April 12, 2006
Volume 8, Issue 8
Midwifery Today E-News
“Colostrum”
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In This Week’s Issue:


Quote of the Week

"These are the moments when a woman is only who she is. There is no pretending, and there is no running away. There is only being."

Heather Hilton


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The Art of Midwifery

My friend made my stool from a kitchen chair with a plank bottom. He took the back off, cut the legs off to a semi-squat level, and cut out the seat to resemble a toilet seat. He put handles on both sides so mom can hang on to it if desired. I put a plastic bag on the cross bars under chair and when mom tells me it is time to push she gets on it. I sit on the floor and catch and hand off baby to mom if she wants or help her to bed if she wants. Also, it is painted with a good enamel paint so it washes easily.

Claudia Toms, 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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Passionate Midwifery Education

Conference as Midwifery Education

I just returned from our conference in Philadelphia thinking that if every aspiring midwife could experience one of these conferences she would have a great launching pad for her midwifery career. In the Beginning Midwifery class we teach about the art, science and practice of midwifery. The class is designed to give some basic understanding of midwifery, such as normal labor physiology and prenatal care. We have a practicing midwife who opens her birth bag to the class, which is always fascinating to participants. The rest of the day deals with many other issues you will encounter in midwifery. The conference is rich in both classes and mentors—perfect for getting grounded in midwifery while having fun.

Sometimes figuring out just where you are headed in becoming a midwife can be difficult. Many women choose to become a doula so they can help with birth care while determining whether they want go on to become a midwife or carry out the call in some other way. Some midwives have gotten much of their academic education just by going to various conferences. In addition to providing initial and continuing education, Midwifery Today's conferences are a great vehicle for networking, bouncing ideas off of each other and finding mentors.

We are in the process of planning next year's conference in Eugene, a two-day "Paths to Becoming a Midwife." We believe in the importance of nurturing the upcoming generation of midwives, and are very dedicated to this calling. We also are working on the next issue of the magazine, whose theme is "Midwifery Education." If you do not have a subscription to Midwifery Today, now is a good time to subscribe. It is a great step in your education process. If you cannot afford a whole subscription, at least purchase Midwifery Today Issue 78 as it will overflowing with important information for you.

Remember that you can also earn a subscription to Midwifery Today by writing an article that is accepted for publication in the magazine. We love to hear from you.

love, Jan
Jan Tritten, Mother of Midwifery Today

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Colostrum

Colostrum is low in fat, but high in carbohydrates and protein. It is also very rich in vitamin A, a micronutrient that is essential to good health, particularly in preventing blindness, as well as in preventing infection.

Colostrum contains antibodies that are effective in fighting infection and keeping the baby healthy. It is easily digestible, making it the perfect first food for a baby. Its laxative effect helps the baby pass early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.

The first few days of breastfeeding are probably the most important for a baby, and because the baby's stomach is very small he or she will be able to consume only a small amount of protein at a time. As a result, the baby will need to be fed nine or more times in a 24-hour period.

Colostrum acts like a natural oral vaccine because it contains large quantities of an antibody called secretory immunoglobin A (IgA). IgA protects the baby's mucous membranes in the throat, lungs and intestines from infection. Colostrum also has high concentrations of white blood cells, called leukocytes, which fight bacteria and viruses.

Colostrum is especially important in the gastrointestinal tract. A newborn's intestines are very permeable. Colostrum helps seal the permeable intestines by creating a barrier that helps prevent foreign substances from penetrating and possibly sensitizing a baby to foods the mother has eaten.

While these effects continue once the colostrum changes to milk, the immunological response to viruses and bacteria is not as powerful as in the beginning. However, the effects of the initial colostrum are long-lasting. Studies have shown that children who are breastfed rather than formula-fed have a lower frequency of allergic, inflammatory and autoimmune diseases and lymphomas in their later life when compared with children who have been formula-fed after birth.

Besides these effects, colostrum has a positive effect on blood sugar and aids in development of the heart, lungs and brain.

Cheryl K. Smith, excerpted from "Nature's Perfect Food: Colostrum," The Birthkit Issue 49


In Brazil, where enteropathogenic Escherichia coli (E. coli) diarrhea is a leading cause of morbidity and mortality in newborns, a study used Western blot analysis to determine the extent to which IgA in colostrum is reactive with enteropathogenic E. coli proteins. The analyses revealed that the colostrum samples contained a secretory immunoglobulin A that was reactive with all the virulence-associated proteins studied. Researchers concluded that maternal antibodies in colostrum may protect infants from E. coli infection by interfering with the attaching and effacing lesions brought on by transmembrane and intracellular signals caused by E. coli, and by cell signaling, which involves anti-enteropathogenic E. coli-secreted protein A and B antibodies.

