

[Editor's Note: See Issue 6:8 for Part I of this article.]

Several homeopathic remedies can be quite effective for alleviating the pain of back labour. They may cause the baby to shift positions or even turn from a posterior presentation. Midwifery Today E-News Issue 6:08 described Kali Carbonicum and Gelsemium.

Cimicifuga (black cohosh)

Cimicifuga is an excellent remedy when there is lack of progress at any stage of labour. The labour pains are present but they are not effective. Cimicifuga will help dilate the cervix.

  • Misplaced labour pains felt in the back, hips, and thighs instead of the uterus
  • Pains may shoot up and down the thighs or across the pelvis from hip to hip
  • Cramping in the large muscles
  • Fears that something bad will happen
  • Talks incessantly to relieve her fear
  • Sensitive to noise
  • Worse from cold
  • May become hysterical with the pain

Coffea Cruda (unroasted coffee)

  • Faints because of pain and hyperexcitement
  • Oversensitivity to pain, despair from pain
  • All senses more acute
  • Sleeplessness after delivery (this remedy is great for midwives and doulas after too much coffee and excitement from attending a birth)
  • Only pain experienced is in the small of her back
  • May cry out or scream with extreme fear

Nux Vomica (poison nut)

  • Irregular pains when labour does not progress
  • Desire to move the bowels and to urinate—she will comment on this feeling often
  • Major remedy for fainting during labour
  • Inflammation or fever after labour with a desire to have a bowel movement
  • Irritable and impatient
  • Oversensitive to all external impressions
  • Very chilly

A woman who has experienced severe back labour or an epidural may have residual pain after delivery. I strongly recommend that Hypericum 200C and Arnica 200C be given for three days following labour for women who are experiencing back or neck pain or headaches. They should take the remedies twice a day in alternating doeses to alleviate the discomfort and help heal the process. I also recommend chiropractic adjustments to help the mother recover fully.

Excerpted from "Homeopathic Remedies for Back Labour and Posterior Presentation," by Piper Martin, DS Hom. Med., Midwifery Today, Issue 58

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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; 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 and if there are any other risks involved?


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Question of the Week

Q: A client has a degenerative kidney disease called IgA nephropathy. She is showing +1–+2 protein in her urine, and her average blood pressure is 130/82. She is seeing a nephrologist and getting her labs done monthly: sodium, potassium, chloride, carbon dioxide, calcium, glucose, phosphorus, BUN and creatine, albumin all of which are in a normal range. I am looking into alternative methods for supporting and nourishing her kidneys through the pregnancy. She has seen an acupuncturist (per my suggestion) one time to receive treatment and herbal supplements. She is 20 weeks pregnant. In addition, we helped her with a homebirth 2-1/2 years ago. During that pregnancy no protein spilled in her urine, and her blood pressure was more in the range of 110/66.

Can you share recommendations and or experience?

— S.C.

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.

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Question of the Week Responses

Q: I am a student midwife and doula who has been hired to support a young mom with bipolar disorder. She is due in a few months and has an open-adoption plan for the baby (her second baby, second open adoption). I am currently researching bipolar disorder in pregnancy and have found a lot of information about risks/benefits of drug treatment in pregnancy but very little about the effects of pregnancy hormones on bipolar disorder and what I might expect or watch out for, and when, as her pregnancy progresses. I have heard that if the mom is off medication during pregnancy, the hormonal changes in very late pregnancy are likely to trigger a bipolar episode even if the mom's pregnancy had previously been relatively free from mood disorder symptoms. Does anyone have suggestions for where I can find out more about this aspect of pregnancy with bipolar disorder?

— Anon.

A: I work in a nutrition store in Eugene, Oregon. A few months ago I read an article that described giving bipolar patients 6 to 8 grams of fish oil per day. Most of the patients were off medication within three months. We have a few customers who have followed this same dosage and have added GABA; they have greatly reduced their medication or eliminated it all together. The best way to get this high dosage is by using a liquid fish oil that comes in a great lemon flavor. These supplements of fish oil and GABA are perfectly safe for a pregnant woman. I apologize for not being able to find the article for exact quotes and references. You may have luck finding info online by doing a search for Omega 3 and bipolar.

— Susette

A: I have bipolar disorder that was not diagnosed until about two years after my son was born. I was not taking medications during my pregnancy, and I felt awesome! I had very little mood swings during pregnancy. While nursing I felt even better. When my son was about 6–7 months old he started weaning himself. This really bothered me. I was beginning to freak out about nutrition, bonding, everything. Then he totally stopped nursing. About that time I started having serious mood swings. I was arguing with my husband and had no idea why I was so upset. I would be crying uncontrollably and have no idea why.

Because I had had a depressive episode prior to pregnancy my midwife referred me to a psychiatrist and therapist. We thought it was postpartum depression. I was on antidepressants, mood stabilizers—it seemed we tried everything. Finally I stabilized with lithium and a few other medications three years later.

I have birthed with a mom twice who has bipolar disorder. She was unmedicated during pregnancy and had a hard time postpartum with both babies. It took some time for her to seek aggressive treatment. She had been on lithium before becoming pregnant with baby number 2 and did not go back on it. She has expressed no connection at all to her second baby.

