October 13, 2004
Volume 6, Issue 21
Midwifery Today E-News
“Omnium Gatherum”
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In This Week’s Issue:

Quote of the Week

"One labor and birth is worth volumes of theorizing."

Judith E. Luce

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The Art of Midwifery

Lobelia has been called "the thinking herb," meaning its actions are tailored to what the body needs; it seeks equilibrium. When one is threatening to miscarry, taking lobelia either hastens the miscarriage if it's a defective seed or it stops the contractions if it's a healthy seed. Taking lobelia can help a woman stop worrying and get on with whatever life brings.

Marlene Waechter, 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 University of Bonn [Germany] study that included 3,072 participants age 18 to 79 years concluded that women who had had one pregnancy had a 1.5 odds ratio of developing varicose veins and those who had had three pregnancies had a 1.8 odds ratio, compared with women who had never been pregnant. Women with four or more pregnancies had a 2.3 odds ratio of developing varicosities and a 3.2 odds ratio for telangiectases (dilated superficial blood vessels of the skin, mucous membranes, gastrointestinal tract, and other organs, associated with recurrent episodes of bleeding from affected sites).

OB/GYN News, Oct. 15, 2003

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Midwifery Today books about midwifery

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Forum Talk

Has anyone else noticed a common use of stripping in post-date moms? Here in Canada they are doing this regularly. It has become a common post-date exam procedure. The women are commonly stretched twice or more - the first being just a little bit and progressively worsening as dates go on. A common side effect is going from no contractions to body mimicking active labour and beginning to dilate but then stops, and contractions lessen as days pass. It's really painful and hard on mom because she gets no sleep. The next step is to break the waters if it hasn't already broken from the shock or Pitocin or Oxytocin and so on.


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Question of the Week

Q: What information is available regarding breastfeeding when mom is on 20 mg Paxil [antidepressant] and has been throughout pregnancy?

— Betty Jones, York, PA

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

Q: A friend had a vulval varicosity from week 16 in her first pregnancy and was extremely uncomfortable with it. She is now 17 weeks pregnant with her second baby, and this time it has come up again - from week 9. The local consultant can only offer induction at 37 weeks as a solution (she had her first baby at home and intends to do so again).Does anyone know of remedies, treatments, or solutions to her uncomfortable problem?

— Nickie Sutton, United Kingdom

A: I have problems with varicose veins whenever I am pregnant. I took a supplement called Cataplex ACP from Standard Process. You can get this supplement from a chiropractor, naturopathic doctor, or other healthcare provider. It is all natural and it really helped me - I was truly amazed.

— S.K.

A: I have met pregnant women who have had symptomatic relief during pregnancy using a product called the "V2 Supporter": http://www.motherschoiceproducts.com/v2-supporter.html I have no financial interest in this product.

— Leslie Ashton, RN, B.Sc

A: I had a client (doula) who experienced this in her first pregnancy. All that was suggested to do was to spend some time not wearing underwear, in bed, and also to use ice packs on the affected area for 15 min three or four times a day. Twice a day the grandma-to-be would put pressure on the labia (this was a lymph node acting up, rather than a vein, but it worked). By the 20th week (it started in the 16th) the mom could move around normally and had no trouble with it again, or with the birth, which I attended. She had a short labor, too - only 2.5 hrs for a first baby. She had no further problem with it in a subsequent pregnancy.

— Cathi Cogle

A: I've had clients who have had other varicosities (legs, hemorrhoids) respond magnificently to the herbs white oak bark and butcher's broom. Both herbs are astringent in nature; white oak bark in particular works directly on varicosities. Induction for varicosities? I don't think so!

— Maggie, doula, naturopath, Florida

A: Some homeopathic remedies are bellis perennis, hamamelis and colensonia. Mom can sit on a bag of frozen peas wrapped in a towel or use as a compress.

Some herbals that are helpful are St. John's wort infused oil (this is my first choice), calendula infused oil, witch hazel compresses, calendula compresses (use the tincture or tea), St. John's wort compresses (tea or tincture), oak bark tincture or tea applied as a compress. You can grate potato and apply to the affected area. Compresses of horse chestnut, yarrow are also helpful.

