|March 2, 2005|
Volume 7, Issue 5
|Midwifery Today E-News|
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In This Week’s Issue:
Quote of the Week
"It is worth considering that ultimate satisfaction with the experience of giving birth may not be related to lack of pain."
— Sarah Buckley
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The Art of Midwifery
Blackberry root (Rubus villosus): An old Native American remedy for diarrhea, blackberry root is an excellent astringent that is remarkably effective in just a few tincture doses. Varicosities also respond well to external methods of treatment with blackberry root.
— Susan Perri, The Birthkit Issue 35
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Research to Remember
A study of the reproductive histories of 700 women age 24 to 44 showed that women who have an abortion are five times more likely to report substance abuse compared with women who carry to term. An unrelated Finnish study found that the risk of death from suicide is six times greater for women who have had an abortion compared with women who carried to term. The risk of dying from accidents or homicide is four and twelve times greater, respectively. Researchers have concluded that this is a result of risk-taking behavior that results from untreated self-destructive or suicidal tendencies. However, it is not known if abortion leads to these tendencies or whether it underscores previous self-destructive tendencies.
— American Journal of Drug and Alcohol Abuse, March 2000
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I am entering my third year of direct entry midwifery in New Zealand. As a student last year, I had an experience where a mother (2nd baby) came into the hospital in active labour. On examination, baby was determined breech. The parents both wanted the option of a vaginal birth but were scare-mongered into a c-section (by both the obstetricians and the midwife). I now have a strong pull towards women being able to have a vaginal birth. I want to know from a midwifery perspective how many successful births you have had, and 1) How many of you will support a woman in labour with a breech presentation to have a vaginal birth? 2) How have the outcomes been? 3) Will you accept a birth in any presentation (e.g., footling)? or only frank or complete?
Share your thoughts and experience about this topic.
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Question of the Week
Q: Are there any sources of information regarding the relationship between the throat and perineum during birth—when the throat is tight, the vaginal floor will also be tight?
— Giselle E. Whitwell,
SEND YOUR RESPONSE to firstname.lastname@example.org 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: I have a student who has had a numb and tingling arm for two days. She is 30 weeks pregnant. Any suggestions as to cause or where I could find more information for her? They have started her on the rounds of doctors, but I am concerned they won't have accurate information for her.
— Amy V. Haas, BCCE
Editor's Note: Many readers offered valuable thoughts about this problem. They were roughly divided into carpal tunnel, chiropractic treatment, massage, reflexology and ergonomics evaluation. The outcome, which may come as a surprise to many, is described at the end of readers' answers. You will learn helpful information from readers' thoughts; the lesson is to remember, too, to consider all possibilities and consult carefully and accordingly.
A: The symptoms may indicate carpal tunnel syndrome, which is caused by edema in the hands which in turn compresses on the nerves affecting the hands and arm. Another area of compression is in the wrists but affects the whole arm. It can become increasingly worse as the pregnancy progresses and also cause a lot of pain, especially at night. Physiotherapy can sometimes help as well as strapping and supporting the arm. The only cure is the birth of the baby with the swelling and edema resolving once the baby is born.
— Julie Watson, midwife
A: I served a mom whose two arms with one pregnancy and one arm with another got tingly and numb. She said they felt like a piece of wood. She would drop things, and she couldn't feel them very well. It was carpal tunnel syndrome. She got relief with vitamins B6 and C taken together. Doc said that fluid increase in her tissues during pregnancy put pressure on the nerves and caused numbness and tingling. She was not the least bit swollen in her feet or hands. It went away on its own after the baby was born.
— Mary Bernabe, Yacolt, Washington
A: It's probably carpal tunnel. Have her get a wrist brace; physical therapy may help.
Chiropractic and/or Massage Treatment
A: Many years ago, I had a numb thumb, hand and forearm and it was corrected with one chiropractic adjustment! My neck was out of place. I felt the sensation come back into my hand immediately; it tingled all the way home, and all the feeling returned by the end of that day.
