|October 25, 2006|
Volume 8, Issue 22
|Midwifery Today E-News|
“Twin Pregnancy and Birth”
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In This Week’s Issue:
Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Better Birth Education Opportunities page to discover ways to start or continue your education. You'll find schools for both traditional midwives and CNMs as well as an online continuing education program that will earn you 12 contact hours.
Quote of the Week
"Every [hospital] intervention is a lesson in who really owns your body and your baby's body."
— Jock Doubleday
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The Art of Midwifery
For postpartum compresses, place a large handful of dried yarrow in a quart jar. Pour in boiling water, cover and steep for 2–4 hours or even overnight. You can also use fresh herb. Strain. Dip 4 x 4 gauze pads in the infusion. Fold them in half. Lay out on a cookie sheet in the freezer. When frozen you can package them together with some waxed paper between them to keep them from sticking together. Postpartum moms can place them in the sanitary pad, and also use them on sore nipples or on hemorrhoids.
— Helena Wu
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 email@example.com.
Passionate Midwifery Education
Each of us must take responsibility for our own education. This is so even for those who are planning to attend a midwifery school. You need to find the school that will best help you learn your calling in the way you are called. Some of you will be nurse-midwives, others will be direct entry midwives and some will choose to be lay midwives. You need to make sure you can be the best midwife possible within your calling. A key issue is that you will be serving motherbaby and the family and you will need to determine the most important areas of study. This is true even beyond your formal or informal training. Your midwifery, doula or childbirth education will continue for your whole life.
You may find that some of the curriculum is not helpful, but you typically need to do a certain amount of busy work. Your job all along the path of lifelong education is to be the best you can be. Is learning homeopathy more important than pharmacology? The answer will be different for each of you and may change as you journey through your midwifery life. There is no wrong answer but you need to be proactive in your path. I know conference attendees often have difficulty choosing classes—they have so much to learn and be excited about. For most of us, our birth life is one of the most important aspects of our life.
I hope as you look around this amazing world at all the possibilities for your education you chose carefully from the huge smorgasbord of educational opportunities we have today. We can learn from traditional midwives in other countries or from dozens of disciplines. It is an exciting journey. I hope some of you will write and let us know about your path and how you choose what and how to add to your skills.
Our midwifery is often closely wrapped up in our identities partly because we are called to the path that requires all of the love we have to give, then a little more. Welcome to midwifery.
— love, Jan
To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.
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Twin Pregnancy and Birth
Something about the word "twin" seems to inspire an immediate anxiety attack in all concerned: mother, father, grandmother, midwife, and especially obstetrician. Medical literature abounds with information on multiple gestation and the inherent risks to the mother and her babies. Twins are generally viewed as pathology, and very little is written about the possibilities of achieving an optimum outcome. I do not consider "twinning" to be an anomaly, but a very special occurrence which deserves careful management to ensure safety for both mother and babies. Indeed, there is no reason the mother of twins cannot expect to deliver healthy full-term infants when she is properly educated, has a high level of responsibility, and receives excellent prenatal care.
It is not my intent to either advocate or oppose the idea that the management of multiple pregnancies is beyond the scope of midwifery practice, or that out-of-hospital delivery of multiples should be considered. It is, however, my opinion that if one undertakes the practice of midwifery, one should be knowledgeable about all possible "variations of normal" which may—and are likely to—occur.
If you decide to take on the responsibility of assisting at the birth of twins, you must know there are risks involved. However, there is an element of risk in all birth, so my advice is: Learn all that you can, get as much experience as possible, and proceed as your heart dictates. It is also important to understand that the new parents' needs will be much greater as they embark upon the awesome task of caring for two babies at once. Be prepared to assist them with concerns and to help them find competent support during the early weeks. Recognition of the reality of the "fourth trimester" is vitally important.
— Valerie El Halta, CPM, excerpted from "Twins: A Very Special Occurrence," Midwifery Today Issue 39
Read all of Valerie's article in MIDWIFERY TODAY Issue 39. This article includes "A Study Outline on Twin Pregnancy, Labor and Delivery" for study and application purposes on twin pregnancy, labor and delivery. Order the issue.
Lamictal Implicated in Cleft Lip and Palate
The FDA notified healthcare professionals and patients of new preliminary information from the North American Antiepileptic Drug Pregnancy Registry suggesting that babies exposed to Lamictal during the first three months of pregnancy may have a higher chance of being born with a cleft lip or cleft palate. The drug is used to treat seizures and bipolar disorder.
Pregnant women should not take Lamictal without first consulting their physician. More research is needed to verify this link.
For further information see: http://www.fda.gov/medwatch/safety/2006/safety06.htm#Lamictal
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Research to Remember
According to a study of more than 151,000 women in Sweden, those who gain weight, but are not necessarily obese, after their first pregnancy have a higher chance of developing complications during subsequent pregnancies than those who maintain their weight. Complications include pre-eclampsia, gestational diabetes, cesarean delivery, large-for-gestational age birth and stillbirth. The researchers, who used body mass index (BMI) to determine weight increase, suggest that the results of the study lend credence to the possibility to women whose BMI increases prior to pregnancy may also be at risk for perinatal complications.