J Pediatric Gastroenterology and Nutrition, 1998, 27(2)


A study determined that the anti-infective factors in the colostrums of mothers of preterm infants differ from those of mothers of full-term infants. The 25 mothers were matched for age, parity, quality of nutrition and hemoglobulin levels. In the mothers of preterm infants, the concentrations of total protein and the antimicrobial agents SigA, lysozyme and lactoferrin were significantly greater than in the colostrums of the mothers of full-term infants, although the mean 12-hour volume of colostrums was significantly lower in the preterm group. The preterm colostrums also contained far higher counts of total cells, macrophages, lymphocytes and neutrophils. Degree of prematurity correlated with volume, protein, concentration and cell and macrophage counts. The study concluded that although the volume of colostrums is lower the more preterm the infant, the quality is higher in terms of soluble anti-infective agents and cells.

J Trop Pediatr, 1991, 327(5)


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Research to Remember

In a survey of 3756 birth records, researchers sought to identify links between maternal position during spontaneous midwife-attended birth and the incidence of perineal tears. Factors evaluated in mothers needing postnatal perineal sutures were maternal age, first vaginal delivery, induction of labor, regional anesthesia, newborn birth weight greater than 3500 grams, deflexed fetal head and absence of occipital anterior fetal position. The need for sutures and the effect of birth positions were compared for each factor. A semirecumbent position had been used by nearly 66% of the women, and that position correlated with the 44.5% incidence of sutures. All-fours position was associated with reduced need for sutures. The most significant factors that correlated to perineal trauma included first vaginal birth, regional anesthesia, deflexed fetal head and newborn weight of more than 3500 grams.

Birth, Vol. 32, Sept 2005


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Forum Talk

I'm investigating with an infertility/perinatal specialist group the cause of my three miscarriages. In my speculating about the possible results of tests and the course of action we may take, I realized that what we find may have huge implications on my having midwifery care or not. So may I ask, do you ever take on care of women with thrombophilia and who are being treated with Lovenox (heparin) throughout pregnancy? If you do care for such women, would you have any limitations (like only prenatal care, not birthing, or the opposite)? I'm wondering if any of you have any thoughts on this. I'm looking for info specific to the US and not necessarily homebirth. My previous plan had been to use an experienced midwife who assists her client in an in-hospital natural birthing center. I'm thinking that this may not be possible if my suspicions of a clotting disorder are correct.

Robsgirl


Share your thoughts and experience about this topic.
**Please do not send your responses to E-NEWS!**


Question of the Week

Q: I know that everyone says a VBAC should not be attempted if a vertical cut or T-cut caesarean section was done previously. Have any studies been done that show this to be of greater risk if induction is not done? Or is it just by implication because of the length or location of the uterine scar?

— Judy Jones


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: Does anyone have tips to help a mom who never gets the urge to push during second stage? She is completely unable to push with the contractions even though she gets in great positions: kneeling, squatting, hands and knees, birth ball, birth pool, etc. Two babies have been born fine as mom allowed her uterus to do all the work while she breathes through contractions. Is it best to let the uterus do its work alone or is there something that can help an "urgeless" mom?

— CLM, doula

A: The best way to avoid such a situation is complete privacy and silence. The art of midwifery is the art of creating the conditions for an authentic fetus ejection reflex (i.e., a short series of irresistible and powerful contractions). Such a reflex is more likely to occur suddenly is there is nobody around but an experienced, motherly and low profile midwife/doula who is not staying in front of the laboring woman and who is not guiding her. It is more likely to occur if the baby’s father has been given an urgent task, preferably outside the house (in the case of a home birth). It is counter-productive to give rational information about the progress of labor, or to behave as if you were expecting the fetus ejection reflex now. It is counter-productive to suggest postures. It is counter-productive to reassure with words when the laboring woman is suddenly expressing a fear (kill me… let me die…, etc.): this is a good sign of the sudden release of adrenaline announcing that the fetus ejection reflex will start shortly…if the mother is not brought back to our planet. During a fetus ejection reflex women find by themselves appropriate and complex postures, adapted to their particular case.