Increase fiber intake. Eat more garlic. Eat more colorful foods - squash, berries, etc. Mom can also look into internal herbs, including yarrow, witch hazel, oak bark. Elevate legs. Exercise.

— Demetria Clark

A: As a third-year midwifery student in New Zealand I have met three women who have had marked improvement of vulval varicosities by taking raspberry leaf (rubrus idaeus) tablets. These women were 20-30 weeks pregnant, however. Check the potency of tablets available. She can also drink raspberry leaf tea.

— Margriet Wilson

A: My personal experience with vulval varicosities was miserable. They did get worse with each pregnancy but fortunately went away after the pregnancy. The solution was to use prescription support panty hose. These were a nuisance, but they took the swelling down enormously and pretty much relieved the aching pain I felt anytime I was upright. I did not have any other varicosities.

— Edie Wells, CPM, Beloit, WI

Regarding severe menstrual cramping [Issue 6:20]:

A: I have had many patients, as well as myself, with the same pains and problems that you have with your menstruation. What we have found to be beneficial are chiropractic adjustments, which help the pelvis and the uterus go back into their normal healthy position, thus alleviating the cramping and pains that go along with it. There is also a special adjustment that will relax the muscles to the uterus and make you feel much better. The adjustments also help regulate your periods. Since I have been under chiropractic care I no longer have cramps at all, and I know exactly when my period will begin and end. The good news is it's all natural.

— Dr. Charmin Gans

A: Your symptoms ring very true to endometriosis, which affects 90 million women worldwide. Unfortunately a lot of them go undiagnosed and develop permanent damage and fertility problems. Definitive diagnosis can only be done by tissue biopsy and so involves a laparoscopy. Depending on severity and symptoms, a variety of treatments are available. One of them is the Mirena, an intrauterine device that releases hormones locally (not throughout the whole body). It seems to be very effective for some women.

Research has shown that a lot of young girls are unaware of the condition. Results are so much better if treated earlier rather than later. One optional treatment is to take continual hormonal pills to prevent ovulation as the displaced tissue is oestrogen fed.

I have a very close friend who had symptoms very similar to yours (fainting, hot, etc.) She is now quite well but needs to stay on these hormonal tablets without a break so as to not ovulate. Read more at: www.mirena.co.nz/

— M.

A: I found taking a combination of nutritional supplements, especially magnesium and zinc, incredibly - miraculously - helpful. After 20 years of pain and sickness it seems to have been a great help in alleviating pain. I also find exercise really helps. If I can go for a swim just as I feel I am going to come on, that too helps.

You may find it interesting to get hold of a book called "The Optimum Nutrition Bible" by Patrick Holford (ISBN No 0-7499-1855-1). I was so interested in the findings of this book, I went on to do a home study course and am now a complete advocate of Optimum Nutrition. As well as easing menstrual pain, it's also helped me enormously with my fibromyalgia symptoms. Another book along the same lines is Optimum Nutrition Before, During and After Pregnancy, again by Patrick Holford and Susannah Lawson (ISBN No 0-7499-2469-1).

I would advise, though, that you take further advice about supplementation. Vitamins and minerals need to work in conjunction with each other, and taking too much of one can actually deplete you of another. It's the balance that's important. Your local health food shop or a nutritionist would be able to give you further advice.

— Kate Strand, MICHT, massage therapist specialising in pregnancy and postnatal care

A: Try a tincture of crampbark diluted in water. Start taking it when you feel your period coming on but before you start bleeding. My friend has had very severe cramps and she found that after a while the pain meds didn't work. She found that using a hot water bottle, crampbark, and eating nourishing food helped almost entirely alleviate the pain. I found if I take time to sit and be quiet I won't get cramps, but if I am running around too much it just hurts.

— Casandra Harrison, Bellingham, WA

A: My daughter had very similar troubles with periods for ages. We tried every different idea until we came upon taking calcium magnesium complex tablets. She has very little pain and discomfort since starting them. She started with one tablet twice daily in case of reactions but is happy with the results of taking two twice daily. These tablets have 200 mg calcium, 100 mg magnesium, 145 mg phosphorus, 2 mg zinc, 1 mg manganese, 50 mg copper, and 1.875 mg vitamin D3.