— Villamor, E. and S. Cnattingius. 2006. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. The Lancet; 368: 1164–70.
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Any tips for getting heart tones with a fetoscope at 20 weeks or less—especially on a mom with a little additional weight around the waist? What is the earliest you've managed to hear fetal heart tones with a fetoscope?
Share your thoughts and experience about this topic.
Question of the Week
Q: I am a new midwife from Victoria, Australia. The midwifery-led unit I work in is being pushed into providing an obstetric model of care (by the obstetricians) rather than the current woman-centred model of care. This has resulted in the introduction of a protocol requiring that a vaginal assessment be carried out within 1–4 hours of arrival at the unit and 4–6 hourly until babe is born.
This current protocol will remain unchanged unless we can produce some evidence/research supporting nonintrusive methods of assessment. The majority of the midwives, including the unit manager, do not want to see this become policy, and a focus group has been formed to address this issue. Can readers point me in the direction of research that addresses the impact that invasive interventions such as vaginal exams can have on a woman and her childbirthing experience, and any alternate methods of assessment?
— Amy Corlass
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Question of the Week Responses
Q: I have been told that raspberry leaf tea promotes labor. I very much want to have a natural birth, and if this will help me get through it quicker, please tell me how do I drink it, how often, etc. I am 35 weeks already, but I am sure it's not too late to start, or maybe it's too early?
— Donna S.
A: It is never too late nor too early to start drinking red raspberry leaf tea. It is one of the most valuable herbs for the female reproductive system. Unless promoting labour is contraindicated, such as for mutiples perhaps and then only under supervision, definitely drink 3–5 cups a day. Make a pot in the morning, after you have just boiled fresh water; wait for it to stop bubbling and pour it over a couple of tea bags, organic, leave to steep, and enjoy throughout the day. If you need to rewarm it, do so at a low temperature so as not to destroy the vitamins.
A: I have found in my experience as a doula that a cup of red raspberry leaf tea will promote labor and relax mom, though relaxation is the effect of the warm tea more than a medical benefit. I also found that there seemed to be more of an effect with epidural moms than with the natural births. I only give RRLT during active labor or beyond and have noticed that any earlier than that there was less effect unless it is during an early predomal labor, and in that case it does seem to speed things along.
— Ashleigh W.
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.
Think about It
All of us have experienced incidents of dystocia with our clients, and in my experience, it is usually psychological. A woman might be an incest survivor, or she might have high control needs, or at the very least she has been influenced by the negative and fearful images of birth in our culture. I have made it my business to watch for and learn methods to ease psychological dystocia. There are so many ways, both prenatally and during birth, we can help our mothers birth easily. In my practice, for example, I do not ask clients to attend childbirth classes; unless there is an instructor who I am certain gives only the most positive and encouraging instruction, I ask that they not attend at all.
The "meta-message" we give our clients in childbirth classes is usually "childbirth is difficult and you cannot do it without much practice and lots of help from professionals." Throughout prenatal care, even with Amish primips who have had almost no information on childbirth, I emphasize that everything is fine, and that having a baby is usually just like throwing up or going to the bathroom—it just happens. I do give them factual information, but I do not want to raise their fears by concentrating on complicated breathing techniques or comfort measures. I'll always remember the time I was attending a woman in labor with her sixteenth baby. At one point in transition, she looked at me from where she was leaning up against a bureau and asked, "Should I do my breathing now?" I had to laugh and tell her, "You're the expert, you do whatever works." I haven't seen many Amish women use breathing techniques that anyone taught them. Almost without exception, my mothers tell me that giving birth wasn't hard at all.
Midwifery Today E-News readers may be interested in an update on the recent work of MOMS (Midwives on Missions of Service) and our nonprofit, dedicated to improving maternal/child health and maternity outcomes through education and service. We do this through service projects and our school, the International School of Traditional Midwifery.
MOMS has been invited to Sierra Leone by Women for Women of Sierra Leone and the Minister of Health. We have been assigned the Jawi "chiefdom" which is a region of villages in the eastern part of the country near Liberia. We will be going over in December to do a needs assessment. When we come back, we will begin to write a custom curriculum based on those needs. The literacy rate for women in Sierra Leone is under 30% so we will be looking at teaching methods that are culturally appropriate and effective. We are particularly excited because they want us to train the midwives in homebirth.
Sometime in 2007 we will return to Sierra Leone and begin to implement our program as well as work side by side with the Sierra Leonean midwives to improve their infant mortality and maternal morbidity rates which are some of, if not the, worst in the world. We anticipate that this will be a project that will last for several years until we can turn over the training to midwives there. It will take a lot of support and resources from our circle of supporters here in the US so we will be doing a lot of fundraising and gathering of supplies.
— Sudy Storm
[Editor's Note: To learn more about MOMS and how you can help: http://www.globalmidwives.org/ ]
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Use theatre for social change! BOLD is a global movement to make birth mother-friendly. Join our online book club or organize a BOLD performance in September 2007. Visit: http://www.birththeplay.com/bold/bold.html
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