June 21, 2006
Volume 8, Issue 13
Midwifery Today E-News
“Massage in the Childbearing Year”
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In This Week’s Issue:


Quote of the Week

"Qualities inherent in safe, loving childbearing experiences must be recognized as the global rights of all women."

Leilah McCracken


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The Art of Midwifery

To soothe the discomfort of hemorrhoids, melt shea butter in the microwave, add a few drops of tea tree oil, then place on the affected area. Tea tree oil can also be added to bath water. Applying witch hazel to a cotton ball and placing it on the affected area is soothing and healing.

Anon.


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

Crafting Your Own Education

I just made friends with an amazing young woman, Shawna Wentz. We are working together on a book called Wisdom of the Birth Elders. She is a very strong, service-oriented photographer, birth activist, promoter of women and maiden midwife. She has come up with the most creative, purposeful approach to midwifery education I have encountered. She has intentionally put together her education by working with midwives and other women in situations she admires or in which she feels called to help.

Her photography, activism and diligent dedication to serving others have opened many doors. She is proactive and willing to take risks. She has worked in Africa, gleaning from the cultures there, as well as here, the holy threads she is weaving into her "program." She is careful not to sacrifice her ideals and she is conscientious of serving along the way.

If she admires someone as a midwife she seeks to work with them. She has worked with a very experienced midwife in Hawaii, done births of friends, worked at Mothering magazine, photographed many pregnant women and attended many births. As outreach coordinator for Mothering for three years she was able to work with and help many people. She recently worked with Suzanne Arms on a vision of creating a network of birth activists in this country. (See www.birthingthefuture.com)

I would like you to consider such purposeful gleaning of knowledge and experiences and the collecting of skills for what you want to do in your life. As you look, think of your qualities and how you can serve. Consider the skills you can gain and then share by serving others. Your education for becoming a midwife can be an incredibly creative endeavor—the way you want it to be. It is not about "getting your numbers," a sad modus operandus of many student midwives trying to qualify for NARM certification. The wonderful thing about the US is you do not have to fit into a box to become a midwife. This holy calling requires the most creative and spiritual part of you and it can begin with your education. I love John Lennon's saying, "Life is what happens to you when you're busy making other plans." If you live purposefully your life will really count for motherbaby. Make it start now.

love, Jan
Jan Tritten, Mother of Midwifery Today

To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.


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Massage in the Childbearing Year

Intuitively and experientially, women have known that massage and touch are valuable assets during pregnancy and birth. Contemporary scientific research now confirms this ancient wisdom. Tiffany Fields, MD, at the Touch Research Institute in Miami, Florida, has collected extensive data on the profound healing effects of touch. The Journal of Psychosomatic Obstetrics and Gynecology published a study by Fields in 1999 demonstrating that regular massage during pregnancy results in

  • decreased anxiety
  • improved mood
  • reduced back pain
  • improved sleep patterns
  • reduced leg pain
  • reduced stress hormone levels
  • fewer complications during labor
  • fewer complications for infants following birth.

The musculoskeletal system experiences enormous changes during the childbearing year: weight gain (enlargement of the breasts and uterus), muscle stretching (abdominal and perineal), muscle compression (lower back and pelvic region), loosening of ligaments (pelvis and uterus), and displacement of the center of gravity. Massage therapy and bodywork are extremely effective in easing the musculoskeletal compensations of pregnancy.

Compassionate touch also nurtures psychological and emotional health. Pregnancy is a transformative event colored with deep emotions. Women's reactions to their changing bodies vary greatly. Many women love the beauty and glow of pregnancy and revel in the miraculous changes within their bodies. Others experience great anguish over their weight gain and rounding bellies. Ecstatic feelings of fulfillment may dance with insecurity and depression. Massage during the childbearing year can enhance emotional health by helping the mother to

  • enjoy the changing pregnant physique
  • cultivate inner awareness, necessary during labor
  • reduce stress
  • relax deeply
  • trust the birth process.