— Robyn J Aulmann, RM, Rutherglen Vic 3685, Australia

A: I have had this problem, too, to the point that my doctor had to give me shots to knock me out for a day. I found that I had an oversupply of prostaglandins. I took ana-prox for a while. I don't think it is a hormone. After I got married and had babies I did not have so much troubles; I now have five kids. I also think diet is a factor; if you drink a lot of coffee or pop and eat a lot of processed foods it can be hard on your body. Try some herbal teas instead. As I entered my late 40s and early 50s pain returned due to a prolapsed uterus.


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.

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Editor's Note: In Issue 21 we published a letter from a 16-year-old young woman named Nicole who is interested in becoming a midwife. Several readers offered guidance:

I am neither a doula nor a midwife, but a mother of two. I had both my boys with a midwife—the first in a birthing center and the second at home. I would highly recommend you become a doula first, then work your way through school to become a midwife. My midwife was a doula first, and I believe that is one reason she is such a great midwife.

You may want to check with DONA (Doulas of North America) to find a doula or classes near you. Their Web site is: www.dona.org

If you want to go straight into midwifery, check into Ancient Art Midwifery's correspondence course. That may be a good place for you to start—especially if you aren't interested in becoming a nurse midwife, but are interested in becoming a lay or licensed midwife.

Maria, West Virginia

Following are a few books you might want to read, and there are many good Web sites if you are going to go to a traditional midwifery school. There are also online schools such as Ancient Art Midwifery Institute.

The books:

  • Becoming a Midwife, by Carol Steiger
  • Spiritual Midwifery, by Ina May Gaskin, and tons of others
    (you might want to do a Google search on midwifery books, there are so many)

For schools:

  • Miami-Dade Community College has a licensed midwife program. I believe it is the only community college in the country that offers this kind of program.
  • Seattle Midwifery School
  • The Farm Midwifery Workshops in Tennessee (These are only one week at a time, intense, but designed to give you a good overview. Then you work at home with a preceptor/mentor to do your clinicals and other bookwork to prepare you for the NARM exam.)
  • Frontier Nursing School (but you must be an RN first)
  • Casa de Nacimiento in El Paso, Texas
  • Casa de la Luz, also in Texas

This is just scratching the surface. I would do a Google search to find schools. There are many out there now.

— Cathi Cogle

Midwifery Today has books on getting an education, but right now start reading anything about normal and natural childbirth that you can get your hands on. I started my path toward becoming a midwife by reading Silent Knife first, then Immaculate Deception II, then Homebirth by Sheila Kitzinger. I moved on to Henci Goer's books, Tom Brewer, Gail Sforza Krebs (aka Gail Brewer), Penny Simkin, Polly Perez, William Enkin and the NAPSAC books. William Sears has good stuff from a consumer perspective. Attend La Leche League meetings, local midwives' meetings, doula meetings, childbirth educator meetings. Humbly and quietly become a sponge.

Offer to help midwives in nonbirth ways such as housecleaning, filing, typing, babysitting. Earn their trust.

I started educating myself by printing off every great article or e-mail I got and put them into binders. I now have three such large binders with research, articles and tricks of the trade that I have collected over the years, all sorted into categories such as hypertension, anemia, prolonged labor, presentation, counseling, etc. I attend used book sales (check your local library—mine has a book sale twice a year) to pick up books for my private library.

Check all your options carefully, expose yourself to the blood, sweat, tears, poop, vomit and exhaustion of the life of a midwife, then look into the various schools, apprenticeships and degrees that are available. Decide what your philosophy of birth is, then find a route to education that fits that philosophy. And be patient! I started this road seven years ago, and am just now apprenticing.

— A.W.

I am a South Carolina licensed midwife who made a course many years ago for apprentices, called Midwife To Be. It's approved by the South Carolina Department of Health and is done by mail or e-mail. It's only $50 to start and then $25 each unit (30 total).It takes approximately 30 months, but it can be quicker or slower. Check out www.newlifehomebirth.com for more information.