A: All she may need is an adjustment by a chiropractor. I had the same problem with my fifth baby, and an adjustment fixed the problem. It may be hard to find a doctor willing to work with her at this point, but any chiropractor who is unwilling to is probably doing things too roughly anyway. Keep looking! I received care from my chiropractor till the end of my last two pregnancies (sixth and seventh) and by two weeks postpartum. Chiropractic care is also wonderful for changing unfavorable fetal positions. These manifest as vulvar numbness, sciatica, ligament pain, etc. in the mom. Of course, it also helps baby move into a "better" position in which to birth.
— Amy, Missouri
A: It's most likely a nerve entrapment. Without knowing her pattern of numbness and tingling, it's hard to say where it could be happening, but possible causes are an entrapment at the brachial plexus, elbow or wrist. Always look "upstream" for the entrapment, i.e., if the numbness starts in the forearm, then the problem lies at or above the start of the symptoms. One more serious cause of numbness/tingling in the arms is a disc problem (bulge or herniation) in the neck. If this were the case, however, she would be having severe pain and/or weakness along with her numbness. She also may need to have her neck adjusted by a chiropractor.
Pregnant women are more prone to nerve problems like this due to increased load on the spine and changes in posture. Also, extra blood volume allows less room for the nerves, particularly in narrow passageways! She should be seeing a chiropractor and/or a massage therapist who specializes in orthopedic conditions and is experienced with prenatal issues.
Allopathic medicine will most likely do nothing for her, unless they can refer her to a good physical therapist who can give exercises and do manual therapy for her.
— Candace Palmerlee, CMT, CD
A: I am a massage therapy student who has been studying pathology this semester. I would have her go to a massage therapist and ask about thoracic outlet syndrome. A nerve could be entrapped in her axillary region; those muscles surrounding it could be massaged and relaxed for them to "let go" of the nerve(s).
A: I am a reflexology therapist and have had a few pregnant ladies complain of numbness and tingling in the arm later in pregnancy. Theirs seemed to have been the result of peripheral nerves being pinched (perhaps by tight muscles against bone or somehow by the weight shift in the body).
Reflexology has been fully effective as treatment for the ladies I have treated. I used vertical reflex therapy (VRT), focusing intensive treatment on the neural pathway of the affected nerve, together with related reflexes. To find a trained VRT therapist: e-mail email@example.com or Web site: www.boothvrt.com
— Clare Roy, Cape Town, South Africa
A: Is it her whole arm or just from the elbow down, particularly on the pinky side, extending into the pinky and ring fingers? If it is from the elbow down and particularly in the pinky/ring fingers, I'd ask her how much leaning she does on that elbow as she sits. A nerve that runs on the outside of the elbow can become damaged from leaning on the elbow. Because I do ergonomic evaluations on co-workers for my "regular" job, I routinely counsel people that "those are 'chair arms,' not 'arm rests.' Use them to help you get in and out of your chair; if you need to rest your arms, lay them on your lap." My actual preference is for people to choose chairs without arms, but pregnant women sometimes do need help getting up and down in late pregnancy.
— Jenn Riedy, BCCE, CPS
The Actual Outcome
A: It turns out this mom had a small stroke (diagnosed by an MRI). She is doing well, but they have put her on blood thinners to help prevent a further stroke. She has almost totally recovered and is receiving physical therapy. You cannot tell by looking at her that she has had any difficulties.
While everything I have found (a few comments and stories from Midwifery Today E-News!) indicates that a calm, gentle birth with mother-initiated pushing (what we should all be doing anyway) is probably the least trauma-causing scenario, the blood thinners present a problem. She is getting different opinions from different doctors—one says she should have a c-section; another says no c-section due to the risk of bleeding out, and that they should induce, but she can't have an epidural due to risks (she doesn't want one anyway).
Now they say they have to induce her so they can schedule when to stop the blood thinners. We all know the risks of induction, and this mom is not happy about it. Does anyone out there have any other comments/info/sources for us? She really wanted a natural birth, but does continue to go to a regular obstetrician.