— Michel Odent, MD


Q: Has anyone out there had any experience with the autoimmune disorder, morphea, and pregnancy? I currently have a client who has it and it has been very difficult finding any information about its effect on pregnancy and pregnancy risk. As I understand it, and this is mostly from being educated by the client herself, morphea is a sister disease to scleroderma but does not affect the internal organs, just the skin. My client has an area of hardened scar-like tissue on her lower back but otherwise she has no problems. She is an acupuncturist and very well-educated about her condition.

At first I didn't think much of it, but I decided to run it past my backup OB just to make sure she would be low-risk. Once he heard that it was related to scleroderma he said that even he wouldn't take care of her, he would refer her to a perinatologist. Apparently he had a woman with scleroderma who ended up dying at 35 weeks or so because a blood vessel popped in her brain. I tried to explain to him that this condition was different because it doesn't affect the internal organs, so he recommended a perinatologist consult.

The first perinatologist I sent her to had no idea what morphea was but nonetheless recommended a whole slew of coag studies and genetic tests. I decided to get a second opinion and phoned a perinatologist in my area. He hadn't heard of it, but when I described my understanding of it to him and he did some quick research, he said that my client is right and it should pose no problems with the pregnancy or birth. I'm much more inclined to go with his assessment, but I'm wondering if anyone out there has ever dealt with this before and what the outcome was.

— Corina Fitch, LM, RN, Miami

A: I found this Web site while doing a search on morphea; it has some information regarding treatments, and so forth: http://matrix.ucdavis.edu/rxderm-archives/morphea. Maybe one of the doctors on this message board would be a good resource.

— Christie Pillado, El Paso, Texas

A: I believe it is a collagen disorder that makes skin hard and inelastic. This could be a problem in pregnancy, I'd imagine. Morphea is a localized, versus systemic, version of scleroderma. Medication for scleroderma can include methotrexate, a Category X (e.g., absolutely contraindicated) drug. Try www.scleroderma.org for general information. For a good posting, look at this info: http://www.scleroderma.org/medical/localized_articles/Friedman_2001.shtm

— Emma


Q: What do you do to encourage women to trust birth?

E-News staff

A: The first and foremost thing to do (for the doctor or midwife who is taking care of the pregnant woman) is to differentiate between the women who trust their bodies and the process of birth from those women who do not. Once you are able to assess the level of a woman's trust in her body and in nature, further work becomes easier because then we know which woman needs more attention.

The next step of basic importance, in my experience, is to build a relationship of trust and acceptance with the given woman. I am a gynecologist, and hundreds of pregnant women have been under my care. I've learnt through my practice that taking care of pregnant women is not just about giving the best medical care or doing more tests. Acquiring more knowledge, attending more conferences, or reading more books is important but still secondary. I believe that these external aids focus our attention on the skills, on the importance of the said method. They may even take our attention away from the person under our care because we are so busy applying the new technique we just learned about or read about. But if we keep in mind that the person under our care and before us is unique in every way and we open our eyes and mind and heart to get to know her, to accept her with her background, upbringing and behavior, and respond to her needs as they arise, we build trust. When she feels that we accept her totally as the person she is, the woman under our care begins to open to our advice and the professional experience that we have to offer. Because now deep down, intuitively she knows that we have her best interest in mind and heart. We convey these signals to the women under our care through the way we listen to her, the way we respond to her, the way we pay attention to her needs.

It's important that she feels that we are always making our best efforts to find solutions to her individual problems and not forcing our methods and practices on her. For example there is no point in forcing herbs or homeopathy on a woman who has never used them, during the first meeting, even though these are the best remedies in your opinion. The challenge here is to help her through methods she is open to. Next time she comes she may be more open to your proposal, seeing that you really care for her. I see this happening all the time in my practice. Practicing this way, I've built a special relationship of mutual trust with each woman.

I'm the mother of three children, with one homebirth, and I have a strong belief in nature and in my body. I believe that every woman, given the right information and consistent support, can learn to have faith in her body and in the process of birth. To serve this end I also provide antenatal classes for women under my care. During these classes, besides learning about the physiology of the birth process, we do a lot of talking—about fears, stating opinions, discussing, etc. I also show them films about women who, by changing their belief systems, started trusting themselves and trusting their bodies and had very satisfying motherhood. Women in the film talk about their experiences during pregnancy, birth and the period after birth. I've observed that seeing such real life situations has a very empowering effect on other women.