— Lisa Aman, LM EMT

The first thing I did when I decided to become a midwife was to start reading. The first book I read was Heart and Hands: A Midwife's Guide to Pregnancy and Birth by Elizabeth Davis. That was great for me then—not too much information, but enough to feel like you're really learning. It also gives you a really good idea of what a midwife does and helps you decide if this is really what you want to do.

Other good books include Holistic Midwifery by Anne Frye, Myles' Midwifery (get the current edition, I think 14th), Understanding Diagnostic Tests by Anne Frye, and The Breastfeeding Answer Book by Nancy Mohrbacker. You can get these books through interlibrary loan—just call your local public library and give them the title and author and tell them you want to order through interlibrary loan.

Read all the articles on the Midwifery Today Web site, go to Mothering.com and read all the birth stories, Google topics you're interested in from your reading, and research, research, research. Check out Paths to Becoming a Midwife, published by Midwifery Today. It talks a lot about the various routes to becoming a midwife and gives information about schools and ways to licensure.

Call a local midwife and see if she can give you the scoop on what the legal status for midwives is in your state. In some states, the practice of direct-entry midwifery (midwives who are not nurses first) is illegal. Nurse-midwifery (midwives who have a bachelor's degree in nursing and a master's degree in midwifery) is legal in all states, but the disadvantage is that the schooling tends to be more medical than holistic (although this is not true of all schools). Talking with a local midwife might give you an idea about whether you want to go the direct-entry or nurse-midwifery route.

— Anon.

[Editor's Note: See Midwifery Today book list above to learn more about becoming a midwife and practicing midwifery.]

My husband is in the military, and we were recently relocated to Riverside, California. I am 28 weeks pregnant and looking for a midwife who takes my insurance. I have Tricare/Triwest. I haven't had any luck and have been getting the run-around by receptionists. I am an aspiring midwife, and it's important for me to have a midwife attend my birth. I am seeing a doctor while I look for a midwife, and she has explained to me that it's a hospital rule that I stay in bed after I'm 4 centimeters dilated. I asked her if I could sign a waiver, and she told me it would cause a hostile environment for myself and she wouldn't want to help me after that. I am having a really hard time locating a midwife and am very against these rules and regulations. If anyone has any help or advice to offer I'd appreciate it very much.

Rachel Pudelek

I am 25 years old and mother of 3 boys ages 7, 5, and almost 1. I loved giving birth although my first baby was born in the hospital and while "natural" I still had a very medically managed birth. Luckily I was somewhat prepared, so it wasn't as bad as it could have been (no routine IV, no episiotomy, IFM, or the like). I was told I needed EFM initially (even though I had written in my birth plan that I did not want it) and I would have to fill out paperwork (they had lost it) before I could have my baby there. Also they attempted to cut me off from drinking any more juice and repeatedly tried offering me drugs (again something that was denied in my birthing plan, which was posted on the door). Luckily I was aware of most of my rights and had some strong advocates on my side. Suffice it to say after practically wrestling with the nurse my mother got me the juice my body needed.

After that "natural childbirth" experience I learned the true joys of homebirth. My last two boys were born on my bed. I had the freedoms that I so desired while in the hospital. I could drink all I wanted, move when I wanted, follow my body, and only those I was comfortable with were present. My midwives were incredible, supportive, and still l felt that they were hardly there—a major plus to me.

I am also an aspiring midwife. Having always been fascinated with the amazing power of birthing and babies, I have now realized my true calling. I live in Portland, Oregon, and have started taking some general education requirements (part time so I can be home with my baby) at a community college nearby with every intent to one day become a midwife. My main concern is that every midwifery school near me has very high tuition. I am wondering how other midwives who aren't wealthy have overcome this obstacle. To become a LDEM in Oregon there is a self study option. You must attend a set amount of births with a midwife and must pass the exam to become licensed. I would love input anyone can offer. Is self study a smart option? If so, how does one go about it? I would love to attend an actual accredited school; I just don't know if I can afford it. Ideas?

Ragavati Berry

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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