— Amy V. Haas, BCCE
Regarding platelet levels [Issue 7:4]:
A: Yes it is possible to reverse the platelet drop. However, there is no single remedy for thrombocytopenia in homeopathy. Most platelet crises are the result of medications such as the antibiotic macrodantin. Even after the drug is discontinued, the platelet count does not return to normal on its own. However, with proper homeopathic treatment, the condition can often be reversed. A skilled homeopath can select a remedy that can bring the platelets back to normal. Remedies are prescribed on the basis of each patient's symptoms, history and predisposition. For a serious condition such a platelet drop, it would be a mistake to self-treat with a homeopathic or herbal remedy without consulting an experienced homeopathic practitioner. It is not worth the risk. If the platelet count dropped further, this could lead to a life-threatening condition. By the way, the right homeopathic treatment can often rotate a breech baby and avoid c-section.
— Manfred Mueller, RSHom (NA), CCH
Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
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I have had a query, via Birthrites in Australia, about accessing VBAC information that is presented in Mandarin, for a woman who is being cared for by a wonderful midwife here. A language barrier is making it difficult for the midwife to inform/reassure the client about the choices available to her after her previous c-section. Do you know of anything available that would help? Information sheets in Mandarin? If you could respond to let me know/guide me toward a resource that could help, it would be very much appreciated.
— Jackie Mawson, E-mail: Jackie@birthrites.org
The comment by Ruth Trode [Issue 7:3] that preterm labor is a cry for help from unpampered mothers disturbed me because it felt too close to blaming mothers for "doing too much," or perhaps worse, insinuating mothers must be treated as fragile creatures who need "pampering" (I immediately thought "smothering") by society. Don't women have enough trouble maintaining control of their bodies in pregnancy?
Preterm labor, which affects 11% of all pregnancies, is a complex problem, likely multifactorial, and probably arises from multiple etiologies. At least 30% of preterm labor is associated with some kind of infection, for example. Many researchers are working to uncover the cause(s) and to develop preventions and treatments that work. (I do agree with her that present tocolytics are inadequate.) To attribute preterm labor to lack of pampering by society serves no one.
Ruth's recommendations for bed rest, chiropractic treatments, massage therapy and good food at the end of pregnancy also disturbed me. There is no evidence that massage therapy or chiropractic treatments offer any benefit in preventing preterm labor. As for bed rest, there is no evidence of benefit and mounting evidence that bed rest can place certain mothers and babies at risk for complications such as thrombosis. As for good nutrition, there is evidence that prevention of complications of pregnancy, including preterm labor and delivery, may involve good nutrition. However, the evidence points to good nutrition beginning early in pregnancy when the placenta is first developing.
As for pampering mothers to prevent preterm labor, the best thing the evidence says is that society should offer affordable dental care. A visit to a dentist for a thorough check-up, cleaning and treatment of periodontal disease in early pregnancy does reduce the possibility of preterm labor. I think pregnant women would be better served by being informed of existing evidence so they can make informed choices, rather than being offered mere opinions or unproven and potentially risky therapies.
— Natalie K. Bjorklund, Postdoctoral Fellow researching Uterine Smooth Muscle
I'm a doula who moved from Venezuela to the United States three years ago, and I'm just starting to slowly get some clients here. I'm learning a lot about the mentality (fears, beliefs and so on)—very interesting. Most of the births I assisted in Venezuela were natural, homebirth and waterbirth; I also assisted with some c-sections.
Right now I'm starting to work with a woman who is expecting three babies; two of them are twins sharing one placenta. This is a first for me, and before I start researching on the Internet and start reading all kinds of articles from conventional medicine, I thought Midwifery Today readers might have had some experience with this kind of situation and can give me some advice, information or suggestions to help support this situation with more clarity and knowledge.
I broke my coccyx in a fall during pregnancy, and still had a terrible delivery. Our prenatal instructor had broken hers during an unmedicated delivery and didn't know until afterward. It sounds odd that you could break a bone and be completely unaware, but I didn't have confirmation that mine was broken until 1-1/2 years after the fall. My midwife just kept telling me, "Give it time." After 15 months, I'd had enough and went to a D.O. I know this isn't conclusive, but maybe if more of us speak up, that little part of our bodies will get the attention it needs.