The Journal of Psychosomatic Obstetrics and Gynecology also published a study by Fields in 1997 demonstrating that massage therapy during labor was highly correlated with

  • decreased labor pain
  • decreased anxiety
  • shorter labor.

Infant massage is a routine and essential part of baby care in numerous cultures. There are long histories of women massaging their babies among indigenous cultures worldwide. Dr. Fields has produced research showing that premature infants who receive gentle and regular massage grow faster and are able to leave the hospital an average of six days earlier than preemies who are not massaged.

Women who experience massage during their childbearing year are also more likely to massage their infants. Infants who are massaged regularly by their parents are healthier, grow faster and are well attached to their parents.

Massage can also assist the new mother. Compassionate touch eases the transition into motherhood and the growth of a family. Postpartum massage can

  • hasten postpartum healing
  • hasten post-cesarean healing
  • promote musculoskeletal realignment
  • prevent depression
  • ease muscle strain caused by infant care.

Kara Maia Spencer
excerpted from "The Primal Touch of Birth: Midwives, Mothers and Massage,"
Midwifery Today Issue 70

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A study to identify the benefits of massage to depressed pregnant women was undertaken at the University of Miami School of Medicine. Study participants were 84 depressed pregnant women in their second trimester who were randomly assigned to receive regular massage, routinely practice muscle relaxation, or receive standard care. The study also included 28 nondepressed pregnant women as a control group.

Partners of women in the massage group gave the women two 20-minute massages per week for 16 weeks. The partners had been trained by professional massage therapists.

Women in the muscle-relaxation group participated in a 20-minute progressive muscle-relaxation routine twice weekly for 16 weeks.

Study measures were level of anxiety, depressed mood, and degree of leg and back pain. Urine samples were analyzed for levels of cortisol, serotonin and catecholamines, including norepinephrine, epinephrine and dopamine. Fetal movement was measured using ultrasound at 18 to 24 weeks and at 36 weeks pregnancy. Researchers noted fetal single-limb, multiple-limb and gross body movements, as well as no movement.

At the end of the study, women in the massage group had significantly increased levels of serotonin and dopamine and significantly decreased levels of cortisol and norepinephrine. No significant changes in corresponding levels were noted in women of the other groups.

In addition, women who had received regular massage showed a significant decrease in depression, and the women in the other groups showed no significant decrease in depression. Fetal activity in the massage group was decreased, as was the incidence of premature birth. Researchers concluded that massage therapy reduces stress hormones, stressful mood states, leg and back pain, obstetric and postnatal complications and improves fetal outcome.

Journal of Psychosomatic Obstetrics and Gynecology, June 2004


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Research to Remember

Misoprostol (Cytotec), the controversial ulcer treatment drug currently in wide, off-label use for labor induction, is being sold on the black market as an abortifactant in increasing numbers in poor, immigrant communities in New York. The drug has been legally used for several years in tandem with the abortion pill mifepristone (RU-486). The unprescribed use of the drug is common in Latin American countries where abortion is illegal. In one study in 2000 of 610 Dominican women, Columbia Presbyterian Medical Center researchers found that 37% of the women were familiar with misoprostol, 5% had used it, and 15% knew someone who had used it. Know as "the star pill," misoprostol used in unsupervised conditions can be associated with complications such as infection, excessive bleeding or serious birth defects in cases where the abortion was not successful.

New York Daily News
www.nydailynews.com, accessed 19 May 2006


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This quarterly newsletter has the same kind of information as Midwifery Today magazine and the same focus on safe, gentle birth, but is more relaxed and informal. This makes it perfect to pack in your birth bag or purse to read when you have a few minutes spare time, or to put in your waiting room to share with your clients.


Midwifery Today Magazine Issue 73Can the art of midwifery survive protocols? How can we find a balance?

Read "Changing Protocols" (Midwifery Today, Issue 73) to discover what Michel Odent, Jill Cohen and others have to say about this issue. You'll also find articles on the elective cesarean debate, screening tests, blessingways and more. Order Issue 73.

Love is a strategy for human survival.