I also invite couples after birth to share their experiences in person. Almost all women attending these classes begin to think differently. Some gain more trust, and yet others become pioneers in this field of natural motherhood.

My most amazing discovery after working with women in this way is that even when something goes wrong or not the way these women had planned they treat even the negative situations as empowering experiences and are motivated to become more responsible.

Trust in birth is all about trusting life, building trusting relationships on all levels. Trust in birth cannot be separated and hence cannot be attained in separation from trust in being a woman, in living, in life, in our very existence.

— Preeti Agrawal, obstetrician and gynecologist, Wroclaw, Poland


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.


Think about It

I'd like to propose a new idea: a new movement of midwifery, the Modern Midwife. We midwives know too much about the intricate physiological process of labor and birth to continue interfering with birthing women. Whether learned in the classroom, through self study, or from a more experienced midwife, we all are aware of the delicate hormonal balances present in labor and birth.

If we know all this, why do we continue to interrupt the process? Why are midwives still telling women how to breathe and what position to be in, doing routine vaginal exams and trying to induce labor or hurry it along? Why all the rules? Why all the observation?

The current way of practicing midwifery fills our ego and need to be wanted and appreciated in our community. I'd like to challenge those involved in birth work to love, want and appreciate yourselves. Don't go looking to your clients for this affirmation, for midwives can learn to nurture themselves and love themselves in a variety of ways. When a person looks for approval, affirmation and attention outside him or herself, the end result is usually disappointment or resentment. Clients will learn this, if they haven't already, from midwives who model this kind of behavior.

I imagine the New Modern Midwife to be someone who uses appropriate tools when desired by her client, holds the space so the woman can find her own empowerment (rather than expecting the midwife to empower the client) and recognizes that each family has different needs.

The New Modern Midwife would question routine beliefs—not looking at only evidence-based information, but at what is inherently "right" for that particular woman. She would challenge herself and research the hows and whys, but be hesitant to interfere with the natural process as a matter of habit or routine. Practices such as routine suctioning (even of meconium), perineal support or massage and active management of a normal third stage of labor would be processes that she lets go.

Pamela Hines-Powell, "New Modern Midwife" in The Birthkit Issue 48


BIRTHKIT back issues


Feedback

I am a doula from Australian State of Queensland. It is so refreshing to receive Midwifery Today's newsletter and read how the other half truly lives. We are so behind in our maternity services it is a disgrace. Homebirth is almost outlawed here, and midwives are still practicing under heavy scrutiny by Queensland Health and Child Protection Laws. Rural maternity wards are being closed down because of lack of government funding and midwifery staff shortages. Rural women are forced to travel to major cities away from family and loved ones weeks before they are due to have their babies. Many women don't go to hospital—they just stay home and birth unassisted.

The Queensland Nursing Council still wants midwives to be nurses first. Midwives in rural hospitals often do pediatrics as well as gynecology and general care. Many suffer early burnout as a result of the work load. And because of this broad job description, direct-entry midwives are not even welcome to practise here to fill the gap.

I became a doula because of my experiences having my five children within the system. I saw many shortfalls and a possible solution to a very real problem. Doulas at the moment are providing women with continuity of personalised care (albeit non-clinical), but it is not something that can happen indefinitely. We need more midwives. If enough doulas would like to become midwives through direct entry and Queensland Health and The Queensland Nurses Council would adopt another viewpoint, we may be able to save midwifery and preserve a little of women's choice.

In my home town of Gladstone we have a growing population of 25,000 to 30,000, and our cesarean rate at our private hospital alone is 50%. Our rate of first-baby cesareans is appalling.

I have made calls and sent e-mails at least twice a week wanting to know if they can have homebirths here. It is so sad; the nearest practicing homebirth midwives are 600 km away. Queensland Health needs to be up with the other states in Australia with maternity services before all pregnant women are booked for routine cesareans like their city cousins now. Not out of fashionable trend or modern convenience, but because we don't have midwives or choices anymore. I have four girls and I would like them to have choices and a midwife to assist them to birth their babies in my lifetime. Many of us here in Queensland are rallying for the cause. We still have a ways to go. I myself will study direct entry midwifery in due course when it is introduced in Queensland. Let's pray that I won't be too old to practice then.

Keep your light shining for humanity—we surely need it in this corner of the world.

Sonya Lindley-Jones, ABC Doulas, Australia


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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