When I read Gloria's statement, "One of the reasons we have so much interference in North American birth right now is that young women are overly dramatic," I thought, "Oh thank you, Gloria, I have been saying the same thing for *years*!" As a doula, I think the number one demon I fight is drama.
I am so surprised to see anyone in the birth field be surprised at that [Issue 7:3]. I thought everyone knew that most of obstetric intervention is driven by consumer demand and that much of the consumer demand is based on overly dramatic consumers. Do you not think for example that the high induction rate is largely based on dramatic women who simply "cannot be pregnant another week!" Do you not see that as overly dramatic?
Do you not think that the high epidural rate might be affected by women who enter the hospital at 1 cm dilation and demand "Something for this pain? Is that not overly dramatic?
Do you not think that the c-sec on demand debate is being fueled by young women begging their physicians to "just do the c-sec so I don't have to push something that big out of a space that small!" Is that not overly dramatic?
I am constantly, gently reminding women that they are not the first woman to ever give birth and that no, it isn't the drama that they are portraying it to be. I try to get them to change their focus from thinking of it as dramatic to thinking of it as special. I think the difference is that each woman should think, "This is my special event and it will be beautiful" rather than "This is my ordeal and I have to get through it." Isn't it our jobs as doulas and midwives to educate women who have misguided views of birth? How can we do that if we can't even recognize misguided views?
If you don't think young women today are overly dramatic, walk down the hall of L&D at your local hospital. At a recent birth I stepped into the hall and could hear a woman dramatically crying from her room about how she could "still feel pain. Why isn't this epidural working?" When I contrast that with my client a few doors down who was calmly breathing through transition, focusing on her baby moving down, and thinking about her special event rather than how awful it is to be going through this "punishment," I am amazed at what education and level-headedness brings about.
Do any midwives out there have experience of a woman suffering a deep vein thrombosis (DVT) after a birth and then going on to have more pregnancies? I am in this situation and am trying to gather information that will help me make choices and decisions for the birth of my second baby.
— Jenny Gardner
I would like to address the use by many midwives of mediolateral episiotomies when needed. As a midwife, I was trained to cut a medioateral (diagonal cut toward one of the legs) if needed, which of course is rare. During my own homebirth it became necessary for my midwife to cut an episiotomy due to loss of heart tones and a head in the OT (looking over the shoulder) position. As she was trained the same way I was, the cut was a small mediolateral one. I found out by experience and through research that the recovery from this type of episiotomy is extremely painful, much more so than with a midline cut (one that goes straight toward the anus).
It was two months postpartum before I could stand for more than 10 minutes without a lot of pain. It is now eight months since my birth, and I still have quite a lot of discomfort, especially during sex.
I have been told that midwives are instructed to cut a mediolateral epis to prevent the episiotomy from tearing into the rectum as the head emerges. While I believe one should take great care in this situation, I believe that most midwives are careful enough about guarding the perineum that a tear-through is highly unlikely. I have talked with other women who have had a midline cut, and they did not experience the type of discomfort I felt. I can say for certain that, should the situation ever arise in which I will need to cut an episiotomy, I will go with a midline cut rather than the mediolateral that I was trained to do.
It is the duty of midwives to provide not only a great birth experience but also to see to it that a woman can also have a great postpartum experience. To all you midwives out there, if you ever have to cut an epis, please consider using a straight, midline cut!
— Jessica Weed, midwife, doula
I just want to say how thrilled I am that there was not one word in Issue 7:4 "Protecting the Perineum" about how the midwife should have her hand on and in the mother's vulva in order to protect it from birth. I am dismayed at how many midwives still believe the basic normal process can be improved on by their manipulations and interventions. This is a myth that I would love to see die out. I also loved that another myth was addressed that birth in itself weakens the pelvic floor. I do not know the history of the creation of these beliefs, but I am pretty sure that it has something to do with men getting involved with birth and then taking it almost totally away from women. In our culture the recovery of midwifery is still in its infancy, still working on separating out what is true birth wisdom from what is obstetric pseudo-science. I am continually heartened to see Midwifery Today at the forefront of that work.
— Linda Hessel
Editor's Note: Only letters sent to the E-News official e-mail address, email@example.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
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