Scientification of Love Read The Scientification of Love by Michel Odent to learn about the short yet critical period of time following birth that has long-term consequences in terms of the capacity to love. Has an undisturbed birth resulted in an expansive capacity to love, or have interventions of many kinds resulted in violent criminality, suicide, impaired sociability, schizophrenia? Order the book.

Midwifery Today Magazine Issue 74Are you passionate about birth? Then you need Midwifery Today magazine. This 72-page quarterly print publication will satisfy both your mind and your heart. Open its pages to find in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Give yourself a subscription!
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Web Site Update

Read this article excerpt from the most recent issue of Midwifery Today, Issue 78, newly posted to our Web site:


Advertising Opportunities

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Contact our Advertising Director today at: ads@midwiferytoday.com


Forum Talk

I feel, in my heart and as a result of my research, that a homebirth with an experienced attendant—if I am not excluded because of an unforeseen circumstance—is what I really want. My husband, however, whose father is a doctor and who had a forceps birth, thinks I am crazy. I bring up statistics, stories, protocol in American hospitals (he is European so not totally understanding of the system), pictures of episiotomies (I think I found a winner with this one—he is utterly disgusted), and many other facts and figures, but he remains the same—the hospital is safer. I also think that since we are a ways off, he is not totally receptive to the concept, so he shuts down a bit. How have others approached this situation aside from studies and statistics? I am speaking mainly of a philosophical approach. What methods have worked or not worked?

N.


Share your thoughts and experience about this topic.
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Question of the Week

Q: My husband and I are both 35 and have two children, 9 and 11 years old. We are trying to conceive for the sixth time, as we've experienced three early pregnancy losses with no known cause. (I have two minor heart conditions which are unrelated to the losses.)

In my first pregnancy, I went into preterm labor at 32 weeks and after strict bed rest and the use of Brethine, I carried to 36 weeks and gave birth (hospital with an obstetrician) to a healthy 7 lb 10 oz boy. In my second pregnancy, I went into preterm labor at 25 weeks. It was a much more difficult pregnancy and I was on strict bed rest for 11 weeks and took Brethine again. I managed to carry to 36 weeks and gave birth (hospital again, although with a midwife) to a healthy 5 lb 12 oz boy.

In each pregnancy, I was diagnosed with extreme hyperemesis and even had home-nursing care and IV hydration at home and during occasional hospital stays. I had sickness, vomiting and extreme dehydration for almost seven months of my pregnancies.

I didn't make it past 11 weeks in my last three pregnancies. We are now seeking fertility treatments with a reproductive endocrinologist because we haven't conceived in over eighteen months. After we do become pregnant, I would like to pursue homebirth, but my husband feels we would be safer with an obstetrician in a hospital because of the complications of my past pregnancies and the difficulties we've had conceiving. I would like a midwife's opinion about whether or not I might be a candidate for homebirth and whether it is possible that a midwife would consider assisting us.

— Melissa


Question of the Week (Repeated)

Q: What can we do to have the art of midwifery be more in the consciousness of our culture? As we know, most of the youth in our society think, as many adults do, that "having a baby" means "going to the hospital." I have been pondering lately what changes might take place in our society if midwives made a point of visiting their local middle and high schools (private and public) to speak with the health/science teachers and volunteering to come into the classroom to give a workshop (or whatever term you wish to use) as a professional expert when the class is studying human reproduction. Wouldn't it be wonderful if natural birth was presented to the youth of our society so that it is thought of as a very normal thing when, later, they are adults preparing to have children?

— Kathryn Balley


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. Responses to any Question of the Week may be sent to E-News at any time.


Think about It

The impact of the place of birth may be more complex than just a choice for a woman. If we believe that birth is a powerful, sacred event that has personal significance and meaning for the mother, baby and family, then we need to recognize that where it takes place is a sacred and holy site. This is recognized in certain cultures when a place is set aside in the community for birth to occur where women are revered during pregnancy and supported by other women during birth. Babies are born into the heart of the community and welcomed as part of the larger family. In the western world, where families live in isolation and the majority of babies are born in the hospital separated from the community, there has been a loss of the sacredness of the birth process and, to an extent, the value of women who go through the event.