I have heard midwives say that bipolar moms have a huge chance of becoming psychotic postpartum.

— Anon.

A: Check with the Perinatal Psychiatry Program at Massachusetts General Hospital, where a fair amount of research is being conducted. They have wonderful psychiatrists who treat bipolar women during pregnancy and postpartum all the time. Also check out the book Women's Mood Disorders by Deborah Sichel and Jeanne Watson Driscoll.

— Deborah Issokson, Psy.D.

A: I have extensive experience with bipolar disease in general as well as in pregnancy. If the mom is not on medications, her most vulnerable time will be postpartum. There is a greatly increased risk of postpartum psychosis, and close observation and support of the mother in the month after birth is critical. In pregnancy, her symptoms can be variable. "Affective storms" are intense mood swings characterized by episodes of spontaneous rage that feels uncontrollable, and the onset can be sudden. They can be an early signal of a mood swing. The depressive period of bipolar is more common than a hypomanic or manic period. Many people have "mixed states" (i.e., depression along with brief periods of hyperactivity). Treating depression with the standard medications *without* first treating the person with a mood stabilizer greatly increases the chance of a manic episode. Books written by women who have experienced bipolar disorder would probably be more helpful than the medical literature to get a sense of what can occur and what strategies can help maintain stability. Because bipolar is one of the most genetic mental illnesses, the adoptive parents need to know the history so they can obtain early help if the child shows symptoms. Symptoms in children are very different than in adults and are usually misdiagnosed as attention deficit, conduct disorder, etc.

I married a person who turned out to be bipolar, have a child who has severe bipolar disorder, and treat and prescribe for women with the disease. I urge you to be sure your client has access to a knowledgeable mental health provider who can assist if needed. The death rate from suicide in those with bipolar disorder approaches 20%. Forty to 65% of persons with the disease abuse alcohol or drugs. Problems with the legal system are disproportionately high in those with bipolar. It is a very serious health problem.

— Linda Glenn, CNM, PMHNP

More about posterior-positioned babies [Issue 6:8]:

A: With my last child (my fourth) I experienced back labor. I could have sworn she was trying to come out through my back. I thanked God it did not last more than a few hours. It gave me a deeper respect for the women who labor many hours with back pain.

— Linda Thorpe, CNM, Fort Edward NY

A: It sounds like you are doing an incredible job educating yourself and trying sometimes-effective means of turning a posterior baby. I was just in a Penny Simkin workshop this past weekend, and she demonstrated many effective, nonpharmacologic modes of pain relief (especially back pain with labor), including use of a TENS unit, a wonderful ice wrap for the back called Dura Kold (can purchase online), acupuncture during labor, and use of sterile water injections (just under the skin) in your low-back area. See www.pennysimkin.com for more info.

— Kari Michalski, RN, Labor and Delivery, Minneapolis, MN

A: Becoming aware of emotions that might be influencing a baby to maintain a posterior or breech position can be done easily using hypnosis. Unlike visualization that uses the conscious mind, hypnosis allows access to the subconscious mind where our thoughts, feelings, beliefs and emotions come from. Hypnosis is natural and safe. To be effective, a person must understand what hypnosis is, how it works, and to want to use it. I worked with a mom whose baby was in a breech position. She gained insight as to why the baby was in this position as well as changes she was needing in her life.

— Beth J. Keil, BSN, certified hypnotherapist

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


There are many stories concerning birth-injury brain damage and the treatment of these with "cranial sacral" work—everything from forceps deliveries to being dropped. Often it is just the natural molding of the head in the birth canal that forces the sutures to overlap too far and not return well that causes problems. Cranial sacral can correct these problems and relieve crankiness, nonresponsiveness, apparent pain without obvious cause, ultrasensitivity to environment, and other distress as well as severe problems such as not walking, talking, or hearing at appropriate stages. Any child that has been through a severe second stage or prolonged difficult labor or has had major head molding from the mother's small pelvis or a malpresentation should be checked out by an osteopathic doctor who specializes in cranial sacral or by an experienced therapist who has many years of experience in cranial sacral during the early postpartum period. This treatment can prevent many future problems.

As a midwife who received a brain injury from an accident, I can vouch for cranial sacral making a huge difference in my recovery. Many doctors told me that my damage was unfixable and that I would have to "learn to live with it." Fortunately I listened to a friend who said that cranial sacral might help. It was like someone handed me the key to healing at my first session. This is something that cannot hurt and can make all the difference in the world.

Lindy Cummings, midwife

My third birth was followed by severe after pains. I had a cesarean with my first but didn't experience the pains at all with my second, vaginal birth. They were very intense, and I eventually gave in and my midwife gave me something that she had me hold under my tongue. It helped some. A friend told me she didn't have more children because the after pains went on for three days after her fifth birth. I want to know what causes the after pains and how I can avoid them in the future.


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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What is the ecology of childbirth? Find out at the International Congress of the Ecology of Childbirth—A Celebration of Life, Rio de Janeiro, Brazil, May 27–30, 2004. For more information or to register: www.partoecologico.com.br

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