For those women who choose to birth at home, there is recognition of the value of the environment. Apart from the security and safety aspect of a woman being in her own space and knowing where everything is, she is able to feel more freedom within herself physically, emotionally and spiritually. In reflecting on my own experiences of birth at home, I have no doubt that there was a spiritual presence in the place. I would not have wanted to move from that environment to drive to the hospital. I felt safe and enshrined within my home with my family and belongings around me.

Jenny Hall
excerpted from "The Sacred Place of Birth
Midwifery Today Issue 66

Order Midwifery Today Issue 66.


Feedback

Following is a copy of a letter I just sent to the International Confederation of Midwives. After sending it off, I realized that Midwifery Today should also know about this (disgusting) development in biotechnology.

I would love to get your take on the situation and hear any suggestions that you may have.

To the officers of the ICM,
I am writing this letter to inform you of a situation which in my opinion needs to be addressed by the confederation.
There is a high-tech company called Barnev http://www.barnev.co.il/ that manufactures a product called the computerized labor monitoring system. This product works by placing two clips with electrodes on a woman's cervix and a scalp electrode on the fetus, and by using ultrasound waves measures cervical dilatation and height (descent) of the fetal head. I am aware of this product because it was going through clinical trials at the hospital I am affiliated with. In spite of the midwives' adversity to using this mechanical device on women, we were not able to totally block its use (although some changes were made in the informed consent, and many women did not agree to participate due to midwives' explaining to them what was involved). The trial moved on to other hospitals where the midwives were not as vocal in their opposition, and now the company is trying to promote use in Europe and the US. From what I understand, they have received or will be receiving FDA approval. The product is being promoted as a means to assess women's progress in labor without vaginal examinations.

I feel in this letter to the officers of the confederation that it is obvious and unnecessary for me to go into the reasons why I view this product as taking advantage of and potentially harming women and their babies in labor, all for the purpose of economic profits of a biotech company. However, I do feel that steps need to be taken at a higher level as to the ethical considerations, (although Helsinki approval was received!).

How do you suggest that I carry on from here? Can the confederation offer any support/ideas?

I feel this issue is not only within the midwifery realm, but deals with the basics of the guise of medical treatment taking advantage of women's rights and of women's bodies for research purposes (do you think that a device similar to this would ever be developed or successfully marketed to measure a man's penis who suffers from erectile dysfunction?).

I would very much appreciate your advice on this situation.

Debby Gedal-Beer, CNM, MSc. Coordinator of Women's Health and Midwifery Education
Sheba Academic School of Nursing
Tel Hashomer, Israel


In regard to the statistic of 12 hospital newborns being given to the wrong parents daily [Issue 8:6 and 8:10], I would first ask for clarity or the definition of "given to." I have been an L&D nurse and now a CNM for 40 years and have worked in many tertiary obstetrical units. Unfortunately, I am aware of instances where the wrong infant was "given to" parents during their hospital stay. These incidents have occurred for many reasons, but the bottom line is because someone did not follow policy. And the mother is rarely the person who detects the error; they often do not know their own babies! Fortunately these errors are caught, corrected and the mother is discharged with the right baby. It is when the mother is discharged home with the wrong infant that the mistake is newsworthy. This is a sentinel event and hopefully the occurrence is very low. It can happen mistakenly or with criminal intent.

I can believe a statistic of 12 newborns being given to the wrong parents in the first example: we are aware of the increase in medical mistakes and nursing errors. We are also aware of JCAHO's patient safety initiatives. Because nurses are overburdened with staffing ratio it is even more important that we follow policies that are put in place to keep our patients safe. Proper banding and identifying mothers with their newborns, observing that the ID bands remain in place and are correct, and being careful that infants are placed in the right cribs are just a few essential steps in ensuring that moms receive their infant.

RAD, CNM, Chicago, Illinois


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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